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Menstrual Problems, Osteoporosis And Eating Disorder In Athletes. The Female Triad Syndrome

Updated on October 29, 2013
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Liam Hallam is a sports science graduate. A keen cyclist, runner, and obstacle racer who ran his first ultra-marathon in 2016.

A female runner in full flight

Grace Momanyi running. All these runners are at potential risk of the Female Athlete Triad Syndrome
Grace Momanyi running. All these runners are at potential risk of the Female Athlete Triad Syndrome | Source

The Female Athlete Triad

Women who participate in sports or exercise and train intensely are at risk of a syndrome known as the Female Athlete Triad.

This is a combination of three conditions;

  • Eating Disorder
  • Menstrual Problems (Amenorrhoea)
  • Osteoporosis (or Osteopenia) .

A female athlete can experience one, two, or all three parts of the triad.

The potential impact of the three above factors are on sporting performance and general health. However many of these conditions have potential to be prevented with careful management by athlete and coach.

Energy Deficiency and the Female Athlete

The primary cause of the Female Athlete Triad is deemed to be a long term imbalance of energy consumption and expenditure during exercise. The primary cause is Energy Deficiency[1]

The energy defieciency can be due to a conscious restriction of food intake due to body image consciousness or eating disorder.

Disordered eating can be due to internal or external pressures for a young female or woman athlete to be thin. In many cases there is a misconception that a more lean athlete is more successful therefor a very goal orientated, compulsive athlete may concentrate on this approach towards an assumption it will lead to improved performance.

Female Athletes prepare for the start of a race event

The Female Athlete Triad- the relationship between osteoporosis, eating disorder and menstrual dysfunction
The Female Athlete Triad- the relationship between osteoporosis, eating disorder and menstrual dysfunction | Source

Potential Warning Signs of Eating Disorders in Female Athletes

  • Rapid weight loss
  • Psychological obsession with body weight, food, mealtime rituals, and body image
  • Fluctuations in weight
  • Daily exercise additional to regular training schedule
  • Stress fractures (i.e . micro fractures of bones that may progress to complete fractures)
  • Yellowing of the skin
  • Frequent sore throats despite no other signs of respiratory illness (possibly seen due to self-induced vomiting- Anorexia)
  • Chipmunk-like cheeks due to swollen parotid glands (self-induced vomiting)
  • Many dental cavities, foul breath (self-induced vomiting)
  • Regular fatigue, light-headedness and dizziness
  • Depression, anxiety and low self-esteem.

Osteoporosis and the Female Athlete Triad

Osteoporosis is associated with a decreased bone mass despite no alteration in the mineralisation of bone tissue due to a decreased bone mineral density.

Bone tissue is developped during a female's development through nutrition and the bone tissue response to mechanical stress.

Risk factors for Osteoporosis [2]

Low Energy Availablility

Low energy availability is addressed through balanced diet and nutrition.

Low Oestrogen Concentrations

The long term risk of developing osteoporosis has been shown to be reduced by attaining a a good peak bone mineral density during childhood and the long term exposure to oestrogen. Oestrogen protects the skeleton from bone resorption.

Amenorrhoea as a result of Eating Disorders

Inadequate nutition in relation to exercise level can lead to potential menstrual dysfunction as it can lead to decreased levels of oestrogen, the hormone responsible for maintenance of a female's menstrual cycle.

Endurance exercise leads to the production of endorphins which may have a detrimental effect on the hormones a woman requires for normal menstrual function. This may be a possible link between Amenorrhoea and endurance exercise.

Some girls who participate intensively in sports may never even have the onset of their menstrual cycle. Others may have had periods, however on increasing their training and changes to their eating habits may cause the cessation of their menstrual cycle.

For further information I recommend.

Menstruation And Endurance Training - The Effects Of Exercise On The Menstrual Cycle

Osteopenia and the Female Athlete Triad- What are the symptoms of Osteopenia

The inclusion of Osteopenia in the Female Athelete Triad

Researchers have called for the inclusion of Osteopenia within the Female Athlete Triad[2] due to it's association with decalcification of bone and it's higher prevalence in female athletes.


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    • CyclingFitness profile image

      Liam Hallam 6 years ago from Nottingham UK

      Thanks Kitty. Many people have body weight issues- not just athletes. The main thing is putting the knowledge out there so people can be aware of such issues. Thank You for your feedback

    • kittythedreamer profile image

      Nicole Canfield 6 years ago from the Ether

      Voted up and useful, CyclingFitness. So sad that such strong and amazing women feel they need to be so obsessed with their body's weight. Also, I didn't realize there was a correlation between female athletes and osteoporosis. Thanks for sharing, you are truly knowledgeable on fitness and how it affects our health. :)