The Female Athlete Triad

The female athlete triad represents the interrelation of three clinical conditions that have been observed in physically active women and female athletes. The three clinical conditions are:

  • Relative Energy Deficiency
  • Secondary Amenorrhea
  • Low Bone Mass.

Chronically low energy intake over time can lead to a player not getting sufficient calories to maintain normal body function and this can be exacerbated in players who load physical training in addition to low energy intake. Over time this may lead to abnormal menstrual function which is termed secondary amenorrhea and is defined as the absence of menses for 90 days or more in women or girls who have been previously menstruating. This dysfunctional menstruation can in turn lead to low bone mineral density which can be attributed to low calcium intake and lower oestrogen level.

Low bone mineral density is problematic for women, especially in later life as they lose bone mineral mass earlier and quicker than men as they age. In sports performance and especially in rugby, a low bone mineral density could leave players susceptible to an increased risk of injury.

The female athlete triad is more of a concern in weight class sports and events like running, where low body mass is an advantage, however, coaches must be aware of it and its implications. Educating players around adequate nutritional intake to support their performance is vital in reducing the likelihood of health issues arising from the female athlete triad.

Figure 6. The Female Athlete Triad