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Everything You Should Know About the Female Triad

When you see a teen girl playing sports and paying attention to what she eats, you may well admire her dedication to her fitness and overall health. But, you may only be seeing the surface of what could be a problem. 

The female athlete triad is a collection of disorders that can be detrimental to a young woman’s health. No one knows the exact prevalence of the problem, but experts do agree that it goes undetected often. 

At Downtown Pain Management Dr. Ron Ben-Meir wants to help student-athletes practice their sports safely. Our staff is trained to recognize the signs of the female athlete triad, which is a serious problem. In this post, we describe the three conditions that make up the triad, and what you should look for if you have a female athlete in your life. 

Three factors

Disordered eating, amenorrhea, and osteoporosis are the three conditions that make up the female athlete triad. The three are closely related, because poor nutrition and low body weight, especially combined with intense training can disrupt a girl’s menstrual cycle. Osteoporosis is the loss of bone mineral density, which may also be related to poor nutrition and low body weight. 

Disordered Eating

Disordered eating takes many different forms but usually is focused on losing weight or maintaining a thin body. A person doesn’t have to meet the clinical criteria for anorexia nervosa or bulimia nervosa in order to have the female athlete triad. Instead, they may just have similar disordered behaviors. 

When a person has anorexia, they may have an intense fear of gaining weight and may restrict what they eat in order to prevent weight gain. Another type of anorexia is the binge/purge type, which is when the person overeats then either vomits or uses laxatives to purge. 

In bulimia, people experience episodes characterized by eating much more than you would expect a person of the same size, age, and gender to eat in a specified period of time and they feel like they don’t have control over their eating during that time. Binge eating is followed by purging, which could be vomiting, misuse of laxatives, diuretics, enemas, or other medications, or they may fast or exercise excessively. 


Weight fluctuations and extreme training can affect the amount of estrogen in a woman’s body. If by the age of 14 a girl has not begun to develop secondary sexual characteristics, such as breasts and rounded hips, or if she has not begun menstruating by the age of 16, she has primary amenorrhea. If her period has stopped for six consecutive months, it’s considered secondary amenorrhea. 


Bone loss is dangerous, as it can cause an increased risk of fracture. Lost bone may not be replaceable, and athletes with fragile bones may break their hips or vertebrae -- serious injuries. 

In addition, osteoporosis at a young age can have an enormous impact on future health. Ideally, young women are developing their highest levels of bone mass during this time. Disordered eating can also lead to a lack of calcium intake, which is another problem for developing bones. 

Recognizing the triad

If you notice your athlete displaying behaviors that appear to indicate disordered eating, or she insists on significant extra exercise, you may want to consider having her evaluated. Often correcting the female athlete triad involves a concerted effort between parents, coaches, and healthcare providers. 

If you have questions about the female athlete triad, schedule an appointment at Downtown Pain Management. We’re happy to discuss your specific situation. 

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