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The Female Athlete Triad

by Zamst

The female ‘triad’ is a syndrome composed of three conditions:

  • Energy deficiency with or without disordered eating
  • Amenorrhea/menstrual disturbances
  • Bone loss/osteoporosis

The prevalence within the general population is between 2-5%. However, within sports with an emphasis on aesthetics or leanness, up to 69% of female athletes may be affected. The sports most affected include cross country running, gymnastics, and figure skating. Additionally, recent studies have reported disordered eating behavior in 15-62% of female college athletes.

Signs of the female triad include:
-Recent decline in performance
– Changes in mood
– Dramatic weight loss
– Frequent injury (fracture)

Consequences include but are not limited to:
-Dehydration/electrolyte imbalance
– Fatigue, anxiousness, depression
– Decreased immune function, cardiovascular disease
– Infertility
-Stress fractures

Screening and Diagnosis:
Screenings may take place during pre-participation physical exams.  There should be an emphasis on detailed history and physical signs/symptoms (bradycardia, orthostatic hypotension, hypothermia) and referral for blood testing or bone mineral density (BMD) testing if necessary. A referral should also be made to a mental health care professional if appropriate.

The primary goal of treatment is to restore the menstrual cycle and improve bone density. This typically requires a physician, registered dietician, mental health therapist, coaches, and family. Treatment may include: increasing energy availability (food) and modifying exercise regimens, medication (drug intervention) for menstruation recovery, vitamin D and calcium supplements.  The best approach to beating the female triad is a combination of early detection and prevention.


  1. Nazem TG, Ackerman KE. The Female Triad. J Sports Health. 4 (4) 2012 July; 302-311
  2. Hobart JA, Smucker DR. The Female Athlete Triad. Am. Fam Physician. 61 (11) 2000 June 1; 3357-3364




Alyson Kessner, PT, DPT, CSCS.
ProSport Physical Therapy, 2777 Bristol St, Ste. B, Costa Mesa, CA (949) 250 – 1112

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