Female Athlete Triad.

The Female Athlete Triad refers to women who experience the following conditions: low energy availability (with or without an eating disorder), poor bone health, and menstrual dysfunction (1-3).

Women who don’t partake in regular physical activity can also suffer from the Female Athlete Triad, however it is much more common in women who regularly participate in sport.

Energy Availability

Energy availability refers to “the amount of dietary energy for all physiologic functions after accounting for energy expenditure from exercise” (3). Common signs that a person has low energy availability include fatigue, irritability, tiredness (more than usual), a reduced ability to concentrate as well as mood swings.

There are several reasons a person could have low energy availability (3).

  1. Suffering with an eating disorder and showing restrictive behaviour towards food – i.e. fasting, skipping meals, use of diet pills or laxatives, and binging and purging
  2. Eating in a calorie deficit (on purpose or by accident) – meaning they expend more energy than they consume
  3. Lack of knowledge surrounding nutrition and physical activity
  4. Health reasons

Menstrual Dysfunction

When in a state of low energy availability a women’s menstrual function can be greatly impacted and she can suffer with a condition known as amenorrhea. The three main forms of amenorrhea are described below (4).

  1. Primary amenorrhea = A delay in menarche (i.e. 15 years of age or older)
  2. Secondary amenorrhea = The cessation of a women’s menstrual cycle for three consecutive months
  3. Oligomenorrhea = A women’s menstrual cycle is occurring at irregular intervals (i.e. greater than 35 days)

Its important to note that any other causes for menstrual dysfunction such as pregnancy, thyroid dysfunction and polycystic ovarian syndrome (PCOS), amongst other conditions, should be excluded in the first instance. If you have any concerns regarding your menstrual cycle please make an appointment with your GP or equivalent health care professional.

Bone Mineral Loss

Typically, in women, a loss of bone mineral density is as a result of low energy availability and menstrual dysfunction (i.e. the two other elements of the Female Athlete Triad). Someone with a lower bone mineral density is at an increased risk of stress fractures, with age individuals are also at a greater risk of osteoporosis (4).

You may be surprised to hear that roughly 90% of a person’s bone mineral density is attained by the age of 18 years old, therefore sufficient daily energy (calorie) intake is essential from any early age (4).

Evidently, low energy availability, menstrual dysfunction and bone mineral loss all impact one another, but having low energy availability is arguably the leading cause of the female athlete triad. It is important to speak to a health care professional, such as a GP, if you have any concerns.

Key terms

Menarche – A women’s first occurrence of menstruation (i.e. first getting her period)

“The thyroid is a small butterfly-shaped gland in the neck, just in front of the windpipe (trachea). It produces hormones that affect things such as your heart rate and body temperature” (5).

Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work”. The three main features of PCOS include: irregular periods, excess androgen ( a “male” hormone which causes an increase in excess body hair), and polycystic ovaries (6). I will do a sperate, more in-depth, post on PCOS soon.

The term osteoporosis refers to a health condition which weakens bones, making them fragile and more likely to break (7).


  1. https://journals.lww.com/acsm-essr/FullText/2019/10000/Female_Athlete_Triad_and_Relative_Energy.2.aspx
  2. https://www.sciencedirect.com/science/article/pii/S2468867319300458
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435916/
  4. https://web.archive.org/web/20190222062833id_/http://pdfs.semanticscholar.org/34f1/559394684c08e191f9a4e5055b063e6756e6.pdf
  5. https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/#:~:text=The%20thyroid%20is%20a%20small,problems%20that%20may%20need%20treatment.
  6. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
  7. https://www.nhs.uk/conditions/osteoporosis/

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