Welcome to Stay in the Game, a monthly blog where the team from The Queen's Health Systems share the latest tips on the treatment and prevention of sports injuries. We want to help you play hard and be well - a winning combination that will keep you in the game all season long.

Female Athlete Triad: What is it?

Did you know some female athletes experience low bone density, heart problems and infertility? Dr. Jill Inouye, Primary Care Sports Medicine Physician at The Queen's Center for Sports Medicine, sheds light on Female Athlete Triad, its signs and who is at risk.

Question 1: What is Female Athlete Triad and who is at risk?

Dr. Inouye: Female Athlete Triad is called this because it affects some female athletes in three ways:

1. Low energy levels – Athletes may experience low energy levels by not eating enough to replace the calories they burn or by burning more calories than they consume through over-exercise. This is not always related to disordered eating.

2. Menstrual dysfunction – "Late bloomers" and irregular menstrual cycles may be cause for concern, especially if females have not gotten their periods by the time they are 15 years old, do not get their period three months in a row or have prolonged times (like more than 35 days) between periods for a whole year.

3. Low bone mineral density – The presence of stress fractures in an otherwise healthy individual may be a sign of low bone density.
Female athletes who participate in activities and sports that emphasize appearance and thinness, or place importance on weight classes, are at risk. Common sports and activities that fall into these categories are gymnastics, running, cheerleading, ballet, judo and wrestling.

Question 2: What are some of the signs and resulting complications from Female Athlete Triad?

Dr. Inouye: In addition to low energy levels, irregular or lack of periods and the presence of stress fractures, other physical signs of Female Athlete Triad include weight loss, low BMI, low heart rate and low blood pressure. Disordered eating and exercising behaviors may also be an indication that a person is being affected.

Female Athlete Triad, if left unattended, can lead to low bone density, osteoporosis and bone fractures, as well as electrolyte imbalances, high cholesterol, and even heart problems and infertility or difficulty becoming pregnant.

Question 3: What can be done to help address this?

Dr. Inouye: Education and awareness are key! The more people know about Female Athlete Triad, the more likely people are to recognize its signs and encourage those affected to seek help.

If you are concerned about a female athlete who has experienced stress fractures, is not getting her period or is losing a lot of weight, encourage her to see her doctor for testing. For more information call 808-691-4449 or visit Queen's Center for Sports Medicine.

Request an Appointment



Getting back to training after COVID-19

As government restrictions stemming from COVID-19 are reduced, our ability to exercise is increasing....

Children are NOT little adults

Although they often look like miniature versions of ourselves, children are NOT little adults. Learn...

Diabetes in athletes

Diabetes can appear to be a very debilitating condition for an athlete, but it does not need to be! Learn...

We want to hear from you!

Help us better tailor content for future Stay in the Game features by taking a brief survey.

What is proprioception?

Balance is key to movement, not only in sports but in everyday life. Learn how to improve your balance...

Staph infections in sports

With the start of football and wrestling seasons comes increased risk of skin infections. Learn more...

Just a finger sprain?

I stubbed my finger playing basketball. How do I know if it’s fractured or just a sprain? Learn more...

What is an ACL?

I hurt my knee! How do I know if I tore my ACL? Learn more from Paul Morton, MD, hip and knee reconstruction...

Concussion = Mild Traumatic Brain Injury

That hit to my head was just a small one. I admit I felt a little dazed, maybe a little "foggy." I couldn't...

There's a splint (a.k.a. orthosis) for that!

In occupational therapy, making or fitting joints with splints is a skill that can help protect, support,...