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Female Athlete Triad – by Rita Jairath

The female Athlete triad syndrome is a combination of three conditions that are connected with over-exercising in athletic training - Amenorrhea, Osteoporosis and Disordered Eating. This article reveals what they are and how they can be tackled.

Female Athlete Triad – by Rita Jairath

It has always been challenging for women to maintain their health and well-being. Being in sports and athletics must actually, get you into being super-strong, agile and invincibly energetic.Participation in exercise can be highly beneficial and being in sports is something that can boost the self-esteem and confidence, instilling leadership qualities and a pro-active approach.

However, there is a paradox. Female athletes, who take their sporting endeavour to an extreme, may be subject to worsening health consequences.

Competitive sport has its own challenges. There may be girls who are naturally gifted to perform certain activities and may take on to it. As they get applauded and win laurels, expectations rise and when performing at higher strata, the pressure may increase. At that point of time, they may try to go beyond what comes naturally to them. Taking athleticism to the extreme can make her engage in counterproductive behaviours like restricting calorific intake, over exercising, and overdoing things beyond exhaustion out of despair if they are not able to achieve the milestones that they have set for themselves. This can be potentially damaging to the body.

The female Athlete triad syndrome is a combination of three conditions that are connected with over-exercising in athletic training.

  1. Amenorrhea (abnormal absence of menstruation)
  2. Osteoporosis (disease in which bones become fragile and are more likely to fracture)
  3. Disordered Eating


The most common cause of athlete amenorrhea is Functional hypothalamic Amenorrhea FHA. The hypothalamus is a regulatory centre in the brain that releases hormones, which control multiple bodily systems including the reproductive system.

In FHA, the hypothalamus is silenced from releasing hormones that ultimately allow for ovulation and normal menstrual cycle. FHA is caused by low energy intake, over exercise, weight loss stress, or a combination of these. Since there could also be other causes of amenorrhea, it is advisable to see a knowledgeable physician before being very sure of the diagnosis.

Osteoporosis in Athletes

It is associated with age of the onset of training, intensity and the volume of training, diet and stress- both physical and psychological stress if at all, it has been caused due to extreme athletic endeavours. If it has been caused by genetic tendency, medication factor or other risk factors, then the entire approach towards treatment will have to be different.

Bone loss is mainly seen in the trabecular bone in the vertebrae (back bone) and in the neck of the femur. (In the hip)

Bones require the recommended daily dosage of calcium, vitamin D as well as weight bearing exercises. The stress loading can increase bone mineral density but over-intensive aerobic exercise can affect the hypothalamic-pituitary gonadal axis, which lowers the oestrogen in females. Even over-trained males may have lower levels of testosterone and develop osteoporosis and stress fractures. Therefore bones require normal level of sex hormones too, besides adequate calories, particularly from proteins.

Heavy physical activity must be accompanied by adequate rest, recovery period and optimum nutrition.

Disordered Eating

Female athletes who are engaged in sports that require a very thin body especially those related to visual arts, like ballet, figure skating, gymnastics as well as events like long distance running, tend to get entangled in a psychological web, perceiving themselves to be much bigger than they actually are. Such sports stress on very low body weight and young girls tend to relate any difficulty in their success to being overweight. This causes them to engage in a range of harmful eating behaviours including restricting overall food intake, cutting out complete food-groups, binging, purging and fasting. It is not necessary that an athlete will always have the classic symptoms of anorexia or bulimia nervosa. Disordered eating habits may manifest themselves in various ways, and this will be a part of the female athlete triad syndrome.

Those sports in which there is over-emphasis on weights, be it gymnastics or even bodybuilding where weigh-ins are involved can lead to pathogenic behaviour in girls to control weight. This can lead to lifelong health issues.

Symptoms of Female Athlete Triad

Parents, coaches and mentors can have a major influence on any athlete. Therefore it is very important to be informed about the female Athlete Triad, especially if you are involved with one. Being able to recognise these symptoms is crucial for early treatment and for the prevention of fatal consequences.

If you suspect the Female Athlete Triad, it is important that appropriate treatment is sought to prevent worsening of the symptoms and to ensure that healing takes place.

The symptoms are as follows:

  • Pre-occupation with food and weight
  • Feeling fatigued and lethargic all the time
  • Restricting food intake
  • Weight loss
  • Irregular or absent menstrual cycles
  • Frequent injuries, such as muscle strains or stress fracture
  • Sensitivity to cold
  • Difficulty in sleeping, Insomnia

The treatment would need a multipronged approach, with help from a physician, dietician and a mental health care provider.

Various Modalities of Treatment

The athlete may need to take a temporary break from her sport, to allow time for healing and recovery. Overexercising and training may cause CNS fatigue, lowering the efficiency and cause emotional and psychological setbacks.

This time helps to recuperate from the damage and the break will certainly have a positive impact. It gives time to introspect as well as heal and emerge stronger.

A lot depends on the parents to reinforce and instil positively in the athlete. During this period they can consult a nutritionist and a counsellor.

Pharmacologic involvement and medical management can be done by a physician. Appropriate interventions can prevent irreversible bone loss and resume normal menstruation.

It can also prevent a fatality from eating disorders and not allow to get the situation out of hands.

It is, therefore, extremely important for parents, coaches and mentors be aware of the Female Athlete Triad and the associated risks and symptoms.

In today’s world, women have a lot of opportunities to participate and compete in various sporting events.

They are being encouraged and the gender balance and equity is being considered a major way to bring about harmony in the society.

At the same time, women face many physical, emotional and mental challenges in their athletic journey.

Increased awareness can lead to the prevention of damaging consequences and promote a healthy relationship with exercise and sports.

It is also very important to educate parents, coaches, athletes, athletic trainers etc. and increase awareness about the Female Athlete Triad as well as be sensitive about it, to recognise and prevent the occurrence of this life threatening illness.

At the same time, we need the society as a whole to understand and appreciate that in this entire process, one must never subconsciously develop a gender bias towards female athletes. This alone will bring harmony in society, as every facet of it needs to be acknowledged and respected.

About The Author

Dr. Rita Jairath

Rita Jairath is an entrepreneur and one of the pioneering athletes in women's bodybuilding in India, she won the pro-card from the International Federation of Bodybuilding. she .. Read More..


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