The Female Athlete Triad

Spring has finally sprung and for some of us, the competitive race season is in full swing. Unfortunately, so are some of those running related injuries. I want to take some time to discuss something that is prevalent in the world of female athletics. It is known as the Female Athlete Triad and it is a three-headed monster that debilitates female and their bodies.

The Female Athlete Triad is a health concern for active women and girls who participate in athletics. It involves three distinct and interrelated conditions: disordered eating (a range of poor nutritional behaviors), amenorrhea (irregular or absent menstrual periods) and osteoporosis (low bone mass and microarchitectural deterioration, which leads to weak bones and risk of fracture). Exercise alone does not put someone at risk for developing the Triad; however, an energy deficit, in which caloric intake doesn’t match energy expenditure, is a risk factor. Most likely the cause, disordered eating is where this cycle begins. 

“Disordered eating” is a term that includes the full spectrum of abnormal eating behaviors, ranging from simple dieting to clinical eating disorders. It can be inadvertent, such as when an athlete mistakenly eats too little to adequately fuel her physical activity and her caloric needs for activities of everyday living. However, the most serious and the most difficult cases to treat involve athletes who are willfully restricting their caloric intake for the purpose of becoming thinner or leaner. When you combine poor nutrition with vigorous exercise, menstrual abnormalities can occur. Amenorrhea is often attributed to the hypothalamus turning off the reproductive system due to energy drain. When there is no "fuel" entering the body, the body will not function the way it was designed to. The prevalence of amenorrhea among athletes tends to be higher than for non-athletes. Athletes with prolonged amenorrhea are at increased risk for loss of bone mass as estrogen is necessary for the building of bone. If estrogen is not available due to amenorrhea, you will increase the likelihood of injury. If this process continues without recognition, osteoporosis (porous bone) may develop. This is a disease characterized by low bone mass and deterioration of bone tissue, resulting in bone fragility and increased risk of fracture.


This cycle begins with disordered eating. If you are working at a calorie deficit (this is when calories expended is greater than calories consumed) you will be at an increased risk of amenorrhea. When this occurs, you can see a significant decrease in bone mineral density. Stories of the aforementioned Triad are prevalent in every gym or training center. I have heard countless tales of women who are not getting their period while training for endurance races, or a women in her forties who broke her hip while training for a race, or others who continue training with stress fractures and don't understand (or don't believe) that their eating habits could be the cause for it all. So my advice for everyone out there competing in some races this season: FUEL UP! This is the one thing that can keep you healthy and on the road competing to the best of your abilities!


Chris Fluck