For athletes of all disciplines, there is pressure to be the best, train the hardest, and look like an athlete. For sports such as ballet, gymnastics, swimming, figure skating, and long-distance running, the perception of what an athlete should look like is thin and many athletes face ridicule from teammates, judges, and competitors for being overweight. Some of these athletes will go to great extremes to meet an ideal weight or appearance. And, while some of these tactics or practices may simply be passed off as dedicated training or may not meet the diagnostic criteria for an eating disorder, we should be aware of certain practices. In today’s post, we’re going to discuss female athlete triad syndrome and its warning signs.

Understanding Female Athlete Triad Syndrome

Female athlete triad is a syndrome that manifests in female athletes who train heavily and whose nutritional requirements are not met. The hallmark of the syndrome is the three associated conditions:

  • Amenorrhea,
  • Osteoporosis, and
  • Disordered eating.


Exercise amenorrhea is the abnormal absence of menstruation due to over-training. There are a few reasons that female athletes may skip or stop menstruating and none of them are healthy. When athletes over train and nutritional requirements are not met, the body will begin shutting down organs that are not absolutely necessary for survival. While other organs may be affected, one of the first to be noticed is the female reproductive system, marked by a lack of periods. Extremely low body weight and continuous exercise put the body into “starvation mode,” where resources must be reserved to maintain life.
Another reason that extreme athletes may cease menstruation is the stress of training. While working out, your body is in a high-stress state where hormones and bodily functions respond as though you are in a “fight or flight” situation. For most people who work out, they recover once the workout ends and hormones return to being balanced. For those extreme athletes who engage in workouts or intense exercise for long durations, their bodies do not get the time to recover and the body enters survival mode.


Exercise-induced osteoporosis is directly related to nutritional deficits and amenorrhea. Moderate exercise helps strengthen bones and can help prevent osteoporosis. However, intense, frequent exercise for long durations requires a good nutritional intake and plenty of recovery, especially those high-impact sports like gymnastics or long-distance running. When an athlete is not eating well and is over-training and periods cease, the body’s estrogen levels plummet and the lack of estrogen, calcium, and vitamin D causes the bones to become frail. When continuous training applies impact on the bones, it leads to stress fractures and easy breaks.

Disordered Eating

Disordered eating is a common issue among many athletes, and eating disorders may be missed when they are interpreted as good training or a temporary eating habit for the purpose of enhancing performance. Some disordered eating that athletes engage in may not meet the criteria for an eating disorder, but are unhealthy and can lead to excessive weight loss and female athlete triad syndrome. Some athletes may attempt to reduce fat or calorie intake or may completely restrict entire food groups.

Who is at Risk of Developing Female Athlete Triad Syndrome?

Athletes, especially those who participate in sports where a small frame and low body weight are valued, are at an increased risk for developing female athlete triad syndrome. Things that may increase the risk of developing unhealthy habits like female athlete triad include:

  • Competitive athletes
  • Participation in sports that value low body weight or include regular weigh-ins
  • Athletes who had pre-existing body image issues
  • Athletes who began training as a way to lose weight
  • Athletes who are pushed by parents, coaches, or peers to win at all costs
  • Girls or women who have previously suffered from an eating disorder
  • Athletes who suffer from depression

Warning Signs of Female Athlete Triad Syndrome

It is estimated that nearly 80% of all athletes participate in some form of dieting or controlled eating as a part of their training plan. While dieting or eating differently to help enhance training may not be a concern, there are several things to look out for to help identify female athlete triad syndrome.

  • Weight loss and extremely low body weight
  • Fatigue and inability to concentrate
  • No periods or irregular periods
  • Stress fractures
  • Preoccupation with food and calorie intake vs. expenditure
  • Sensitivity to cold
  • Low heart rate and blood pressure

Some of these warning signs may easily be dismissed by both onlookers and the athlete as normal signs of dedicated training, but in combination or in excess, these signs can indicate a big problem.

Long-Lasting Consequences of Female Athlete Triad Syndrome

Female athlete triad syndrome has long-term, devastating consequences on the bodies of women who suffer from the disorder. Many young women are adolescents when they begin to develop the disorder. When the menstrual cycle is disrupted this young, it can have long-term effects on hormone levels, menstrual cycles, and the ability to reproduce. Early-onset of decreased bone density can result in lifelong brittle bones that do not recover, in addition to stunting growth and limiting height. Low energy levels and an irregularity in calorie usage can result in physical alterations in the hypothalamus and pancreas. Left untreated, female athlete triad syndrome may result in multiple-organ failure. Once caloric intake begins, it helps the recovery by increasing body weight and restoring menses, though the hormonal and bone effects may persist.

One of the most concerning long-term effects of female athlete triad syndrome, especially when it is developed during adolescence is the mental health effect. Many women who suffer from female athlete triad have been pushed to be the best at all costs. This self-competition and development of poor habits at the risk of personal health is hard to overcome. Many girls and women who suffer from eating disorders, extreme competition, and female athlete triad tend to express symptoms of depression. The relationship with food consumption and exertion becomes a life-long obsession.

At Canopy Cove, we treat athletes of all ages and genders who suffer from disordered eating and eating disorders. Our treatment center is located in sunny Tallahassee, Florida and features plenty of wide-open space and activities to allow our athletes to find peace and wellness. We have more than 30 years of experience treating eating disorders of all varieties and offer the physical, medical, emotional, and spiritual support you need to recover from your eating disorder. To begin your treatment, visit us online to learn more and then contact us.



**The research mentioned in this article was not completed by Canopy Cove, but was collected by peer-reviewed sources that can be found here. For more information about female athlete triad, visit these online resources:

The Female Athlete Triad, an article in Sports Health Magazine (2012).

Female Athlete Triad – web source for adolescent health

Female Athlete Triad – information from the American College of Obstetricians and Gynecologists.

The Female Athlete Triad, an article in the American Family Physician periodical from 2000.