Female Athlete Triad
(Exercise-Related Menstrual Dysfunction: Athletic Amenorrhea)
Fee-mal Ath-leet Try-add
by Cynthia M. Johnson, MA
Female athlete triad is a mix of:
The triad occurs when the amount of calories eaten is much lower than the calories used by the body. It is the result of one of these actions:
This imbalance causes a change of hormones in the body. Estrogen is one hormone that decreases. Low levels of estrogen change periods. It also makes it hard for the bones to keep calcium, This makes bones weaker.
Factors that may increase the chance of female athlete triad include any of the following:
Symptoms may include any of these:
The doctor may have an answer based on your symptoms. Info about your periods, diet, and exercise routine will also help.
Other tests may be done to rule out other health issues.
Treatment will be based on specific needs. A blend of treatment often works best.
There are many types of therapy. Choices include single or group therapy, CBT, or sports therapy. Therapy can help:
Work with your care team to find which works best for you.
Diet and Activity Changes
A dietitian can help to make meal plans. It should give enough calories to keep you well. The diet will also give fuel for workouts.
Workout plans should be checked. The length and intensity of workouts may need to be changed.
Medicine may be needed to stop further bone loss. They may include:
Medicine may also be needed to treat depression and anxiety.
To help reduce your chance of getting female athlete triad:
Family Doctor—American Academy of Family Physicians
Ortho Info—American Academy of Orthopaedic Surgeons
When it Hurts to Move—Canadian Orthopaedic Foundation
De Souza MJ, Nattiv A, Joy E, et al; American College of Sports Medicine; American Medical Society for Sports Medicine; American Bone Health Alliance. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clin J Sport Med. 2014 Mar;24(2):96-119.
Female athlete triad. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116009/Amenorrhea . Updated June 19, 2018. Accessed September 18, 2018.
Female athlete triad. Family Doctor—American Academy of Family Physicians website. Available at:
...(Click grey area to select URL)
Updated October 2017. Accessed September 18, 2018.
Female athlete triad: problems caused by extreme exercise and dieting. Ortho Info—American Academy of Orthopaedic Surgeons website. Updated October 2009. Available at:
...(Click grey area to select URL)
Updated June 2016. Accessed September 18, 2018.
Weiss Kelly AK, Hecht S, COUNCIL ON SPORTS MEDICINE AND FITNESS. The Female Athlete Triad. Pediatrics. 2016 Aug;138(2):e20160922
Last reviewed November 2018 by Monica Zangwill, MD, MPH
Last Updated: 9/18/2018
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