Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting
Sports and exercise are healthy activities for girls and women of all ages. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term damage to health, or even death. It can also hurt athletic performance or make it necessary to limit or stop exercise.
Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the “female athlete triad.”
The three conditions are:
- Disordered eating
- Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise keeps the body from getting enough nutrition.
- Menstrual dysfunction
Females at Risk
Females in any sport can develop one or more parts of the triad. At greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running or rowing).
Others feel pressure to lose weight from athletic coaches or parents.
Female athletes should consider these questions:
- Are you dissatisfied with your body?
- Do you strive to be thin?
- Do you continuously focus on your weight?
Female Athlete Triad
Although they usually do not realize or admit that they are ill, people with disordered eating have serious and complex disturbances in eating behaviors. They are preoccupied with body shape and weight and have poor nutritional habits.
Females are five to 10 times more likely to have disordered eating compared with males, and the problem is especially common in females who are athletic. The illness takes many forms. Some people starve themselves (anorexia nervosa) or engage in cycles of overeating and purging (bulimia).
Others severely restrict the amount of food they eat, fast for prolonged periods of time or misuse diet pills, diuretics, or laxatives. People with disordered eating may also exercise excessively to keep their weight down.
Disordered eating can cause many problems, including dehydration, muscle fatigue and weakness, an erratic heartbeat, kidney damage, and other serious conditions. Not taking in enough calcium can lead to bone loss. It is especially bad to lose bone when you are a child or teenager because that is when your body should be building bone. Hormone imbalances can lead to more bone loss through menstrual dysfunction.
Missing three or more periods in a row is cause for concern. With normal menstruation, the body produces estrogen, a hormone that helps to keep bones strong. Without a menstrual cycle (amenorrhea), the level of estrogen may be lowered, causing a loss of bone density and strength (premature osteoporosis).
If this happens during youth, it may become a serious problem later in life when the natural process of bone mineral loss begins after menopause. Amenorrhea may also cause stress fractures. Normal menstruation is necessary for pregnancy.
Recognizing the female athlete triad is the first step toward treating it. See your doctor right away if you miss several menstrual periods, get a stress fracture in sports, or think you might have disordered eating.
Give the doctor your complete medical history, including:
- What you do for physical activity and what you eat for nutrition.
- How old you were when you began to menstruate and whether you usually have regular periods.
- If you are sexually active, use birth control pills, or have ever been pregnant.
- If you have ever had stress fractures or other injuries.
- Any changes (up or down) in your weight.
Your doctor will give you complete physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases, a bone density test will be recommended.
Treatment for female athlete triad often requires help from a team of medical professionals including your doctor (pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a psychological counselor.
Last reviewed: October 2009
Co-developed with the American Orthopaedic Society for Sports Medicine
Shawn Matsunaga, ATC
Shawn Matsunaga received his degree in Physical Education/Athletic Training from California State University Dominguez Hills in 1993. He began his career working for a prominent surgeon Dr. Karlan Michelson. In addition to working for Dr. Michelson, he also worked as an assistant athletic trainer for California State University Los Angeles from 1994-1999. He relocated to Bartlett, Tennessee and began working for the University of Tennessee at Memphis as a senior research assistant. Upon completion of the study, he became an athletic trainer for the Memphis City Schools. In 2006 he became a Certified Specialist in Health Ergonomics. That same year he started his own company called The Ideal Connection which deals with ergonomics/wellness consulting. He was able to help many different types of employees from Delta, Fedex and Accredo Pharmaceutical achieve their goals. Shawn enjoys spending time with his family, snowboarding and fishing.