The Female Triad – Don’t let your athletic aspirations be sidelined

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Have you ever trained so hard that you missed your period? Did you think – ‘Awesome! I don’t have to worry about that dreaded monthly disturbance’? Well, don’t get too excited. As much as that menstrual cycle can make you feel bloated, tired, emotional, a little grumpy and well if you’re anything like me when I have my period, the last thing I want to be doing is training – they are a part of our genetic makeup as females. Missed periods can be a sign that something isn’t quite right. This is why one of the first questions I ask my female athletes in clinic is – ‘are you getting regular periods?’

What causes menstrual dysfunction in female athletes?

One of the main causes of athletic amenorrhea (the technical term for loss of regular periods) is low energy availability.

Energy availability is the energy we get from the food we eat (energy in) minus the energy we use up in training (energy out). It is the energy left over, or available, to support normal bodily processes, such as maintaining reproductive function. So, if an athlete is in a state of low energy availability it means that she isn’t getting enough energy in to support both her training and her normal bodily functions. This then typically causes these bodily functions to become impaired. For example, she stops getting her period, in a bid to reduce the amount of energy that is being used up by the body.

What about the training load? Can an increased training load cause menstrual dysfunction?

Not directly. Training itself does not suppress reproductive function as such, however, it can impact on energy cost and therefore energy availability. So, the more an athlete is training (the higher the intensity and the longer the duration) means more and more energy is being used up in training. If the athlete isn’t compensating that energy expenditure by eating enough, then less energy is available to support normal bodily function, putting the athlete at risk of being in low energy availability.  As mentioned above, one of the consequences of being in low energy availability is menstrual dysfunction.

Do you know how much you need to be eating?

It can be easy to assume that when a female athlete presents with low energy availability this is due to restrictive eating habits (excessively restricting calories) or due to disordered eating. And while this may be the case for some athletes, often it is due to athletes not realising what their energy requirements actually are – and they can be pretty high, especially for long course triathletes – and how much they actually need to be eating to meet these requirements.

It is vital for female athletes to understand how important eating the right amount of calories is and how important proper nutrition is for athletic performance and longevity in their sport.

Low energy availability and your bones

Low energy availability, not only leads to menstrual dysfunction, but it also suppresses estrogen and other metabolic hormones that promote bone formation and increase bone loss. Bone loss in amenorrheic female athletes is irreversible and warrants the earliest possible intervention to prevent further loss. The short-term consequence of this is increased fractures (do you really want to be sidelined by fractures just before an A-race?), with the long-term consequence being osteoporosis.

How can I prevent low energy availability, amenorrhea and ultimately bone loss? 

The first step in preventing or treating low energy availability, restoring regular periods and preventing bone loss is eating enough to meet training demands. Food really is fuel, and to ensure adequate energy availability, dietary intake may need to be increased to better meet the demands of training.  Those athletes who are trying to achieve a certain race weight, under the guidance of a Sports Dietitian; race weight can still be achieved, without sacrificing reproductive and skeletal health.

If you are unsure if you are eating enough to meet the demands of the training you are doing, or if you are concerned about any of the above, contact me for an appointment today, to discuss ways to achieve your athletic goals without compromising your nutrition and your health!


AIS Sports Nutrition. ‘Female Triad’. 12/3/14

Burke, L and Deakin, V. ‘Clinical Sports Nutrition’. Fourth Edition. © 2010. McGraw-Hill Australia Pty Ltd.

Brukner, P and Khan, K. ‘Clinical Sports Medicine’, third edition. © 2007 McGraw-Hill Australia Pty Ltd.

Javed, A et al. ‘Female athlete triad and its components: toward improved screening and management’. Mayo Clinic Proceeds. 2013 Sep;88(9):996-1009. doi: 10.1016/j.mayocp.2013.07.001.

Mallinson, R et al. ‘A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration’. Journal of the International Society of Sports Nutrition 2013, 10:34

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