Care of the Young Athlete Patient Education Handouts

The Female Athlete Triad

F
emale athlete triad refers to the combination of
3 medical conditions—eating problems, menstrual Preparticipation screening for the female athlete
problems, and weak bones—seen in competitive During a sports preparticipation examination female
female athletes. Prevention of the female athlete triad is athletes are asked questions related to the female
important because it can interfere with normal growth and athlete triad (see below). If components of the female
development, cause injury, and result in loss of strength athlete triad are suspected, the doctor may perform an
and endurance. expanded physical examination.
The following is information from the American
Academy of Pediatrics about the 3 conditions and ••At what age did you begin menstrual periods?
general guidance for prevention and treatment. ••How often do you have a menstrual period?
Eating problems
••How long do your periods last?
••When was your last menstrual period?
Eating problems occur when an athlete eats fewer calories ••Have you ever taken birth control pills, and when?
than her body needs for growth, development, and
exercise. Some athletes choose to limit their calories to
••How many meals and snacks do you average
each day?
improve performance or appearance. Other athletes are
unaware that they aren’t eating enough calories to meet the ••List the foods and drinks you had yesterday.
energy demands of their sport. The athlete may be eating ••List the foods and drinks you try to avoid.
enough for a nonathlete, but not enough for an athlete. ••Do you eat or drink milk, calcium-fortified orange
Inadequate food intake is called disordered eating and juice, yogurt, or cheese? How much each day?
can result in low energy availability (not having enough ••What has been your highest weight, and when?
energy to fuel the body). For example, if an athlete only
eats 2,000 calories per day but uses 3,200 calories, then
••What has been your lowest weight in the past
2 years?
she is eating 1,200 calories less than her body needs. In
this case, the athlete will not have enough energy. This ••Are you happy with your current weight?
can hurt performance, slow growth and development, ••What do you feel your ideal weight would be?
and increase the risk of injury and illness. This can also ••Have you ever tried to control your weight by
lead to an eating disorder, like anorexia or bulimia. dieting? Vomiting? Laxative use? Diuretics? Exercise?
Athletes of any sport may develop disordered eating, but
some sports place athletes at higher risk. These include
••What sports do you participate in?
sports that emphasize leanness, such as gymnastics, dance, ••How much time do you spend training for your sport
diving, figure skating, long-distance running, and cross- each week?
country skiing, or sports that use weight classifications, ••How much time do you spend exercising in
such as wrestling, martial arts, and rowing. addition to your sports workout (ie, extra running,
calisthenics, stair climbing machine)?
Menstrual problems
••Have you ever had a stress fracture? When?
Not eating enough calories can cause menstrual periods to
become irregular (oligomenorrhea) or stop (amenorrhea). can be caused by not eating enough calories for energy
In the young athlete who isn’t eating enough calories, expended; they are not caused by low body fat or the
menstrual periods may not start when they should. stress of exercise.
Primary amenorrhea occurs when menstrual periods don’t
start before 16 years of age. Secondary amenorrhea occurs Weak bones
when regular menstrual periods stop for 3 months or more. When a young athlete doesn’t eat as many calories as her
Oligomenorrhea occurs when the time between menstrual body needs, and has menstrual problems, her bones do
periods is longer than 35 days. All types of amenorrhea not develop the normal strength. When this happens,

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Care of the Young Athlete Patient Education Handouts—The Female Athlete Triad
a 16-year-old girl can have bones as weak as those of a If a lack of enough calories is the cause of the menstrual
60-year-old woman. She may more easily develop stress problem, it will be important that the athlete increase
fractures or, if severe, even compression fractures of the her food intake. She will need to eat all of the nutrients
spine. This decrease in bone strength will continue until her body needs, which includes carbohydrates, fats,
she has normal periods again but, even though she can and protein. It may be helpful for her to see a registered
regain some bone strength, she may never catch up to dietitian for nutrition counseling. The athlete should
where she should be normally. gradually increase her food intake until her menstrual
periods return.
Prevention If it is difficult for the athlete to increase her food intake,
The female athlete triad can be prevented by eating enough she may need to decrease her exercise/sports activity
calories, including fat, protein, and carbohydrates. Most instead. Once menstrual periods return, the athlete can
female athletes need a minimum of 2,000 to 2,400 calories slowly increase her activity again while increasing her
per day. Not only will this prevent menstrual problems food intake to maintain menstrual periods.
and weak bones, it will help the athlete perform better! If If an athlete is not having regular menstrual periods, she
an athlete develops menstrual problems, she needs to see needs to eat 5 servings of calcium per day. A serving would
a doctor. It is not normal to skip periods or stop having be 1 cup (8 ounces) of milk, yogurt, or calcium-fortified
periods. If an athlete cuts out the fats in her diet, decreases orange juice, or 1 ounce of cheese.
the amount of food she eats, loses weight, or skips periods, If an athlete struggles with increasing her food intake, it
she should tell her doctor. Finally, if an athlete feels she may be helpful to have her see a counselor to work on why
needs to lose weight, she should consult her doctor first. eating enough is difficult for her.

Treatment

If an athlete is not having regular menstrual periods, she

Notes

The information contained in this publication should not be used as a substitute for the medical
care and advice of your health care professional. There may be variations in treatment that your
health care professional may recommend based on individual facts and circumstances.
Copyright © 2012 American Academy of Pediatrics
All rights reserved.

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