Female Athlete Triad Syndrome

Pam Flores @phflores Health Guide
  • HealthCentral would like to welcome Susie Hathaway who will explain one of our exercise disorders—Female Athlete Triad Syndrome—and its impact on bone mineral density. 


    Susie Hathaway is a personal trainer, specializing in helping women in the over-50 age group strength train for healthy bodies and bones. Half of her clients & class participants have osteoporosis or low bone density. Her mission is to develop safe strength training programs for women, no matter what their age, level of fitness, or physical limitations. She writes a blog about how to stay strong and healthy for an active second half of life at SusieHathaway.com.

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    • Personal Trainer, ACSM* certified
    • Former Elementary Physical Education Teacher and Youth Sports Coach
    • BA in Health Education
    • Group Leader on the National Osteoporosis Foundation’s online Support Community             *American College of Sports Medicine


    Susie has produced a DVD, "Safe Strength Training for Osteoporosis Prevention."


    What is Female Athlete Triad Syndrome?

    It is a cluster of the symptoms of that includes disordered eating, lack of menstrual periods (amenorrhea), and bone loss. It can occur from not eating enough or exercising too much, leading to a drop in estrogen which can lead to low bone density and osteoporosis.


    What are the risk factors that contribute to this syndrome?

    Any woman who is physically active can be at risk for the Triad, especially if she has the discipline for athletic training and the competitive urge to win at all costs. It can affect dancers, as well as athletes in any sport.


    Usually, athletic training results in a high level of health and fitness. However, when athletes don’t consume enough calories because of the perceived notion that ultra-thinness will help performance or make her look more attractive, health can be severely compromised.


    Training past a reasonable level is also a risk factor. Susceptible athletes can be those who participate in endurance activities like running, as well as those in sports with form fitting clothing such as gymnastics, dancing, and swimming.


    What health consequences do we see with this disorder?

    When the body encounters a severe energy shortage, the female hormone estrogen can drop and menstrual periods stop. Osteoblasts, our bone-building cells, respond very well in the presence of estrogen. Without it, a young woman will lose bone at a rate comparable with a woman at the onset of menopause, which is the time of greatest bone loss in a woman’s life.


    Young women need to know that starving their bodies can also starve their bones. Osteoporosis and stress fractures can develop with extended amenorrhea. Bone loss will begin to occur within a matter of months with a lack of periods. The drop in estrogen is similar to the drop that occurs after menopause.


    Achieving peak bone mass and not losing bone is critical for those in their teens and twenties. By the time women and men reach age thirty, most of their peak bone mass has been built.


    What causes this type of excessive exercise and disordered eating? 

    It is not always excessive exercise, but the relationship between the energy output (exercise) and inadequate energy input (not consuming enough calories) to meet the demands of rigorous athletic training. The modern view of the thin woman as the ideal can have devastating effects on the psyche and bodies of young women.


    The disordered eating can occur inadvertently from simply not paying enough attention to getting enough to eat or having poor eating habits. It can be intentional as a means of weight control or, at the extremes of disordered eating, psychopathological in nature.

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    Is there treatment available for the Female Athlete Triad?


    Education of the athletes, coaches, parents, trainers, and athletic directors is important for prevention. Body weight should not be a focus in training. Monitoring an athlete’s health and nutritional intake, watching for a lack of concentration, unusual fatigue, weight loss, and losing lean body mass (muscle) are just a few of the signs to watch for.


    The treatment is to eat more and possibly reduce the amount of exercise. Interventions of nutritional counseling and monitoring work well for many athletes. Those with eating disorders need counseling and should be required to meet a certain baseline of energy intake before returning to normal athletic training levels and competition, waiting until their periods return.


    It is recommended to have a pre-season assessment and if Triad symptoms are suspected, another assessment by a health care team including a doctor, registered dietician, and a mental health care provider, if there is an eating disorder involved. A watchful coach and athletic trainer can be vital in assessing whether a young woman may be showing signs of Triad symptoms, as well as her parents and family members.


    What advice would you give to young women to prevent the Athlete Triad Syndrome?

    • Surround yourself with positive women who are comfortable in their own skin.
    • Nurture a positive body image in yourself and friends. Compliment yourself and others.
    • Resist the high fashion image of thin as an appropriate female form.
    • Know that your long term health is much more important than any sports competition.
    • Find a sport that suits you, not one that requires weight loss or excessive thinness.
    • Seek support from your family, friends, and coaches.
    • Enjoy your food and accept your body.
    • Build healthy lifetime exercise habits and a healthy diet.
    • Get enough calcium from your diet, plus Vitamin D through sunshine or diet to help with the calcium absorption.

    The National Institute of Health recommendations for calcium intake per day:

    Children 9–13 years 1,300 mg

    Teens 14–18 years 1,300 mg

    Adults 19–50 years 1,000 mg

  • Pregnant and breastfeeding teens 1,300 mg

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    Pregnant and breastfeeding adults 1,000 mg

    Adult men 51–70 years 1,000 mg

    Adult women 51–70 years 1,200 mg

    Adults 71 years and older 1,200 mg


    Thank you Susie for a very informative interview!  Your explanation will help to inform our members, that may not be familiar with the Female Athlete Triad.


    We have so many secondary diseases that cause bone loss, that it’s paramount to be aware of them all so we’ll know if our bone loss is genetic or caused by comorbid disorders.


    Young women today struggle with body image more than ever before and this will help those who are trying to find the right balance to their energy output and input.








Published On: March 09, 2013