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  • Michelle Howell

In the Know: The Female Athlete Triad

Low energy, irregular periods, a tendency toward stress reactions

These are all just a few of the characteristics that can present themselves in female athletes, linked to a condition you've probably never heard much about.

I'd never heard the term either until my senior year of high school. I was nose deep in one of my now favorite running-centric books, Fast Track by Suzy Favor Hamilton, during Chemistry (I probably should have been learning about anions and cations or something or other). I was at my lowest weight- 116 or so lbs clinging to my then 5'7" frame. Eating an entirely bland, calculated diet of mostly salad and whatever gluten-free concoction my mom lovingly made for dinner after being diagnosed with an intolerance earlier that year. I was tracking everything to a T- my food, my running, my weight, even the times of all the other girls running my event that year. Most importantly to me, though was that I was running faster then I ever had before.

It didn't last. The following year I'd be plagued by injury, become obsessive about my diet, and a year after that get diagnosed with iron deficiency anemia amidst other issues. Two years removed from sitting in that chemistry class is when I'd begin to realize how prevalent the female athlete triad is in running world and how unknowingly I'd found myself in the thick of it.

The female athlete triad is a term every female athlete should know, yet one that often gets left out of general health class and discussion. It's something now as a coach of primarily young girls I emphasis awareness of.

The triad consists of three medical conditions or rather factors- disordered eating, amenorrhea, and osteoporosis. All of which are intertwined with the potential for one factor to contribute to another. It's most common to occur in sports that encourage competitors to be lean, like running.

Disordered Eating

Like any other athlete who takes their sport seriously, I attempt to adhere to a lifestyle that allows me to be able to compete to the best of my abilities which quite frankly means knowing what's on my plate and how it's going to affect me.

Running's relationship to eating is a tight rope walk. There's an inextricable tie between what we consume and how we perform. From this, there comes in to play the potential for disordered eating to arise.

The National Eating Disorders Collaboration defines disordered eating as:

Disordered eating is a disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating or skipping meals

It can include:

behaviors that reflect many but not all of the symptoms of feeding and eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder or other specified feeding and eating disorders (OSFED)

More and more often girls and women within our sport are coming forward and sharing their stories of disordered eating within the running community. Not all stories or experiences are the same, but it's important to be aware of some of the signs of disordered eating.


Irregularity of periods for teenage girls during their first year of menstruation is a common phenomenon for girls participating in sports. It's also common enough to lose your period during involvement in high-intensity sports. On paper not having to deal with a cycle doesn't sound too bad right? However, there are more downs than ups to having lost your cycle for an extended period of time and could signal to bigger health issues at hand.

The absence of menstruation, amenorrhea, is medically diagnosed after the loss of three consecutive cycles. It can be linked to nutritional deficits, like those brought on by disordered or restrictive eating. It can cause lower estrogen levels which are correlated to low bone density resulting in weakened bones, increased risk of stress-related injuries, and increased likelihood of osteoporosis.


Osteoporosis is the pinnacle of the triad. Unlike other conditions, it can't be cured with a nutritional or lifestyle fix once it's acquired. It occurs when the quality and density of individuals bones are decreased. The literal translation from Greek meaning "porous", not a word you want to be associated with the foundation of your body. The condition is caused by low estrogen and notably low calcium intake. As mentioned above it is linked as well to amenorrhea due to the connection to estrogen which acts not only as a sex hormone in the human body but dictates the activity of osteoblasts (the cells responsible for producing bone) and osteoclasts (the cells that break down bone).

If you haven't realized it yet, the factors within the triad are all heavily linked, especially in regards to nutrition. If you take anything away from reading this it should be that proper nutrition is paramount to an athlete's health- long term and short term, on and off the track. There's no quick fix to resolving this phenomenon. Creating awareness of the triad starts with passionate individuals like yourself who continue to educate themselves on the topic and encourage others to do the same.