The female athlete triad

Young female athletes may be at risk of three interrelated conditions, including lack of adequate calories, menstrual abnormalities and weak bones.

For girls and young women who compete at the highest levels of sports, their days consist primarily of school, homework and practice. These athletes are nothing if not busy. Their parents are as well, often shuttling the girls from practice to practice and then driving them to multiple competitive events a week — some near, some far.

Amid the hustle, it's easy to forget or glide over things such as eating good meals, getting enough sleep, finding time to relax and keeping up with medical checkups. But for elite young female athletes, these habits are incredibly important for both immediate and long-term health and development. They're also key to avoiding the risks of what's known as the female athlete triad.

Components of the triad

The female athlete triad describes three interrelated conditions that tend to occur more often among female athletes than nonathletes. The three conditions are:

  • Low energy availability. When girls and young women don't take in enough calories to compensate for those expended during exercise, the result is an energy deficiency. Doing this once or twice is no big deal. But persistently shortchanging the body's energy account can lead to a state of low energy availability. The result? The body lacks the fuel it needs to function and develop properly. Young women might reach this point inadvertently — they just don't think about the health costs of skipping meals, or they forget or are too tired. Some girls restrict what they eat intentionally, often in an effort to achieve a competitive weight or a certain aesthetic look. Some other girls and young women could have an eating disorder. In any case, not getting enough calories sets the stage for the other two conditions of the triad.
  • Menstrual dysfunction. When a girl's body is running low on energy, the body adopts various energy-conservation measures, including in the reproductive system. Hormone production is suppressed, which can lead to a delay in beginning menstruation, irregular periods or no periods at all. Not having a period can seem like a boon at first, but a lack of hormones such as estrogen can contribute to loss of bone density, as well as problems that become more apparent later in life, such as infertility.
  • Weak bones. Adolescence is the most important time to accumulate bone mass. Not getting enough calories — including nutrients that are key to bone health — can disrupt bone formation at this critical juncture. The physical and emotional stress of high-intensity training and inadequate calories also can cause changes in estrogen, growth hormone and cortisol production. These disruptions correlate with decreased bone mass. In the short term, weak bones make young female athletes more vulnerable to stress fractures and other injuries. And if young women don't achieve full bone mass in these younger years, they will be at greater risk of having weak and brittle bones (osteoporosis) and fractures later in life.
Nov. 04, 2016