Nutrition for Female Athlete Triad

Female Athlete Triad is a serious syndrome that requires a multidisciplinary approach. The Female Athlete Triad is a health concern for active women and girls who are driven to excel in sports. It involves three conditions: disordered eating, (a range of poor nutritional behaviors), amenorrhea (irregular or absent of menstrual periods) and osteoporosis. A female athlete can have one, two, or all three parts of the triad.

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Common signs and symptoms of this syndrome are:


  1. Irregular or absent of menstrual cycles

  2. Always feeling tired and fatigue

  3. Sleeping problem

  4. Stress fractures and frequent or recurrent injuries

  5. Often restricting food intake

  6. Constantly struggling to be thin

  7. Eating less than needed as an effort to improve performance or physical appearance

  8. Cold hands and feet

Anyone may be affected, but women and girls participating in activities which emphasize leanness are at high risk such as:

  • Gymnastics
  • Ballet
  • Diving
  • Figure skating
  • Aerobics
  • Running

Weight class sports associated with disordered eating in athletes, including males, are:

  • Wrestling
  • Rowing
  • Martial arts

Due to pressure to lose weight, women and girls will practice unhealthy weight-control methods, including restricted food intake, self-induced vomiting, consumption of appetite suppressants and diet pills (eg. Xenical, Orlistat), and use of laxatives and compounds to increase urination. Specific eating disorders are known as anorexia nervosa and bulimia.

Due to the imbalance diet and intense exercise, it may lead to decreased in estrogen, the hormone that helps to regulate the menstrual cycle. As a result, their menses may become irregular or stop altogether. However, irregular menses or stop altogether does not automatically mean that a person could have a female athlete triad. It could mean something else thus other conditions such as pregnancy, abnormalities of the reproductive organs or thyroid disease must be ruled out first.

Osteoporosis refers to low bone mass and fragility of the skeleton. Low estrogen levels and other hormonal changes, which accompany irregular or absent menstrual periods, may predispose females to osteoporosis, especially in their teens and twenties when bone mass is accumulating. Adequate nutrition particularly calcium for teenage girls and young women with normal menses is 800-1000mg per day. Females with irregular or absent menses require 1,500 mg of calcium and 400 mg of Vitamin D per day.

The first step for the treatment of the Triad is increasing energy availability, whether via an increase in energy intake or a decrease in exercise energy expenditure or a combination of the two. By increasing energy availability, the aim is to restore the menstrual cycle and increases the Bone Mineral Density (BMD). Menstrual function may be restored by increasing energy availability and an increase in BMD is strongly associated with an increase in body weight and therefore weight gain may be required.


  1. AIS Sports Nutrition
  2. American College of Sports Medicine.