June 2015

The Female Athlete Triad
In 1972, Title IX, the federal law that mandates equal opportunities for both males and females was passed allowing more females to participate in organized athletics due to equal funding.  As a result, participation in female high school and collegiate athletics has grown by over 40% since 1972.  Unfortunately it took some time before athletes, parents, coaches, and doctors learned of the possible negative interaction between excessive exercise and the female body. 
One issue that has come to the forefront is the female athlete triad.  The female athlete triad is a condition of disordered eating/low energy availability, menstrual dysfunction, and low bone mineral density/osteoporosis.   Some studies estimate over 60% of females who train and compete regularly demonstrate signs of disordered eating and amenorrhea (lack of menstruation).  The high prevalance of disordered eating and amenorrhea is important to note since it is these factors that lead to bone mineral density.  Outlined below are the signs and symptoms of the female athlete triad which will allow early detection and early intervention.
Risk factors:

• Low caloric intake

• High volume of exercise/training

• Clinical eating disorders

• Early start to athletic training and competition

• Sports which require body-contour/revealing clothing for competition

Primary causes:

• Low energy intake/energy imbalance

• Inadequate daily caloric intake

• High energy expenditure

• Eating disorder: anorexia nervosa, bulimia nervosa

Secondary signs/symptoms:

 Primary amenorrhea: delay in the initial onset of menstruation (15 years old)

• Secondary amenorrhea: absence of menstrual cycles lasing more than 90 days after initial onset of menstruation

Tertiary responses:

• Reduced bone mineral density/osteoporosis

• Results from a loss of normal bone mass or a reduction in bone mass production

Health consequences of the Female Athlete Triad:

• Eating disorders of anorexia nervosa/bulimia nervosa are associated with psychological disorders

• Amenorrhea - infertility, altered cholesterol profiles, permanent loss of bone mineral density, increased rate of stress fractures


• Multi-disciplinary team approach:

• Physician: assess menstrual function and bone mineral density

• Nutritionist: ensure adequate caloric intake/reduce nutritional deficiencies

• Psychologist: assessment and treatment of behavioral eating disorder, if present


American College of Sports Medicine position stand on the female athlete triad.  Medicine Science Sports and Exercise, 2007. 
Active Performance Chiropractic focuses on the diagnosis, treatment, and rehabilitation of athletic-related injuries.  Treatment is a unique blend of Active Release Techniques, traditional chiropractic therapy, and physical rehabilitation designed to match each patient's goals and lifestyle.