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Female Athlete Triad

  • Cynthia M. Johnson, MA
Publication Type:


Female Athlete Triad

(Exercise-Related Menstrual Dysfunction: Athletic Amenorrhea)


Female athlete triad is a mix of:

  • Decreased energy—with or without an eating disorder
  • Changes in menstrual periods—may be irregular or fully stopped
  • Loss of bone and body mass—with or without osteoporosis

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The triad happens when the calories eaten are much lower than amount used by the body. This decreases a hormone called estrogen. This causes periods to change. It also makes it hard for the bones to absorb calcium. This causes them to weaken.

Causes of female athlete triad are:

  • Reducing the amount of food eaten while raising activity level
  • Not eating enough of the right foods to support high levels of activity

Risk Factors

This problem is more common in competitive athletes. Other things that may raise the risk are:

  • Exercising beyond the level needed for a sport
  • Being in sports that:
    • Focus on being thin, such as gymnastics, ballet, figure skating, and distance running
    • Have weight classes
  • Pressure to lose weight from parents or coaches
  • Restrictive dieting
  • Binge eating
  • Forced vomiting
  • Excess worry about weight and eating
  • Low self-esteem or poor family dynamics


Problems may be:

  • Weight loss
  • Missing or irregular periods
  • Tiredness
  • A decline in sports performance
  • Focus and mood problems
  • Feeling very cold
  • Muscle cramps or weakness
  • Poor self-image


The doctor will ask about symptoms and health. This will include questions about medicines, diet, periods, and exercise routine. A physical exam will be done. This is often enough to make the diagnosis.


The goals of treatment are to gain weight and resume normal menstrual periods. Treatment will be based on specific needs. It may include:

  • Nutrition counseling—to balance calories with activity level
  • Cognitive behavioral or group therapy—to change unhealthy thought processes
  • Medicines, such as:
    • Hormones found in birth control pills
    • Supplements like calcium and vitamin D to strengthen bones
    • Anti-depressants


The risk of this problem may be lowered by:

  • Keeping a healthy weight
  • Eating enough calories to fuel activities




  • Female athlete triad. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/female-athlete-triad.
  • Female athlete triad. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/female-athlete-triad.
  • Female athlete triad: problems caused by extreme exercise and dieting. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00342.
  • Nose-Ogura S, Harada M, et al. Management of the female athlete triad. J Obstet Gynaecol Res. 2018;44(6):1007-1014.


  • Dianne Scheinberg Rishikof MS, RD, LDN
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.