Female Athlete Triad: The Risks of Diet and Exercise Extremes

Exercise and sports are a part of a balanced, healthy lifestyle for many girls. Research shows that people who play sports and exercise are healthier, get better grades, are less likely to experience depression and engage in risky behavior than those who don’t participate. Unfortunately for some girls, not balancing the needs of their bodies and their activities can have major health consequences. 

The Female Athlete Triad can develop when a young female athlete goes to the extremes with dieting and exercise. This can cause long term damage to health and even death. The female athlete triad can be any combination of the three interrelated illnesses that consist of:  disordered eating, menstrual dysfunction, and premature osteoporosis. 

Females athletes in any sport can develop theses illnesses. Those at greatest risk include athletes in sports that classify by weight class such as rowing and wrestling, sports where a thin appearance is valued such as gymnastics, figure skating, or diving, and sports where “losing just a few pounds will make you faster” such as distance running. Problems such as low self-esteem, perfectionism, and high competitiveness can also put athletes at risk. 

Disordered Eating

Disordered eating is any abnormal eating habits or excessive exercise that keeps the body from getting enough nutrition. It can take many forms from the athlete starving themselves to engaging in cycles of overeating and then purging. They may severely restrict calories, use diet pills/laxatives, or fast for prolonged periods of time. Most people with disordered eating do not realize or admit that they are ill.  Many are preoccupied with body shape, weight, and have poor nutritional habits. 

Disordered eating can cause immense problems including dehydration, muscle fatigue, erratic heartbeat, hormonal imbalances, and other serious conditions.

Menstrual Dysfunction

Missing three or more periods in a row is cause for concern with young female athletes. Disordered eating and exercising intensely can lead to a decrease in hormones that help regulate the menstrual cycle. It is normal for teenagers to occasionally miss periods.  A missed period does not automatically mean that they have female athlete triad. It is important to just be aware that something may be going on and it is important to discuss with a doctor. 

Premature Osteoporosis

Premature Osteoporosis is low bone density for the athlete’s age. Low estrogen levels and poor nutrition especially low calcium consumption contribute to osteoporosis. This can cause weakening of the bones and improper bone formation.  It makes the skeleton fragile and puts the athlete at increased risk for fractures. 

Female athletes should be building up their bone mass to their highest levels in teenage years, which is peak bone mass. Not getting enough calcium in their younger years can have a lasting effect on how strong their bones are later in life. 

Signs and Symptoms

If an athlete has risk factors for the female athlete triad, she may already be having some signs and symptoms of the illnesses such as,

     -weight loss

     -irregular periods or absence of periods

     -fatigue and decreased ability to concentrate

     -stress fractures or fractures without significant injury

Athletes with the female athlete triad often have signs, and symptoms of disordered eating such as,

     -continued dieting in spite of weight loss

     -preoccupation with weight and food

     -frequent trips to restroom during and following meals

     -laxative/diuretic use

     -brittle hair or nails

     -sensitivity to cold

     -low heart rate and blood pressure

     -heart irregularities and chest pain


Treatment for female athlete triad requires help from a team of medical professionals, including a pediatrician, nutritionist, athletic trainer, and psychological counselor.  Contact your local SSM Health Cardinal Glennon SportsCare Liaison and they can help navigate the health care system to find the most appropriate health care provider. You can reach your local representative at 314-577-5640 or by visiting https://www.ssmhealth.com/cardinal-glennon/sportscare.





Amanda Sullivan, MS, ATC, LAT
Outreach Liaison – Cardinal Glennon SportsCare
SSM Health Cardinal Glennon Children’s Hospital


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