Health-Related Disorders and the Female Athlete: Part II: Problems Caused by Extreme Exercise and Dieting

Health-Related Disorders and the Female Athlete:  Part II: Problems Caused by Extreme Exercise and Dieting

Exercise andFemale Athlete Triad3 sports participation are a part of a balanced, healthy lifestyle and therefore should be promoted in women of all ages due to the health benefits and enjoyment. However, for some women, not balancing the needs of their bodies and their sports can have major consequences. That is why special medical concerns should be considered when training or caring for female athletes.  

Female athletes are expected to be lean, fit, and competitive in their sport. Moreover, they have the pressures of today’s society which places emphasis on body image. For these reasons, some athletes will use extreme measures to reshape their bodies. In order to become lean, female athletes are more likely to diet or restrict various food groups. Unfortunately, the dieting techniques or eating practices are usually unhealthy and often lead to disordered eating patterns.


What is the Female Athlete Triad?

Constant dieting and/or restriction of caloric (energy) intake can have negative effects on nutritional status, repair of muscle tissue, and bone health. Female athletes often develop a medical condition known as the Female Athlete Triad which is a combination of three factors:

1.  Low Energy Availability (Disordered Eating)

2.  Irregular or Absent Menstrual Periods (Amenorrhea)

3.  Low Bone Mass (Premature Osteoporosis)

Estrogen is necessary for the building of bone, but can be unavailFemale Athlete Triad2able due to amenorrhea (absence of menstrual periods). Amenorrhea was discussed in part one of this two-part series. Amenorrhea develops due to the effects of dieting (insufficient energy intake), weight loss (low body fat), and extreme exercise (high energy expenditure). These factors cause the ovaries to stop producing estrogen and the woman to stop menstruating (amenorrhea).

Osteoporosis is a disease caused by premature bone loss or inadequate bone formation. Women build bone until approximately age 34. Bone loss starts to develop at a rate of ~0.5% a year after age 35. In young female athletes, premature bone loss is mostly caused by the decreased estrogen levels associated with amenorrhea combined with decreased calcium intake caused by disordered eating patterns.  

An amenorrheic athlete can lose five percent of her bone mass in one year. As the bone mass decreases, the risk for fractures, especially stress fractures, increases. Even with the return of more normal estrogen levels, and calcium supplementation, some of the bone loss may be irreversible. This is very problematic for the young female athletes who should be forming bone during this timeframe. Irreversible bone loss is one of the most serious complications of the triad.

Treating the Female Athlete Triad

The primary treatment of the female athlete triad is to decrease exercise intensity and start dietary modifications. After the diagnosis is established by a health care professional, the athlete is usually referred to a registered dietitian for nutritional instruction. The dietitian is used to educate and monitor the athlete for adequate nutrition and to assist her in achieving and maintaining a healthy “goal” weight. 

The athlete, physician, and dietician should agree on a goal weight, with consideration for the weight requirements for participation in the athlete’s chosen sport. Some women may be prescribed medications (hormones) to supply their bodies with the estrogen needed to prevent further bone loss. Recovering from this condition often requires a multidisciplinary approach that includes a physician, nutritionist, a counselor, as well as the athlete’s coach and family.

 The Female AthletFemale Athlete Triad4e Triad is a serious medical condition that can result in long-term health consequences. If you are a female athlete who has been experiencing infrequent menstrual cycles or recurrent stress fractures, don’t ignore these symptoms. Seek medical attention.  A visit to a physician for a complete history and physical, blood work and perhaps bone density testing may prevent long-term health problems.



Torstveit, M. & Sungot-Borgen, J. (2005). The Female Athlete Triad exists in both elite and controls. Medicine & Science in Sports & Exercise. 37(9), 1449-1459.

Weltman, A., Snead, D., & Weltman, J. (1992). Effects of calcium supplementation on bone mineral density in premenopausal women runners. Medicine & Science in Sports & Exercise, 4, S12.



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