The Female Triad

What is the Female Triad?

Not supplying the body with enough overall calories for

daily activities, especially if combined with exercise,

creates a negative “energy drain.” In women this

condition is known as the female athlete triad. The

female athlete triad has three components:

1. low energy availability,

2. menstrual irregularities, and

3. low bone mass.

Athletes suffering from the triad may experience

problems in any one of these three areas, but all are

related to not taking in enough calories.

What is low energy availability?

“Low energy availability” is the term used to describe

a lack of energy resulting from consuming inadequate

calories or by using up more energy than is available

during exercise.Of course, this can happen to anyone—for example,

an active individual may be eating normally for a non-

active person but unknowingly not eating enough

calories to meet his or her energy needs.

However, when it occurs, and if it persists, low energy

availability can reduce immune function, decrease

energy levels, and stunt growth. In addition, in active

women, reproductive function and bone formation begin

to be suppressed when energy availability is reduced by

more than 30 percent.

Low energy availability can also negatively impact a

person’s metabolism, eventually slowing the metabolic

rate, and even increase the breakdown of lean body

tissue (including muscle).

What is menstrual irrregularities

The absence of a menstrual period is divided into two

categories: primary and secondary amenorrhea. Primary

amenorrhea occurs when a female has not started

menstruating by age 15 and secondary amenorrhea

refers to a woman’s menstruation stopping for more than

three months consecutively.

Despite popular misconceptions, research indicates

that the intensity of exercise actually has no effect

on menstruation. In active women, without any other

hormonal imbalance or medical diagnosis, amenorrhea

occurs because the body does not have enough energy

left to sustain reproductive function.

For a healthy young female, it is unsafe to stop

menstruating. Even if an athlete misses her period

occasionally during times of high volume or intense

training, there is still cause for concern. Any athlete

or active female who is experiencing menstrual

irregularities or who has not begun menstruating by age

15 should see a qualified health professional familiar with

the female triad.

What is low bone mass

Active individuals and athletes generally have higher

bone mass than those who are inactive. Low energy

availability suppresses estrogen and other metabolic

hormones. This results in an increased rate of bone

breakdown and prevents bone formation. Low bone mass

is the third symptom of the triad.The consequences of untreated

menstrual disturbances and low energy availability on

bone health are an increased risk of osteopenia (bone

mineral density lower than normal) and potentially

osteoporosis (a disease of the bone that leads to

increased fractures) later in life.

In addition, low bone mineral density will put athletes

at a much higher risk of developing stress fractures. Any

factor that increases load, decreases bone strength, or

interferes with the repair process of the bone potentially

increases the risk of bone stress fractures.