Reducing Risk in Sports: The female triad – who is at risk?

Reducing Risk in Sports: The female triad – who is at risk?


Reducing Risk in Sports: The female triad – who is at risk?


USA TODAY High School Sports and the National Athletic Trainers’ Association have partnered on a monthly column to address injuries, prevention and related issues to help schools, coaches and student-athletes. Here is the latest column from Scott Sailor, the president of NATA.

Generally, athletes strive to perform at their optimal best both physically and mentally to achieve success in their sport. Sometimes achieving that goal can take a toll on the body and particularly for female athletes who may be at risk of or have a condition called the Female Triad. The Triad involves three (triad) factors that include

  1. Low bone mineral density (thin or weak bones)
  2. Disordered eating (not consuming enough calories to sustain the energy needed to perform at practice or competition); and
  3. Menstrual dysfunction (when a female has fewer than nine periods a year).

There are many reasons and possible medical conditions why someone has missed her period – this does not automatically mean she has the Female Triad but it is a consideration.

There are many reasons why female athletes may be at risk:

  • Body image issues: Due to peer pressure and a desire to “be the best” at all costs, along with pressure from parents and/or coaches.
  • Low energy availability (using more calories than what is taking in): Restricting calories will strongly affect an athlete’s health, fatigue level and athletic performance.
  • Inappropriate weight loss: Most girls with the Female Triad try to lose weight because they think it will improve their athletic performance. This is a myth. Attempting to lose weight may lead to a decrease in muscle strength, low energy availability and potentially eating disorders (a lifelong health issue). These are all factors that will decrease athletic performance.

Symptoms of the Female Triad can include:

  • Weight loss
  • Irregular periods or absence of a period
  • Fatigue and decreased ability to concentrate
  • Depression
  • Increased number of injuries (i.e. fractures of the weight bearing bones)
  • Decreased athletic performance

If you are experiencing any of these symptoms, confide in your athletic trainer, others on your sports medicine team or your primary care provider who may refer you to a specialist in this area. It takes a team to help with the emotional and physical effects of the Female Triad. Professionals who should be included are:

  • Physician: will perform an extensive physical exam including a medical history and lab work. You will be asked questions about why you may be losing weight or missing your period, as well as other related issues.
  • Registered dietitian: Will help you reach and maintain a healthy weight while consuming adequate calories and nutrients for your health and athletic performance.
  • Psychologist: can help you deal with depression, pressure from coaches or family members or low self-esteem, and can help you find ways to deal with problems other than by restricting food intake or exercising excessively.
  • Athletic Trainer: Once you have a diagnosis, your school’s athletic trainer will play an important role in supervising treatment to help prevent and control symptoms.

Here are some important tips regarding the Female Triad:

  • Keep track of your periods; know what a normal period is for you.
  • Pack and eat “travel foods” such as bananas, muffins and bagels, in-between classes, meals and practices to avoid going without food during the day.
  • Talk to friends, parents or those who are close to you if you are feeling pressure to compete or to lose weight.
  • Participate in a sport because you want to compete, not because of pressure to compete.

With proper nutrition and monitoring of activity levels, the Female Triad may be prevented. If a friend, sister, or teammate has signs and symptoms of the Triad, discuss your concerns with her and encourage her to seek treatment. If she refuses, mention your concern to the athletic trainer, school nurse or coach. For additional sports safety tips for athletes and parents, visit


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