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The Female Triad: Causes, Warning Signs, and Prevention

October 18th, 2021 | 4 min. read

The Female Triad: Causes, Warning Signs, and Prevention
Lauren Hendrix

Lauren Hendrix

Licensed Physical Therapist, PT, DPT // SCS // FAAOMPT // CSCS // RRS

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Every athlete needs to ensure their body is performing well. A lack of appropriate awareness can lead to health complications, overtraining, and reduced performance. For female athletes, this is especially important. If they do not maintain an appropriate energy level, they put themselves at risk for serious health conditions, such as the female triad. 

It is easy for athletes to become distracted with life and not pay attention to how their body is really doing. In the female athlete particularly, this can be severely detrimental to their overall health. At EW Motion Therapy, we work with many female athletes, and we encourage constant self-awareness and evaluation to make sure that your body is operating as it should. Also, athletes should not push themselves beyond their physical limits - there are many healthier ways of improving performance other than pushing yourself too hard. 

In this article, we will discuss the three components of the female triad, the warning signs of each component, and how to prevent them from occurring. With this information, female athletes can understand how important it is to listen to their bodies so they can make the best decisions for their health and stay injury-free. 


Components of the triad 

As the name suggests, there are three components of the female triad: disordered eating, menstrual disturbance, and osteoporosis. These conditions can come about independently, but the combination of the three is unfortunately common in female athletes and can lead to unwarranted injury. 

Disordered eating 

For any athlete, nutrition is a key component of a comprehensive program. The calories you burn during your workouts should be recovered by the food you eat that day. If not, your body does not have the fuel it needs to function, and you may start to break down. 

Disordered eating could be irregular eating patterns, or it could manifest in any known eating disorder. These can include anorexia, bulimia, and eating disorders not otherwise specified. All of these disorders can lead to bone loss and muscle breakdown.

Menstrual disturbances 

A menstrual disturbance is defined as the absence of a menstrual flow. This component of the triad is seen in up to 66% of female athletes, and unfortunately, it often goes undiagnosed for long periods of time. 

Menstrual flows are characteristically irregular for most women, but when female athletes overwork their bodies and do not provide ample recovery, their cycle can stop for months on end. This can disrupt the reproductive cycle and normal hormonal release patterns, and it is never normal. 

Additionally, if you are a young athlete and your menstrual cycle has not yet started for the first time, that can be a serious issue if it goes unnoticed. Combined with poor nutrition and overtraining, this can lead to a cascade of other health issues, such as bone loss and reduced muscle mass.

Let me repeat this: if your menstrual cycle has not come for months, that is not normal. It is a warning sign from your body that something is off. If your cycle has not come for at least two months, please take this seriously, and discuss your symptoms with a healthcare provider. 


A common misconception is that osteoporosis only occurs in the older population. Many female athletes can have early-onset osteoporosis or osteopenia due to a lack of calcium and overall poor eating habits. A diet lacking in calcium and vitamin D can lead to decreased bone density, tissue breakdown, and decreased energy. 

Lower bone density puts you at a risk for fractures and breaks. Additionally, a lack of energy can affect your ability to train and recover, which results in poor performance. 


Warning signs 

Now that I’ve told you about the components of the triad, you may be wondering, “how will my body let me know I have one of these disorders?” It is important to know the warning signs of the female triad so that you can seek professional help as soon as possible. 

All three of these conditions can stem from overtraining and poor nutrition. You may wake up feeling more tired than usual. If you worked out the day before, you may feel increased soreness, and over time you may see an unexplained weight loss. 

Psychological symptoms can be present and may worsen. You may find yourself losing interest in things you used to enjoy, or you may become more irritable. If you have experienced anxiety symptoms previously, those can intensify. These can manifest in panic attacks and unexplainable sad or lonely feelings. 

If you are a female athlete with any of these symptoms, seek professional help. There could be a much larger problem buried underneath the surface. If untreated, it could lead to increased tissue breakdown, decreased performance, greater risk of injury, and a possible decrease in overall mental health. 


How can I make sure I’m performing my best? 

Now that you have this information about the female triad, you can look for warning signs from your own body, and seek professional help when you need it. Addressing these imbalances can help restore your body to its functional normal and maintain your overall health. 

If you are a runner, maintaining this functional normal is extremely important, as your body is the only equipment you use in your sport. If you would like to learn more about how to ensure your health, then check out our EW Run program and how it can help you learn more about your body. 

Watching for warning signs of the female triad is essential to ensuring your body is performing at the level it should. At EW Motion Therapy we use our physical therapy background to train athletes of every sport on how to maintain their health and not push their bodies beyond their capacity. If you are interested in seeing a therapist here at EW for your treatment, fill out the Request an Appointment form on our website, and someone from our staff will contact you within 48 hours with your next steps.