The Female Athlete Triad

This weekend I was getting my nerd on at the American Physical Therapy Association's Mass Chapter annual conference. Phew that was a mouthful! Anyways, I attended 2 orthopedic courses which I thought would carry over well to my work. I had no idea that the runner's course would blow my mind and serve as inspiration for a post! 

Ok, so really one aspect of the lecture caught my attention. Something called the "Female Athlete Triad." From here on out I'm just going to call this the triad, because unfortunately the acronym for this diagnosis is... FAT... and well, I don't want to type that over and over. 

I hope your eyes aren't glazing over yet because we all need to hear this! If you are an active woman, you may have or be at risk for the triad. This includes any female who works out, yes, even if you aren't competing or participating in a specific sport. 

What is the triad? 

The triad is an umbrella term which describes three different problems that are closely related: low energy availability, menstrual dysfunction, and low bone mineral density. Keep in mind that all three of these conditions have a spectrum from normal to full on medical diagnosis.

OK Monika, what is low energy availability?

"Low energy availability" used to be called disordered eating. It is calculated in kilocalories by subtracting how much energy you use during exercise from how much energy you consume. In real people talk it basically means how much energy does your body have left after your training to keep up basic bodily functions.

Remember, energy comes from food! It's not simply how much you eat, but what you are eating that impacts your energy levels. The best way to determine if you are meeting your nutritional needs is to work with a registered dietician or nutritionist. 

What about "menstrual problems"?

Let's bust a big myth: missing periods is normal when you are training heavily. Wrong! While it may be common, especially among endurance athletes, its NOT ok. If you have more than 35 days between periods or don't have a period for more than 3 months, then you meet the criteria for "menstraul problems" and need to see a physician.  

Low bone mineral density

When we hear this its typically about postmenopausal women or adorable little grandmas who break a hip. Unfortunately this isn't  something which you can diagnose yourself with, but you should suspect it if you have a history of stress fractures or have been underweight for more than 6 months.

Why does it matter? 

As I mentioned earlier, these conditions are linked very closely. We currently believe that disordered eating is the cornerstone of the triad as it can lead to development of the other 2 parts. Irregular periods are associated with low estrogen. Estrogen protects your bone mineral density by regulating how much the body breaks it down - this is why women after menopause are more likely to develop osteoporosis. Having even one component puts you at risk for developing the other 2 and for medical problems in general. 

Low energy availability may impact your ability to recover (both from training and from injuries), have a period, get pregnant, and may lead to cardiovascular problems. 

Screening for the triad

Here's the part that really shocked me- most medical professionals don't know about this! One study found that  only about a 1/3 of physicians and 1/2 of physical therapists know about the triad, and even fewer than that can identify each part of it. With stats like that, it's time to take matters into your own hands. 

Ok, so maybe you are thinking "hmm I have some of those problems.." Now what? If only half of medical providers know about this condition, then why should you care? It's your health and you shouldn't wait for someone else to take charge of it. The first link below leads to an excellent review article about the triad. Even though it says it is for physical therapists, it's a great overview and includes guidelines which your medical doctor can apply to his/her practice as well. 


The Female Athlete Triad: What Every Physical Therapist Needs to Know, from the International Journal of Sports Physical Therapy 2015.

2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad, from the British Journal of Sports Medicine 2014.