Female Athlete Triad: Symptoms, Causes & Treatment

What is Female Athlete Triad?

Sports and exercise play a key role in ensuring a balanced and healthy lifestyle. People who engage in sports are generally healthier, have lower cholesterol, good bone strength, healthy blood pressure and are less likely to suffer from depression and anxiety. However, women who are physically active may suffer consequences if they fail to balance the needs of their bodies and sports. Women who engage in intense sports activities are at risk of suffering from the female athlete triad. Female athlete triad is a medical condition that involves three components — menstrual dysfunction, low bone density and low energy availability (with or without disordered eating) (x). It is mostly common in physically active women due to inadequate calorie intake during strenuous exercise.

Women undertaking any sport can develop one or more aspects of the triad. Those engaging in sports that favor being thin or light weight — like gymnastics, figure skating or distance running, for example — are at the greatest risk. Women that experience increased pressure to perform at certain standards are more prone to developing athlete triad syndrome (x). Some women suffer from depression or low self-esteem due to fashion trends or pressure to lose weight from society.

Those suffering from female athlete triad may experience symptoms like bone loss, fatigue, self-induced vomiting, stress fractures and weight loss, among others. Early treatment is ideal in order to prevent worsening symptoms.

Female Athlete Triad Symptoms

The term ‘female athlete triad’ (triad stands for three) refers to athletes who have the following health concerns.

Inadequate Nutrition

Inadequate nutrition is when the body is not gaining enough energy from the food consumed. Eating regularly may not be adequate for a very active person to retain a normal weight. Some women fail to take in enough calories during the day while others don’t consume enough healthy fats due to societal misinformation about the role of fats in the diet. Healthy nutrition is necessary to have consistent menstrual cycle and maintain normal estrogen levels. Losing weight too quickly can cause irregular periods. Many people also experience eating disorders like anorexia nervosa, bulimia, generalized disordered eating, anorexia athletica, binge eating disorder and several more (x).


This term refers to the absence of menstrual periods for periods over six months. The absence of periods can be due to factors like significant weight loss, intense exercise and disordered eating. A precise percentage of body fat is essential to maintain strong bones and healthy weight. Lack of periods happen when weight reduces to unhealthy levels or when the body is not adequately nutritionally balanced. Lack of enough nutrition intake in the body can cause light or delayed periods for up to 2-3 months. A healthy weight is necessary for the body to manufacture enough quantities of the female hormone, estrogen. Maintaining normal levels estrogen is essential to the body as it helps in the absorption of calcium, a crucial mineral for stronger bones. Estrogen deficiency can mean low bone mass (x).

Low Bone Mass

This is when bones are abnormally weak. Physical activity plays a key role in building strong bones and a healthy skeleton. However, intense exercise can lead to problems in people with irregular periods and normal estrogen levels. The right balance of estrogen, body weight, exercise and the right intake of calcium and vitamin D is imperative for healthy bones (x).

Symptoms of Female Athlete Triad

Causes of Female Athlete Triad

Energy Deficiency

This is the main cause of female athlete triad. Nutritional energy imbalance is caused by the body expending more energy than is taken in. Energy deficiency can occur due to disordered eating, or unintentionally through lack of tracking of nutritional knowledge. An athlete may not know the number of calories required to compensate for the activity level (x, x). Low energy negatively affects bone health and menstrual function.

Restriction of Food Intake

Women who have amenorrhea restrict their eating and are at the greatest risk for female athlete triad. The condition occurs in some women who consciously restrict their food intake.

Female Athlete Triad Symptoms

Weight Loss

One of the symptoms of the female athlete triad is that due to the nutritional energy imbalance. The body uses more energy than is provided by dietary intake, which causes weight loss (x).

Difficulty Sleeping

This symptom is due to high levels of cortisol. It is the body’s primary hormone that makes it difficult to sleep (x).


Fatigue can be a symptom on its own, as well as a result of several other symptoms like energy deficiency from low caloric intake, hormonal changes and the general strain from heavy physical work. It can also contribute to the feelings of anxiety and depression (x).

Stress Fractures

These are fractures that occur through repetitive use, especially when bone density can be negatively effected by nutritional imbalance.

Menstral Cycle Distruption

Also known as amenorrhea. This is perhaps the most serious risk of the triad. Intense exercise and insufficient caloric intake can lower hormones like estrogen and progesterone, which take part in regulating a woman’s menstrual cycle. Women with this condition can fail to have a menstrual period for three months. Female athletes can have functional hypothalamic amenorrhea, which are fairly regular but still disrupted periods (x).

Bone Density Loss or Osteoporosis

A hormone disturbance in women can put them at a higher risk of low bone mass. Sometimes this leads to weakened bones or osteoporosis. Low levels of female hormones like estrogen weaken the bones and put them in a higher likelihood of injuries like breaks, fractures and stress fractures (x).

Treating Female Athlete Triad

There are a number of avenues to pursue when treating the female athlete triad. These are a combination of lifestyle changes and official treatments.

Increase Energy (Calories) Intake

Energy is a key component in treating the female athlete triad. The majority of the symptoms and effects of female athlete triad are caused directly (weight loss) or indirectly (loss of bone density) by nutritional insufficiency. More calories might be required in young girls and active teenagers (x). Calories requirement can rise up to 3,000 or above for some female athletes.

Minimize Exercise

Many women with female athlete triad are required to refrain from exercising in order to resolve some of the issues. Some may actually have to quit all sporting exercises. It is also advisable to consult a physician to learn about the exercise that your body can tolerate. Slowing down the amount of energy going out can be done by doing gentle forms of exercise like yoga, swimming, casual walking (x).

Getting Enough Rest

Lack of enough sleep makes it harder for the body to recover and resume its normal functions after workouts. Sleep helps the body to repair damaged tissues, regulate mood, produce and balance hormones. People experiencing insomnia can try to focus more on reducing stress and eating nutrient-dense foods (x).

Reduce Inflammation and Stress Levels

Inflammation and chronic stress make any health condition worse. This includes mental health issues, bone loss and hormonal imbalances. Increased stress can alter a woman’s reproductive hormones and also affect her menstrual cycle. Inflammation may worsen menstrual disorders or complicate other health issues like sports-related injuries (x).

Seek Medical Advice

This is good advice for anyone experiencing any of these symptoms, or from the symptoms of underlying issues like disordered eating. The doctor will want to learn about the patient’s medical history and other factors like their physical activity and history of the menstrual cycle (x). They can help people dealing with these problems by recommending a course of action and treatment.

Supplements for Female Athlete Triad

Maca Root Extract Powder

Maca root extract is an antioxidant that can benefit women’s health and improve energy, memory and mood. As a dietary supplement, take 1,000 mg (scant ½ tsp) of maca root extract powder three times per day, or as directed by a physician.

Pure Phenylethylamine

Phenylethylamine (PEA) HCL is a compound found in foods like chocolate. It may improve mood and promote feelings of well-being and calmness. It is suggested that when used as a supplement, phenylethylamine (PEA) HCL powder should be taken in servings of 100 to 500 mg once daily. Taking more than that can result in overstimulation, potentially causing mania and erratic mood swings.

Glycine Powder

Glycine is a nonessential amino acid, but still plays an important role in muscle maintenance and energy production. It also functions as an antioxidant. Glycine powder is recommended to be taken in serving sizes of 1,000 mg up to three times per day, depending on intended effect. As the body is able to manufacture glycine on its own, a glycine supplement is usually not necessary before use, especially when you have had a prior medical condition.


Fenugreek powder is created from the seeds of the fenugreek plant, a Mediterranean herb that contains several vitamins and helpful alkaloids. It is also used as a flavoring in several foods and drinks, such as artificial maple syrup. Take 1,000 mg (about ½ tsp) of fenugreek powder up to three times daily, or as directed by a physician. May also be useful as a culinary spice.

Whey Protein Powder Isolate

Whey protein comes from milk and is a rich source of proteins. It contains 90 percent protein and a complete amino acid profile, ideal for building muscles. As a dietary supplement, take 15 to 30 grams of whey protein powder daily, or as directed by a physician. The recommended serving size for weightlifters is 1 gram of protein per kilogram of body weight.

The Bottom line

The female athlete triad is a condition that affects women — especially teenagers and young women who play sports — which result from energy deficiency. Energy deficiency is the primary cause of female athlete triad. It involves the intake of a few calories while burning too many at the same time. Symptoms of female athlete triad vary in severity in different women. Treatments options for female athlete triad mainly focus on reducing energy loss and increasing energy intake. Several supplements can also serve as useful remedies for female athlete triad.

Author: BulkSupplements Staff