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Female athletes in a huddle.

Female athlete triad is a syndrome that involves an unbalanced relationship between a female athlete's energy available to use for activity, the quality and strength of her bones, and her menstrual cycle. 

Female athletes are at an increased risk of developing the triad due to the high demand that athletics place on the female body physically, as well as the increasing societal pressures for performance and image. For example, a female runner may feel that altering or restricting caloric intake will make her a faster runner, therefore gaining an edge on the competition and earning greater success in her sport.

It can have negative effects in the early stages of its development, and have long-term effects on overall health and well-being as women age. Female athletes are at an increased risk of developing the triad due to the high demand that athletics place on the female body physically as well as the increasing societal pressures for performance and image.

The three measurable factors of female athlete triad are:

  • Energy availability. This is calculated by how much energy you gain from dietary sources, minus the amount of energy expended during activity.
  • Bone mineral density. When your bones are not supplied with necessary nutrients or are stressed because of too much exercise, they may begin to weaken. This can lead to osteopenia (lower than normal BMD) and further, osteoporosis(a loss of bone strength that increases the risk of fractures).
  • Menstrual dysfunction. Abnormal menstrual can range from eumenorrhea (normal menstruation) to oligomenorrhea (inconsistent menstrual cycles) to amenorrhea (absence of a menstrual period) in females who are of a reproductive age.

Symptoms related to the triad may develop over time, ranging from months to years, and may include:

  • Low energy during school, work, or exercise.
  • Irregular or absent menstrual cycles.
  • Stress-related bone injuries (stress reactions or fractures).
  • Difficulty concentrating.
  • An unexplained drop in performance.
  • Changes in eating habits.
  • Altered sleeping patterns.
  • An unusually high focus on performance or image.
  • Experiencing high levels of stress.

Physical therapists can identify signs and symptoms of the female athlete triad and initiate multidisciplinary care, as appropriate and needed. They also understand the implications that the triad may have on exercise prescription. Once an athlete's symptoms are resolved, a physical therapist will design an individualized return to activity program that encourages a safe, progressive level of activity, in order to achieve an optimal performance level.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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