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  • Writer's pictureDavid Wilderman

Female Athlete Triad And Why You Need To Be Aware Of It

Female Athlete Triad is a condition involving an unbalanced relationship between a female athlete’s energy levels, bone mineral density (BMD), and menstrual function that can lead to a number of health concerns. Female Athlete Triad can impact negatively in the early stages of its development, and have long-term consequences on overall health and well-being as females get older.

What Exactly Is Female Athlete Triad?

Female Athlete Triad is a condition that involves the interdependence between three measurable factors–how much energy you have available to use for activity, the strength and quality of your bones, and your menstrual cycle. Clinically, if there imbalances in any one of these areas, the female athlete can be susceptible to eating disorders, osteopenia/osteoporosis, and/or menstrual dysfunction. Female Athlete Triad (also simply known as the Triad) has been described as a condition involving both the physical and mental aspects of health.

Available energy is measured by how much energy you gain from dietary sources minus the amount of energy you expend during activity. What is often seen with Female Athlete Triad is that poor energy availability is the driving force behind abnormal bone mineral density and menstrual irregularities. While nutrients provide the needed source of fuel for muscles and bones, poor nutrition can also have a negative impact on the part of the brain that controls hormones that regulate the menstrual cycle.

Bone Mineral Density is just one aspect of bone health. When bones are stressed too much through over exercising or when your bones do not receive necessary nutrients they may start to become weak. This can lead to osteopenia (below normal bone mineral density) or, further, osteoporosis (loss of bone strength, leading to brittle bones and an increased risk of fractures). When an individual has low bone mineral density, she may become predisposed to an increased long-term risk of bone mineral loss resulting in fractures as she gets older.

Menstrual Dysfunction signifies abnormal menstrual periods. This can include a wide spectrum from eumenorrhea (normal menstruation) to oligomenorrhea (inconsistent menstrual cycles) to amenorrhea (absence of menstrual period) in females of reproductive age.

Female athletes are susceptible to developing Female Athlete Triad because of the high demand physically that athletics place on the female body in addition to increased societal pressures for image and performance. As an example, a female runner may think that restricting caloric intake will make her a faster runner, thus gaining an edge on her competition and achieving greater success in her sport. And Female Athlete Triad is not exclusive to elite athletes striving to reach high-performance goals…it can also affect the adolescent female whose body is going through normal changes associated with puberty. At any rate, there are definite physical and psychological aspects of this condition that affect its extent, impact, and treatment.

What Does Female Athlete Triad Feel Like?

Symptoms related to the above-mentioned three components of Female Athlete Triad may develop over a period of time, ranging from months to years. Since there is no traumatic event that leads to the onset, there are typically no immediate symptoms initially. The female athlete may begin to experience the following symptoms, conditions, or changes (separately or together) that may indicate that she is starting to develop Female Athlete Triad:

  • Low energy during school, work, or exercise

  • Stress-related bone injuries (stress reactions or fractures)

  • Irregular or absent menstrual cycles

  • An unusually high focus on performance or image

  • An unexplained drop in performance

  • Difficulty concentrating

  • Changes in eating habits

  • Experiencing high levels of stress

  • Altered sleeping patterns

How Is Female Athlete Triad Diagnosed?

Female Athlete Triad is normally diagnosed by a multi-disciplinary team of medical providers. The team can include Physical Therapists, MDs, athletic trainers, nutritionists, and psychologists. However, non-medical individuals can also be a vital resource to help identify female athletes who demonstrate signs of Female Athlete Triad–these persons include parents, friends, coaches, teammates, teachers, and work colleagues, as these are all people who spend time with the athlete.

If there are suspicions that a female athlete is demonstrating one or more components of Female Athlete Triad, various medical and psychological and consultations may be recommended, including:

  • Diagnostic imaging of bone health–X-ray, DEXA scan (bone density scan), MRI

  • Referral to a Physical Therapist for functional assessment (strength, motion, movement quality)

  • Referral to a primary care or family medicine physician for monitoring of menstrual function or related medical tests (blood work, assessment of the natural stages of development (e.g. the onset of puberty, etc)

  • Referral to a nutritionist for dietary assessment

How Can Physical Therapy Help?

Physical Therapists are expertly trained in identifying signs and symptoms of the Female Athlete Triad, as well as initiating multidisciplinary care as appropriate and necessary. They are also well-trained to understand the implications that Female Athlete Triad may have on exercise prescription. Once an athlete’s symptoms are resolved (such as a stress fracture), her Physical Therapist would then be able to design and initiate an individualized return to activity program that encourages a safe, progressive level of activity. The absolute benefit of Physical Therapy is the education of the athletes and their families on Female Athlete Triad, and to work with and monitor the athletes to prevent or resolve the condition, and guide the athlete back to safe, optimal performance levels. In many instances this care and attention for a female athlete’s overall health can improve performance in athletics as well as school, and even overall self-esteem. Many athletes state that they feel more confident, stronger, and better able to achieve their goals when they feel that they have a strong support and a plan for sustained health.

Can Female Athlete Triad Be Prevented?

Absolutely! The Female Athlete Triad is a very preventable condition. The best, most effective method to prevention is education. As both the incidence of Female Athlete Triad and the level of female participation in competitive sports has risen over the last two decades, a stronger emphasis has been put on educating athletes, parents, and coaches on strategies to prevent the development of causal factors for this condition. It is of critical importance to start educating young female athletes as early as middle school age on a variety of topics including smart physical training, recovery and rest, healthy eating, and taking care of their bodies.

Coaches must be educated as well in order to monitor training and its impact on the overall health of the athlete by encouraging pain-free participation in sports. They may also be encouraged to track training and performance in order to spot any abnormal health or behavioral signs. It is also of utmost importance that individuals who are involved in the life of a female athlete promote an open, honest, and safe environment for the athlete. That way she will feel comfortable and at ease discussing challenges or issues she may be facing without the risk of external pressure or judgment.

If you or someone you know is exhibiting signs and symptoms of Female Athlete Triad don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at to schedule your FREE 30 minute consultation to see how Physical Therapy can help. Don’t wait–schedule now!

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