The Female Athlete Triad

What is it and why is it important to understand?

The female athlete triad is made up of 3 components; low energy availability, menstrual dysfunction, and impaired bone health. These three pieces are interconnected but not all athletes experience them all together. Experiencing one or all of the components of the triad can have a negative impact on health and athletic performance.  Becoming familiar with the Female Athlete Triad is an important first step in keeping your body healthy in sport and in life.


ONE ~ Low Energy Availability 

Providing our bodies with adequate fuel is essential to longevity and sustainability in sport. This means that our energy, or food, intake must match the energy our body needs to exercise AND perform essential daily processes.

Another way to think about it is that energy in (food) must match or exceed energy out (exercise). When input and output do not match, our bodies might not have enough energy resulting in low energy availability. This can happen through eating disorders/ disordered eating as well as unintentionally underfueling due to a lack of knowledge around fueling needs. Low energy availability is at the core of both the Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S). Athletes at all levels from elite to recreational can be impacted by low energy availability which is what makes spreading this information essential to athlete health. 


TWO ~ Menstrual Dysfunction

Periods are powerful and tell us so much about the health of our bodies. When the body does not have sufficient fuel, energy is directed away from essential bodily processes like growth and reproduction. This happens because our body, with the limited fuel it does have, must prioritize other more vital processes like regulating temperature, cell health, and movement. With low energy availability athletes can experience menstrual dysfunction or the loss of a regular period. This can present in the form of oligomenorrhea, primary amenorrhea, or secondary amenorrhea.


THREE ~ Impaired Bone Health

Low bone mineral density results when an athlete has low energy availability and menstrual dysfunction. Without enough energy for the body to go through its essential processes the bone remodeling process is compromised. This can lead to weaker bones that cannot rebuild and remodel after stress from exercise. 













De Souza MJ, Koltun KJ, Williams NI. The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes. Sports Med. 2019 Dec;49(Suppl 2):125-137. doi: 10.1007/s40279-019-01217-3. PMID: 31696452; PMCID: PMC6901401.

Mehta J, Thompson B, Kling JM. The female athlete triad: It takes a team. Cleve Clin J Med. 2018 Apr;85(4):313-320. doi: 10.3949/ccjm.85a.16137. PMID: 29634467.


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