The Female Athlete Triad
- Rachel Lintz
- May 1
- 3 min read
The Female Athlete Triad consists of three interrelated conditions:
Low Energy Intake (intentional or unintentional)
Amenorrhea (irregular of absent menstrual periods)
Osteoporosis (low bone mass which leads to weak bones and risk of fractures)
This condition can surface among women at any time, however, it's prevalent in girls and young women involved in leanness sports. A young girl or woman who is determined to achieve this lean appearance for athletic success may excel through malnourishment while continuously meeting the physical demands of her sport. This approach, if led long enough, can lead to possible eating disorders, menstrual disturbances & low bone density.
Low Energy Intake - Driver of the Female Athlete Triad
Young, growing women require a significant amount of energy to support their natural growth and development. When they begin participating in sports and increase their physical activity through regular training, their energy needs become even greater. If these increased demands aren't met with adequate nutrition, it can lead to a condition known as low energy availability—the primary driver of the female athlete triad.
Low energy availability can occur intentionally or unintentionally. Some young female athletes may not realize that as they train harder, they also need to eat more to fuel their bodies adequately. Others may deliberately restrict their food intake in an effort to change their physique or enhance performance, especially in sports that emphasize leanness, such as gymnastics, distance running, dance, and swimming. If left unaddressed, this condition can progress into more severe clinical disorders like anorexia or bulimia.
In many cases, the drive for a lean appearance is influenced by societal expectations, pressure to succeed, or a lack of guidance & knowledge from coaches and parents. This can lead to a harmful cycle where an athlete may seem to excel in their sport, but is actually doing so while malnourished—putting their long-term health at risk.
Amenorrhea; Irregular or absent menstrual periods
The consequences of low energy availability are serious. Without enough fuel, the body begins to compromise other essential functions, such as the menstrual cycle, for the sake of other vital processes and organs, such as the heart and lungs. If you experience the loss of your cycle for 3 (or more) months, amenorrhea is present. Even if the cycle is irregular or missing from month to month, that is a sign there's something wrong. When our cycle is irregular or goes missing, it's likely there isn't enough circulation of hormones throughout our body - one of those important hormones being estrogen. Estrogen plays a critical role in maintaining a regular cycle and supporting overall health.
Low Bone Density, Osteoporosis, and Injuries
Estrogen’s role goes far beyond reproduction. It supports cardiovascular health, brain function, and most critically in this context, bone health. Bone is living, dynamic tissue that is growing and changing, especially through puberty - and estrogen plays a vital role in that growth.
Estrogen is in charge of assisting the body with absorption of calcium from the food we eat, and it slows down osteoblast activity, or the cells that break down bone. Therefore, if we don't have enough estrogen circulation or enough calcium absorption from food, osteoblasts become more active, break down bone, and bone stress injuries, even osteoporosis, can become more common for the athlete.
Becoming aware of the Triad
If you are a young female athlete, or someone who works with young female athletes, it's important to be aware and able to recognize signs of the triad. The root cause is often low energy availability, which occurs when the body doesn't receive enough nutrition to meet both daily needs and the demands of intense physical activity. This deficit can be intentional—due to dieting—or unintentional, resulting from a lack of knowledge or support.
Over time, inadequate fuel forces the body to compromise vital functions, leading to missed or irregular periods and disrupted hormone levels, particularly estrogen. Estrogen is essential for bone development, especially during puberty, and without it, bone breakdown accelerates, increasing the risk of fractures and long-term damage.
Early recognition and proper nutrition are key to preventing the serious health consequences associated with the Female Athlete Triad. Encouraging a balanced approach to training, body image, and fueling the body can help young athletes perform at their best—without sacrificing their health.
Support at Monarch Wellness
At Monarch Wellness, we’re passionate about supporting female athletes with the knowledge and resources they need to thrive—both in sport and in life. Our nutrition classes and exercise physiology services are designed to educate and empower women with evidence-based strategies to fuel their bodies, improve performance, and protect long-term health.
Our licensed professionals provide personalized guidance to help athletes meet the physical demands of their sport in a safe, sustainable way—without sacrificing menstrual health or bone strength. Whether you're recovering from a sports-related injury, navigating irregular cycles, or simply looking to optimize your performance, Monarch Wellness offers a holistic approach rooted in science, compassion, and long-term success.
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