Menstruation and the Female Athlete Traid

The effects of disordered eating and eating disorders can be extremely harmful - not only to an athlete’s performance, but to her physical and emotional well-being. While female athletes may be able to sustain their performance during the early stages of disordered eating, lack of adequate energy to train and compete will eventually limit their performance and adversely affect their health.

The Female Athlete Triad is a condition that affects girls and women in a wide range of sports. The Triad is among the most serious health concerns facing girls and women in sport. It includes disordered eating, amenorrhea, and osteoporosis.

Disordered Eating

Disordered eating often begins as a preoccupation with losing and gaining weight or muscle, or an intense fear of becoming fat. It is considered disordered eating when this fear or concern leads to abnormal eating and exercise patterns. These patterns can include bingeing (eating large amounts of food), purging (ridding the body of food), fasting, and/or the use of diet pills, diuretics, laxatives or excessive exercise.

Under the range of disordered eating are body image disorders such as muscle dysmorphia (aka: reverse anorexia). At the extreme end of disordered eating are eating disorders, such as anorexia nervosa (starvation), bulimia nervosa (bingeing and purging), and binge eating disorder (compulsively eating).


When a female athlete over-trains, does not eat properly or does not have enough body fat, she may lose her ability to menstruate. Amenorrhea is when a female athlete misses her period for at least three months or hasn’t had a menstrual period by age sixteen.

Amenorrhea can also be caused by other factors like stress, and does not necessarily mean that an athlete is experiencing disordered eating.


To make strong bones, the body produces a bone substance called bone matrix. The body needs food and energy to build bone matrix. Calcium makes the bone matrix rock hard. The role of estrogen is to get the dietary calcium to the bone where it can be used. When a female athlete loses her period, it indicates that the body does not have enough food energy for this important function. Therefore the body is unable to absorb dietary calcium. If the body does not have enough energy for menstrual periods, it will not have enough energy to build bone matrix. The result is osteoporosis, which is a weakening of the bones that makes athletes prone to fractures. When an athlete has osteoporosis, such fractures can even occur during lower impact activities like walking.

Signs and Symptoms 

  • Stress fractures
  • Loss of menstrual period
  • Low weight and low body fat
  • Low endurance and energy
  • Fatigue
  • Cold intolerance
  • Intestinal difficulties

If a female athlete has symptoms of the triad, involve a medical professional immediately. Ensure that they are informed about the Female Athlete Triad and will help build a team around the athlete (coaches, parents, physicians, registered dieticians, mental health professionals) to support the recovery process.

Information on this page has been adapted from the following sources:

Goss, J.D. & Langley, S. (2001) Detecting the Female Athlete Triad: The Coaches Role. Coaches Report, Vol 7(3), Coaching Association of Canada: Ottawa, ON

Otis ,Carol L.., & Godengay, Roger. (2000) The Athletic Woman’s Survival Guide: How to win the battle against eating disorders – amenorrhea – osteoporosis. Champaign, IL: Human Kinetic