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Female Athlete Triad

Medically reviewed by: Mary L. Gavin, MD

What Is the Female Athlete Triad?

The female athlete triad (“the triad,” for short) is a medical condition with 3 parts.

Girls with the triad may:

  1. not eat enough for their activity level. Some girls may diet, avoid some foods, or have an eating disorder.
  2. miss periods or stop having periods
  3. have weak bones that can lead to

A female athlete can have one, two, or all three parts of the triad. Because girls with one part of the triad are at risk for the other parts, it’s important to catch the signs early.

What Are the Signs & Symptoms of Female Athlete Triad?

Signs of the female athlete triad include:

What Happens in Female Athlete Triad?

Exercising a lot and not eating enough calories can cause problems like a decrease in the (such as estrogen) that help control a girl’s monthly cycle. Low estrogen levels, poor nutrition, and not enough calcium or vitamin D in the diet cause bone loss.

Who Gets Female Athlete Triad?

Female athletes, especially those who play sports that look for thinness — such as dancing, gymnastics, cheerleading, figure skating, distance running, and rowing — are more likely to have the triad. Other things that make someone more likely to have the triad include:

  • focusing on one sport at a young age
  • training too much
  • dieting, losing weight, or feeling pressure to lose weight
  • family problems

How Is Female Athlete Triad Diagnosed?

A doctor might think it’s female athlete triad if a girl has period problems, stress fractures, overuse injuries, weight loss, or a low BMI. At yearly checkups or sports physicals, female athletes might be asked to fill out a questionnaire. The answers can help doctors find girls who may get the triad. The doctor also will ask about periods, diet, and exercise habits.

There’s no test to diagnose the triad. But a doctor may order:

  • blood tests to check for other reasons a girl may be missing periods or losing weight. The doctor also may check for anemia, low vitamin D, or other nutrition problems.
  • electrocardiogram (EKG) to look for irregular heartbeats in girls with eating disorders
  • bone density testing (dual-energy radiographic absorptiometry, also called DEXA or DXA scan) to measure bone health. This might be done when girls have stress fractures, poor nutrition, or no periods for 6 months or more.

How Is Female Athlete Triad Treated?

A team of specialists usually treats girls with female athlete triad. This may include doctors, nutritionists or dietitians, mental health specialists, and athletic trainers. The goal of treatment is to help girls get their energy into balance, start having periods, and improve bone health. Girls will learn to eat enough to support their level of physical activity.

The treatment plan includes: