Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting

Bone diseases in female athletes

Sports and exercise are healthful activities for girls and women of any age. From time to time, a female athlete who concentrates on being thin or lightweight may eat too little or work out too much. Doing so can cause long-term damage to health, or even death. It can also hurt athletic performance or make it necessary to reduce or stop working out.

Three interrelated illnesses may form when a girl or young woman goes to extremes in dieting or exercise. Combined, these problems are known as the "female athlete triad."

The three conditions are:

•   Disordered eating

Irregular eating habits (i.e., fad diets, binge eating) or excessive exercise keeps the body from getting sufficient nutrition.

•   Menstrual dysfunction

Poor nutrition, low calorie consumption, high energy demands, physical and emotional stress, or low percentage of body fat may cause hormonal changes that stop menstrual periods (amenorrhea).

•   Premature osteoporosis (low bone density for age)

Lack of periods interferes with the body's bone-building processes and weakens the skeleton, making bones more likely to break.

Females at Risk

Females in every sport can cultivate one or more components of the triad. At greatest risk are those in sports that reward being thin for appearance (like figure skating or gymnastics) or improved performance (like distance running or rowing).

Fashion trends and advertising often urge women to try to reach harmful weight levels. Some female athletes suffer from low self-esteem or depression, and might focus on weight loss because they think they are heavier than they actually are. Others feel pressure to lose weight from athletic coaches or parents.

Female athletes should think about these questions:

•   Are you discontented with your body?

•   Do you endeavor to be skinny?

•   Do you constantly focus on your weight?

If the answers are yes, you may be at risk for developing abnormal patterns of eating (disordered eating), which can result in menstrual dysfunction and early osteoporosis.

Disordered Eating

doctor weaver mexico missouri mo columbia jefferson city mid mo central missouriAlthough they usually do not realize or admit that they're ill, individuals with disordered eating have serious and complex disruptions in eating behaviors. They are obsessed with body shape and weight and have poor nutritional habits.

Females are five to ten times more likely to have disordered eating compared with males, and the problem is especially common in females who are athletic. The illness takes numerous forms. Some individuals starve themselves (anorexia nervosa) or take part in cycles of overeating and purging (bulimia).

Other people severely control the amount of food they eat, fail to eat for extended periods of time or misuse diet pills, diuretics, or laxatives. Individuals with disordered eating might also exercise excessively to keep their weight down.

Disordered eating can cause many problems, including dehydration, muscle fatigue and weakness, an erratic heartbeat, kidney damage, and other significant conditions. Not taking in enough calcium can lead to bone loss. It is especially bad to lose bone when you are a child or teenager because that is when your body should be building bone. Hormone imbalances can result in more bone loss through menstrual dysfunction.

Menstrual Dysfunction

Missing three or more periods consecutively is cause for concern. With normal menstruation, your body produces estrogen, a hormone which helps to keep bones strong. Without having a menstrual cycle (amenorrhea), the amount of estrogen may be lowered, causing a loss of bone density and strength (premature osteoporosis).

Should this happen during youth, it may become a serious problem later in life when the natural process of bone mineral loss begins after menopause. Amenorrhea may also cause stress fractures. Regular menstruation is needed for getting pregnant.

Premature Osteoporosis (Low Bone Density for Age)

Bone tissue wears away, making your skeleton fragile. Low bone mass puts you at increased risk for fractures.

Doctor Examination

Identifying the female athlete triad is the first step toward treating it. See your doctor right away if you miss several menstrual periods, get a stress fracture in sports, or think you may have disordered eating.

Give the physician your full medical history, including:

•   What you do for physical activity and what you eat for nutrition.

•   What age you were when you started to menstruate and whether you usually have regular periods.

•   If you are sexually active, use birth control pills, or have ever been pregnant.

•   If you have ever had stress fractures or other injuries.

•   Any changes (up or down) in your weight.

•   Any medications you're taking or symptoms of other medical problems.

•   Family history of diseases (i.e., thyroid disease, osteoporosis).

•   Factors that cause stress in your life.

Your doctor will provide you with total physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In certain cases, a bone density test will be suggested.


Treatment for female athlete triad often requires help from a team of medical professionals including your doctor (pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a psychological counselor. The best first step for you is to contact Audrain Orthopaedics in Mexico, Missouri at 573-582-0444.

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