The Female Athlete Triad

A couple of weeks ago, I put on a free seminar discussing sports nutrition for female athletes. During this talk, I offered in-depth detail about the female athlete triad. I am extremely passionate about this topic, as I strongly believe it is something that all female athletes, as well as everyone who works with female athletes, should be aware of.

The female athlete triad is composed of three serious health problems that are linked together. The three interrelated conditions are:

1. Energy deficiency: Inadequate calorie intake to support calorie output
2. Weak bones: Reduced bone mineral density
3. Menstrual dysfunction: Amenorrhea (no period) or irregular periods

Under-fuelling, not taking in enough energy to make up for the calories expended through everyday life and exercise, leads to any energy deficiency. Having an energy deficit that is too large means that there isn’t enough energy left over for other normal body functions like having a period or building healthy bones. As a result, females can start missing their period and develop weak bones leading to an increased risk of stress fractures or reactions.

Menstrual dysfunction is a serious issue that should not be overlooked. Menstrual dysfunction is not a normal response to training but rather a clear indication that health is being compromised. Way too often, I have heard people say, “It’s normal for female athletes to not get their period.” This is not true. If you have irregular or missed periods you should see your healthcare provider as there are health consequences that come from not menstruating.

Amenorrhea or missed periods can be either primary or secondary. Primary amenorrhea is a lack of a period by 15 years of age. Secondary amenorrhea is when someone has begun getting their period but then misses their period for more than 3 months. There are other menstrual dysfunctions as well, such as oligomenorrhea, which is irregular periods. Birth control pills can cause artificial bleeding. What this means is that someone on birth control can have amenorrhea but not know it because their birth control pill will still cause them to artificially get their period each month. The only way to know if they are getting amenorrhea would be to stop taking birth control and see if they get their period.

Of course, periods are needed for fertility, but having a family is not the only reason that they’re important. Another important function of menstruation is bone health. When periods are missed or less frequent, the body produces less estrogen. Estrogen is a hormone that is critical for building strong bones. Because of the reduced estrogen, those with irregular or missed periods are at an increased risk for getting stress fractures or osteoporosis.

Eating too few calories probably means that you regularly feel irritable, have difficulty concentrating and feel more tired. You may find that you are less motivated to do things. Athletes often find that their performance suffers and they are more likely to get injured.

For those with menstrual dysfunction, the first step is seeing their health care professional to determine the cause. If it is determined that the menstrual dysfunction is caused by an energy deficiency, there are two things they can do to restore energy balance:

1. Increase the  number of calories eaten
2. Decrease the amount of calories expended

Many female athletes are simply not aware of how much food they need to eat to support their training. Athletes should be eating like children, aiming to eat every 3-4 hours. This means three meals a day and at least two snacks. Listen to your body. If you’re hungry, then your body is requesting fuel. You should honour this hunger and eat.

Make sure that you’re including all food groups in your diet. Unfortunately, fad diets promoted through the internet, social media and magazines recommend removing certain foods such as grains, milks etc. This is not a good idea. All food groups are needed to provide important nutrients that are important for health and sports performance. 

If you find yourself becoming preoccupied with weight, then I would encourage you to throw away the scale. We all come in unique shapes and sizes. Fuel your body properly and let it find its natural genetic weight rather than trying to achieve a specific number on the scale. Don’t compare yourself to others. Again, we all come in unique shapes and sizes.

The female athlete triad is a serious health concern that should not be overlooked. You do not need to have all three components of the triad to be at an increased risk for health problems. Having just one component is enough. If you find yourself becoming overly preoccupied with your weight, have lost a noticeable amount of weight, have reoccurring stress reactions or fractures, have menstrual disturbances and/or have excessive or compulsive exercise habits, then please see a health care professional.

If you would like more information on the female athlete triad please go to: http://www.femaleathletetriad.org/for-professionals/what-is-the-triad/. If you are experiencing menstrual disturbances caused by an energy deficiency, I would love to work with you to restore energy balance. Please contact me at: megankuikmanRD@gmail.com or phone me at: 519-802-9445.