Evidence-Based Comprehensive Psychological, Nutritional and Medical Care

What Is the Female Athlete Triad?

The Female Athlete Triad is a syndrome that exists as the result of three interrelated conditions. These conditions are:

  • (Low) Energy Availability (Disordered Eating)
  • Disruption of Menstrual and Endocrine Function
  • Loss of Bone Mineral Density


These three aspects of The Female Athlete Triad are seen as interrelated as each one can affect the others. For example, disordered eating can play a role in menstrual disturbances, and both energy deficiency and a low estrogen environment can lead to bone density loss. Additionally, these three aspects can also exist at varying levels of severity. Therefore, athletes may have symptoms that exist somewhere in between the healthy and extreme conditions of The Female Athlete Triad.

Symptoms of The Female Athlete Triad

The Female Athlete Triad is a combination of three specific health issues each with its unique symptoms.

Energy Availability (Disordered Eating): The older term “Disordered Eating” has been supplanted by “Energy Availability.” Energy availability is the energy that is left (available) after the body accounts for all of its physical activity (energy expenditure). Low energy availability occurs when the athlete ingests too few calories to fuel her exercise and support normal bodily processes. If low energy availability is severe or persistent, medical and psychological complications can occur. Sometimes in such cases the athlete is inadvertently eating too few calories, but many times it involves willful dietary restriction by the athlete in an attempt to lose weight or be leaner. Athletes may rationalize this restricted eating by saying that they need to lose weight in order to perform better. If the athlete cannot or will not increase her caloric intake, decrease her energy expenditure, or both when informed of the caloric deficit, her eating should be considered “disordered” and treatment is warranted.

Menstrual Function: Low energy availability has been proposed as the explanation for “exercise-induced menstrual dysfunction. That is, disturbance of menstruation is caused by the reduced estrogen levels that result from the imbalance between calorie intake and the amount of exercise performed (low energy availability).

Bone Mineral Density: Osteoporosis or reduced bone density results from the combination of reduced estrogen levels and inadequate nutrition. Decreased bone mineral density increases the risk of stress fractures, broken bones, and other musculoskeletal injuries.

Who is At Risk for The Female Athlete Triad?

The Female Athlete Triad can occur in female athletes in any sport but occurs more often in “lean” sports that emphasize/recommend/demand a thin/lean body size and shape, and/or a low weight. These typically include aesthetic sports (i.e., diving, figure skating, gymnastics, and synchronized swimming), endurance sports (i.e., cycling, distance running, and triathlon), and weight-class sports (i.e., lightweight rowing, judo, and wrestling).

Getting Treatment for The Female Athlete Triad

Obviously, early identification of Triad symptoms is most important. Any athlete, who has one component of the Triad, should be evaluated for the other two. Resistance to being evaluated and treated should be considered diagnostic. Resistance usually increases with the severity of the problem. When such resistance or other impediments to recovery preclude effective treatment on a traditional outpatient basis, the athlete should be referred for intensive treatment. The Victory Program at McCallum Place is specifically designed to treat athletes with Triad symptoms by eliminating disordered eating thoughts and behaviors and restoring health, while teaching mental skills that can improve athletic performance when the athlete returns to training and competition.

Treating Eating Disorders: Anorexia  •   Bulimia  •   Binge Eating  •   Emotional Eating  •   Compulsive Exercising

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