What is Female Athlete Triad?

Female athlete triad is a syndrome made up of a trio of health conditions that impact women involved in sports, typically at the high school or collegiate level. It is a relatively new diagnosis, characterized by a consistent pattern of consuming less energy than the athlete expends, which leads to dangerous and often irreversible symptoms. The female athlete triad can occur in non-athletes as well but is much more common among those who compete in sports. Because this can lead to serious medical complications, it is essential to understand the female athlete triad, its symptoms, and its treatments.

Female Athletes at Risk

The population most at risk for developing the female athlete triad, are female collegiate athletes. This is especially true of those who compete in sports where body shape and appearance is very important. For example gymnastics, swimming, or ice skating. Students who compete in team sports or high-endurance competitions, like softball, basketball, weight-lifting, and track are also at high risk. Females who do not compete in sports may experience symptoms as well. Generally, athletes are more likely to develop this condition due to the high rate of energy that they expend during training and competitive events.

Recognized by American College of Sports Medicine

Diagnosis of the female athlete triad was first noted by the American College of Sports Medicine. ACSM monitors trends and developments in amateur and professional sports. They noted that female athletes were prone to developing these three conditions together. Many colleges specifically train coaches and athletic trainers to recognize the signs and symptoms of the female athlete triad. This allows for earlier treatment before too much irreversible damage is done. Because the causes include body dysmorphia, it may be difficult for athletes to recognize that they have developed this syndrome without outside intervention from coaches and trainers they believe they can trust.

Symptom: Disordered Eating

The first symptom of the triad is disordered eating, whether intentional or unintentional. Females who suffer from the female athlete triad often develop an eating disorder as a result of body dysmorphia related to their sport. Consequently, they try to expend more energy than they take in to lose weight. This can be done through dieting and food restriction, purging, excessive training, and exercise, or a combination of all three. Gymnasts suffer from eating disorders at a higher rate than most athletes. However, athletes in other sports may also feel pressured to lose weight or train more intensely. This results in the development of the female athlete triad even if they do not have body image issues.

Symptom: No Menstrual Periods

The second symptom of the triad is the loss of menstrual periods. For athletes who begin patterns of disordered eating and excessive training at a young age, they may never experience menstruation, to begin with. For many years, trainers and athletes mistakenly believed this was common in all female athletes. In relatively recent years, ACSM has emphasized that all female athletes should experience regular menstruation regardless of their activity level. This major change is a result of the discovery that lack of menstrual periods is actually a sign of poor nutrition and energy output that exceeds energy intake, not just intense activity levels.

Symptom: Osteoporosis

The triad’s final symptom is osteoporosis. Osteoporosis is a condition in which bones are weakened and at an increased risk for fractures as a result of low bone mass. Athletes who develop the female athlete triad may be at a heightened risk for stress fractures and other broken bones, due to the lack of nutrients in their system to support bone health. These nutrients, like calcium and vitamin D, are either not consumed in sufficient quantities due to dieting and food restriction, or are lost during intense and lengthy training sessions that consume large amounts of energy. As a result, athletes are more easily injured despite their extensive training.

Treatment: Increase Food Intake

For those with female athlete triad, it can be daunting to begin the path to recovery. One of the best steps is to increase food intake over time gradually. Add in small, energy-rich snacks, like carrot sticks with peanut butter or yogurt topped with fruit. Consume more food during meals, increasing serving size over time. A nutritionist or physician who works with young female athletes regularly can help to come up with a diet plan that meets your individual energy needs. For those with body dysmorphia or intentionally disordered eating, a psychologist or counselor may help to change the way you view your self-image and your health.

Treatment: Decrease Training Levels

If energy expenditure outpaces energy intake, a good way to reduce the symptoms of female athlete triad is to cut back on the use of energy. That means decreasing training sessions in both intensity and duration to reduce the amount of energy needed. It’s possible to remain competitive in your sport despite decreasing training levels by 10-15%. And it will allow your body to absorb the nutrients you need to stay healthy more easily. Talk to your trainer and physician about altering your training regimen to one that is much healthier for your body long-term.

Treatment: Supplements and Vitamins

Both increasing food intake and decreasing the intensity and duration of training sessions are changes that will be implemented slowly over a period of time. It is important to stop the symptoms of female athlete triad from getting any worse in the meantime. Under the supervision of your physician and trainers, the use of calcium, iron, and vitamin supplements may be beneficial to limit any future damage to your body. Getting these nutrients naturally from food sources is much healthier than taking them in supplement form. This should be a short-term strategy unless your doctor tells you otherwise.

Risks: Long-term Damage

One of the biggest problems that results from female athlete triad syndrome is that most of the damage that occurs is long-term damage, rather than immediate damage. This means that many women ignore minor symptoms, without any thought to the future repercussions of doing so. Unfortunately, damage done to the bones, reproductive system, and other body systems are often irreversible. Later in life, women who suffered from female athlete triad in high school or college may find that they struggle with infertility. Or high rates of stress fractures in their bones caused by osteoporosis. This is why it is so important to recognize and treat the condition early.

How to Help

If you know someone who may be at risk for developing the female athlete triad, it is important to provide support to them. As a coach or trainer, you are usually in a position to advise their training regimen and nutrition. This can help to steer them in the right direction. For friends, teammates, and family members of female athletes, it is important to be encouraging rather than critical. By creating a positive support system, you can help to discourage athletes from developing unhealthy eating and training habits that cause irreversible damage to their bodies.