Female Athlete Triad

[Lifeafterballet]

Everything Experts Want You to Know About the Female Athlete Triad

Health & Wellness

This sneaky syndrome affects athletes of all ages and abilities. Thankfully, it can be treated using a team approach.

Last updated: 28 February 2023

5 min read

For female athletes of all ages and fitness levels, involvement in sport and exercise has been proven to offer a host of benefits, like improved self-esteem and a stronger, healthier body. But for some athletes, prioritising exercise over adequate recovery and nutrition can occur, resulting in a relatively common condition: the female athlete triad.

The Female Athlete Triad, Explained

According to a 2000 article in American Family Physician, the female athlete triad consists of three components: 

• Disordered eating. "Without ample nutrition to fuel and repair the body, the athlete may become fatigued and/or not perform as well as they should", said Bridget J. Quinn, MD, a sports medicine doctor in the Female Athlete Program at Boston Children's Hospital and head medical adviser for the Boston Ballet. 
• Irregular periods. Poor nutrition, low calorie intake and high energy demands from exercise can cause irregular periods or lead to amenorrhoea, which is the loss of the period. "If your menstrual cycle is being influenced, that's a vital sign that something in the body is malfunctioning", Quinn said. 
• Low bone mineral density. If periods stop, subsequent hormone changes can disrupt bone-building processes, which can weaken bones and cause osteoporosis (low bone mineral density) in severe cases. 
   

The triad is especially prevalent in endurance sports such as athletics, swimming, gymnastics, figure skating and rowing. "But it can strike athletes of any age and ability", Quinn said. 

According to "Female Athlete Series: Female Athlete Triad", published by Boston's Children Hospital Sports Medicine, if left untreated, the female athlete triad can have severe consequences like infertility, an increased risk of heart disease and heightened vulnerability to stress fractures.

The female athlete triad falls under the umbrella of relative energy deficiency in sport, or RED-S, a syndrome of health issues and declining athletic performance due to a lack of sufficient calories to support the energy demands of training, according to Boston Children's Hospital.

How Is the Female Athlete Triad Diagnosed?

Because the symptoms fall on a spectrum, the female athlete triad can be tricky to diagnose. For one, the three conditions may ebb and flow. For example, over-exercising may take the main stage while someone continues to menstruate.

Alternatively, despite an athlete programming correctly, their period may be lost due to low caloric intake. "It's not necessarily an either-or scenario", Quinn said.

To receive a diagnosis and map out a treatment plan, it's crucial to visit a doctor or comparable licensed medical professional. Quinn shared that key factors will be considered during these initial reviews to result in a diagnosis, such as:

• Miss several periods in a row
• Get a bone stress fracture in sport
• Think you might have disordered eating

However, Quinn encouraged athletes to think outside these factors. "Low energy availability affects so many systems in the body", she said. The triad may also show up as:

• Frequent gastrointestinal (GI) issues, such as bloating and constipation
• Chronic fatigue
• Nagging injuries

Bottom line: If things feel "off", see your registered GP.

Be ready to give your GP a complete medical history. The American Academy of Orthopaedic Surgeons recommends going over what you eat, any changes in your weight, whether you've missed any periods and your injury history.

The doctor will give a physical exam that may include checking height and weight, blood pressure, vision, and heart and lungs, and examining your muscles, bones and joints. They may also use laboratory tests to check for pregnancy, thyroid disease and other medical conditions to rule out other potential causes of your symptoms. And if symptoms and medical history suggest weakened bones, the doctor may recommend a bone density test. This will arm the athlete with insights to train and recover the best way possible for their body—while lowering the risk of stress fractures and other commonly related injuries.

How Is the Female Athlete Triad Treated?

If you get a triad diagnosis, the doctor may refer to a team of specialists for treatment. "It's an interdisciplinary approach", said Michelle T. Barrack, PhD, RD, CSSD, FACSM and President of the Female and Male Athlete Triad Coalition. 

Depending on symptoms and health issues, these specialists may include a sports dietitian, counsellor or psychologist, and a gynaecologist and/or endocrinologist.

The primary goal of treatment is to improve nutrition to build a healthy body weight, replenish energy and restore the menstrual cycle. 

Should the athlete also receive an eating disorder diagnosis, it's essential to work with a mental health practitioner and a registered dietitian if possible.

The Bottom Line

"The female athlete triad is a sneaky syndrome", Quinn said. Be aware of the warning signs and get in touch with a doctor or other licensed medical professional for help earlier rather than later. "The earlier that treatment begins, the easier it will be to optimise energy and nutrition and prevent long-term consequences, especially to bone health", Barrack said.

Words by Lauren Bedosky

 

[Lifeafterballet]

I wish we had heard of this. Actually, I wish my child’s school and the schools GP had heard of this too. Maybe then the long term damage would be less. 
Female Athlete Triad, RED-S and Hypothalamic Amenorrhoea should be talked about in vocational ballet schools and those affected should receive the right education and support to help prevent long term implications. 

[Lifeafterballet]

I forgot to mention my change of name 😊 When I joined this forum spontaneously in 2013, Dd was in year 7 and that evening I was sat drinking a bottle, not a whole one, of Cote du Rhone red wine 🍷. There have been many bottles consumed during our families ballet journey. It’s nearly over now and I felt it was time for a more appropriate name 🤣

[Jan McNulty]

Do you have the link to this article please?

[Guest oncnp]

13 minutes ago, Jan McNulty said:

Do you have the link to this article please?

Everything Experts Want You to Know About the Female Athlete Triad. Nike HR

[Jan McNulty]

1 minute ago, oncnp said:

Everything Experts Want You to Know About the Female Athlete Triad. Nike HR

 

Thanks

[Lifeafterballet]

https://www.nike.com/gb/a/what-is-female-athlete-triad
 

Sorry, took time to work that out 🤣

[Kerfuffle]

Does  stress have something to do with this too, even with an excellent bill of health from doctors? My DD eats very well but is tiny and can’t seem to gain weight ! She is y11 and working hard at GCSEs auditions etc 

[Lifeafterballet]

1 hour ago, Kerfuffle said:

Does  stress have something to do with this too, even with an excellent bill of health from doctors? My DD eats very well but is tiny and can’t seem to gain weight ! She is y11 and working hard at GCSEs auditions etc 

It’s an imbalance, input vs output. 

 

The vocational school GP my 13 year old, BMI down to 16 and overtraining pre appraisal daughter saw, prescribed her Ensure build up drinks 😡 Funnily enough she didn’t drink them. There was a problem and that wasn’t the solution. 

She didn’t get the help and treatment she needed until she stopped ballet and saw professionals not connected with that world. 

Its something that isn’t checked and sadly causes long term damage 😞 

If they aren’t growing there is a problem. And for the record my daughter never stopped eating, she controlled her intake to pause her growth and was rewarded for this. 

[Thecatsmother]

https://bjsm.bmj.com/content/bjsports/49/7/421.full.pdf

[Lifeafterballet]

22 minutes ago, Thecatsmother said:

https://bjsm.bmj.com/content/bjsports/49/7/421.full.pdf

Thank you for sharing.

Every ballet / dance student and parents should be educated in RED-S, Female Athlete Triad and Hypothalamic Amenorrhoea. 

Diagnosis and treatment could prevent long term health problems. 

[Thecatsmother]

10 hours ago, Lifeafterballet said:

Thank you for sharing.

Every ballet / dance student and parents should be educated in RED-S, Female Athlete Triad and Hypothalamic Amenorrhoea. 

Diagnosis and treatment could prevent long term health problems. 

Yes, it is hard to ensure dancers get the right support. Dr Nicky Keay is a specialist (endocrinologist) in this area and sees dancers. 

[Thecatsmother]

https://nickykeayfitness.com