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What is Female Athlete Triad Syndrome?

By , SparkPeople Blogger
I first heard about Female Athlete Triad Syndrome a few months ago from one of the female running coaches at my gym. However, after doing my own research, I discovered this syndrome has been an issue for quite some time. I was surprised to read that the women suffering from this condition are quite athletic in nature and truly embrace their sport, many times to the point of obsession. While appearing to be the picture of health, these young women often lead a secret life of calorie restriction and over-exercising. In doing so, they believe this will give them an added edge to be the best of the best in their chosen sport.

So what exactly is Female Athlete Triad Syndrome? It is a disorder involving three conditions as a consequence of calorie restriction and over-exercising.
  • Eating disorders such as anorexia and/or bulimia or severe to moderate calorie restriction
  • Lack of menstruation (AKA secondary amenorrhea) due to low estrogen production
  • Osteoporosis (thinning of the bones)

Research shows that 12-15% of elite athletes suffer from this condition; however, it is not unheard of in the general population, where it may affect as many as 5% of the normal active female population.

As with others suffering from eating disorders, low self-esteem and the need to be the best in their sport is what drives many of these young women to an unhealthy means of controlling their weight. And this condition is becoming more prevalent in young teens, especially those participating in competitive sports such as gymnastics, soccer, ice skating, and dance.

So who is at risk for the development of Female Athlete Triad Syndrome?
  • As mentioned earlier, any girl or woman who competes competitively in sports or dance
  • Young women who participate in sports where checking one’s weight is a factor (ie rowing and martial arts)
  • Young women who have overly ambitious parents/coaches who put too much emphasis on winning
  • Those who spend more time participating in their sport than they do with friends or participating in other social activities

What are the signs and symptoms?
  • Fatigue and a general lack of energy to perform even simple tasks
  • Weight loss
  • Lack of menstruation or irregular menstruation
  • Stress fractures even if there is no known history of injury
  • Anemia due to lack of proper food intake
  • And symptoms related to other eating disorders such as cold intolerance, eroded tooth enamel, and the need to eat alone

If this syndrome is not detected early enough, many of these young ladies could experience such complications as decreased serum estrogen levels, irreversible bone loss, and yes, even development of increased cardiac risk factors.

This syndrome, like any other eating disorder, should be approached with extreme care and immediacy. Getting help for these women and girls is essential to their success and requires an intervention by a doctor, behavior therapist, dietitian or all of the above.

Do you believe society puts too much emphasis on young women to be the best in their chosen sport, therefore causing them to be driven to such drastic measures? What about the pressure from parents and coaches? Have you ever suffered from this syndrome, or do you know of anyone who has or is currently suffering from this syndrome?

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YMWONG22 7/21/2020
Thank you for sharing. Report
Not all people who menstruate are women, (and not all women menstruate). Report
This describes me ~ 30 years ago when I was 18. I don't believe there was a name for the syndrome at that time. My physician's solution was to prescribe birth control. It worked in that it made me gain weight and start menstruating again. At that time in my life, I had to be perfect in everything I did. Luckily, I haven't been as obsessive in the intervening years. It helps that I recognized in my personality a tendency towards obsession and perfection. Now, I'm a little easier on myself. Report
Wow this is such a great thread, I have learned so much & can def. relate to a lot of these posts. I changed my eating habits completely & began exercising for the first time ever in my life about 2 1/2 years ago when I realized I was the heaviest I had ever been. I have always been pretty thin, not supper skinny but curvy however when I reached 136lbs I felt & looked horrible so I began running & eating healthy natural food & the wt fell right off, now here I am 16lbs lighter & have not had a period in 2 years! I must admit I can be extremely competitive & extreme about things & think I took my eating habits & exercising a little to far especially when I reached my lowest wt of 114lbs. Today I am not as obsessed about eating(eat more fats & sugar) however I do still exercise 5 days a week(cycle 3 days & run the other 2) but I still have not gotten my period!!! Been to the doc, he says I'm healthy & not to worry about it unless I begin having pains in my lower abd area & that it's prob b/c I 'm underweight for my height & have low body fat %. Report
Thanks for the information. I really was not aware. If you have a moment come visit for women’s athletic clothing. Report
This is a very common syndrome in men and women. I dislike the emphasis in the media on it being a "female" syndrome as it skews, in my opinion, the data towards an anti-female-in-sports bias that has been hanging around our society since the Victorian age, driving women who enjoy sports and exercise into a mind set that they have to feel guilty about it somehow and so yes, I think that backfires and they maybe restrict calories in secret and overtrain in secret.

This is not good but it is no different from previous decades when primarily men (and women, too) who were engaged in certain sports abused their bodies with steroid use, etc.

Not every athletic female is abusing her body and women have a right to participate in and enjoy athletics and pay attention to their diets in public.

I agree that the syndrome exists in men and women, I would just like to see the hysteria about it tempered so that active women can relax and be themselves while addressing the need to train and eat in the proper manner. Report
I think this is a really great article. I just wish there were more out there like this. This problem does affect both men and women as I saw in the last few months. I have had to stop running all together because of my severe decline in health, all caused by overexercising for hours for almost a year now. It didn't help matters, that my body has gone through anorexia and bulimia for over sixteen years now and I have a peg tube. Now, my husband and I more or less are having to fight for my life. I wish more people knew about problems like this, to know what to look for as well as understand it better. This info is very helpful, if you listen to your body, to not let things get out of hand. If I could, I would tell people to choose life and health in all they do. Love Always* Report
It was actually a sports med doctor at Michigan state University that diagnosed me. He sees it all the time so he knew exactly what it was. Though I didn't remain in school, I was able to find out why I felt like I was falling apart. (Then I had the flight back to CA...) Report
Yup, that was me! Local doctors did nothing for my hips. They denied there was a problem because they didn't recognize what was going on--stunted growth plates. As an 18 year old, i had the growth in my hips of a 13-15 year old. I was well behind the curve and had debilitating pain from it. I still get twinges and aches in my "sits bones" and it has been 7 years. Report
I think that when I was in high school and just out of high school I had this problem. There was never any specific pressure from coaches or parents it was all in my head that I had to be the best at my sport. I would stay after hour and a half long practices and practice another 2 and that was in addition to my athletics class in the morning where we exercised for an hour. After graduating high school and starting college I would get sick, not intentionally after eating so I stopped eating, but continued with 3-4 hours of exercise a day. I stopped menstrating and now at age 30 I have been diagnosed with a heart condition that was caused by an electrolyte imbalance which I am sure happened when I stopped eating but was exercising like crazy Report
I stopped menstruating for nine months last year and I never found out why. I went to see my doctor and got a blood test done but she couldn't find a cause. Her first guess was that it was stress-related, but I think this could have been a possible cause too. At the time, I was training for a 10-K, running 3 days per week, as well as dragon boating 1-2 times a week and dancing once a week. After all that ended in June I did some physically intensive volunteer work followed by a few weeks of intense athletic summer camps. Looking back, I think I was limiting my calorie intake as well by eating a minimum amount of calories without taking all my exercise into account. I didn't lose a lot of weight, though I did lose some and was easily 10lbs lighter than I am now. However, I was still in the lower middle range of my healthy BMI.

Last fall, once school started again, I reduced my exercise by a lot and starting eating more fats and sugars. I gained some weight but I also started menstruating again. I would have thought I was healthier in the spring/summer of last year because I was more fit. At the time I didn't think I was overexercising and, considering I was in the mid-range of my BMI, I thought I was at a healthy weight (now I am in the higher end of my healthy BMI range). But if I stopped menstruating then my body must have disagreed. I guess I have to find a happy medium. Report
Over the years many young girls in Gymnastics and Ice Skating ha done this to their bodies so they could stay in Competition and try for the Olympics. They have gone so far as to have their breasts Surgically removed.
The world's people have done this to our young girls not only in Sports but in Entertainment. A great dis-service has been done. One that needs to be stopped. Report
Thanks for the article. My daughter, an overachiever in all aspects of her life, may have been close to having this, this past summer and fall. When she was home this summer, she ran everyday, then did other aerobic activities! Her eating habits also changed, she would eat only healthy foods but in good sized portions (some stuff even too weird for me, my husband and son would never eat that way), abandoning some of her old favorites. When she got back to school, one day she got really dehydrated and really panicked. She did see a counselor at school and kind of realized what she was doing. She always has to be "perfect" at everything she does (in school and work), and just kind of took the exercise/nutrition too far. Thank goodness I think she is more level-headed now. I really think this perfection habit of hers is self-inflicted, my husband and I have NEVER tried to push her, and she has 2 girlfriends exactly like her! It does need to be publicized, I think some girls nowadays are so scared of trying to make it in a man's world, to be successful they practically have to kill themselves. Report
I have several (college) students every year who fit this profile. One is a 'marathon runner' (she hasn't got the muscle to run 5k, is the local coach's assessment). Many of these young women claim that exercise makes their under-eating ok; from the outside, it is another layer of their addiction to self-control.
Our athletes are helped a lot by their coaches, who try to balance the weight 'requirements' with safety and common sense; it's the others who concern me most.
Perennially on the other side of the spectrum myself, I'm not the best role model or helper for such, but I try to keep eyes open for material like this, something my students might actually relate to.
As always, thanks for the timely and useful information. Report
I'm not a runner and certainly have no eating disorder, but have two female neighbors who fit this category. Seems as though people place too much emphasis on thinness and appearances at a very young age. I have seen this happen in my family where eating disorders resulted. Report
I actually don't feel there is an inordinate amount of pressure on female athletes. Anyone who participates or competes in a sport must train to be successful. The best thing for a young woman is to value themselves for something other than their looks, athletics allows a woman to feel strong thus boost their self-esteem. If there is any sociatal pressure that adversely affects women, it would have to be the fashion industry's/media's/entertainment industry's promotion of abnormally thin woman as the female ideal. Sports can make female athletes appreciate their bodies for what they are capable of doing, instead of how small/thin they can be! Report
I get a lot of exercise, both strength and cardio almost everyday, but I am not nor ever been obsessed with working out. I think one has to have an addictive or obsessive personality trait to be in that syndrome. We all need to eat properly, and get the right amount of physical activity. I think that is what SP is encouraging, the healthy lifestyle changes not the "diet" or obsessive theories. Report
I have to agree that sometimes I worry that SP encourages these behaviors. When I get digests for my teams, I see many people who are logging hours of workout time each day. I don't think that anorexic/bulimic behaviors can or should be blamed on pressure on girls to excell at sports, though the other pieces of this syndrome certainly can. The calorie restrictions often come from the images of women in the media compounding the body consciousness that always comes with being a teenager. I think we need to spend more time pointing out how frighteningly skinny some celebs are. Girls playing sports should be encouraged to see what a real athlete's body looks like and what it takes to keep that body going should be emphasized. Making excelling at sports a negative would be as bad as making it the only thing. Report
I've been obessive with my exercising on and off in my life (not so much that I have any of these symptoms but I have felt off or guilty if I didn't do my requisite hour of intense exercise) so I can see how the pressure to "win" or "be perfect" can drive some young women to the point where they do get sick in order to be the best. It is sad. Report
I went through this for almost 10 years a long time ago. My two sons are eleven year apart due to my lack of menstrual cycle for that period of time. I weighed 95 pounds, and my percentage of body fat was 5%. I looked like a flamingo, however at that time, I thought I looked great! That was before there was a connection made between eating disorders/exercise/and lack of menstrual periods. Report
Oh my goodness. I have learned something that can help me so much. I have struggled with anorexia/bulimia my whole life, but can keep it together most of the time. Within the last year, the gym has become more of priority than social events and eating is again a dilemma. I have never heard of this syndrome, but it helps to know that I am not alone. I am trying really hard to be healthy and not obsessed by the amount of calories in vs. my workouts...but it's a struggle every day. Report
Half my varsity track team in college were having problems with this. And at least half had some sort of eating disorder, ranging from bulimia to anorexia and sometimes both. Still remember one very bony & flat girl saying to me, "You're so thin, I wish I looked like you." and I had to laugh, because she was way thinner than I was (and taller). Now, I would probably talk to the coach about it, but then I didn't know what to do. Sad, really. Report
Yes, I knew about this sydrome but didn't know the name of it. I've known one lady in particular who exemplifies it. She is an overachiever and very personable and engaging...I've not seen her in a couple years but talk with people who have kept up to date. Super intelligent and has several college degrees--always at the top of her class. When you first meet her you'd think she had it all together. But in addition to the eating disorders and the purging and over exercising, this woman also does the self injury of cutting herself to relieve tension, and has attempted suicide several times that I know of. Obviously, she has other problems besides the Female Athlete Triad syndrom under discussion here.

I've enjoyed reading the comments from all.

Paula Report
I have seen some young women who seem to go all out and spend hours at the gym and have often wondered if there are problems associated with such intensity. Thank you for the information. Report
Sometimes it appears to me as if SP inadvertently encourages this kind of obsessiveness. I hope those who make the decisions are making sure that those who are highlighted as success stories &/or motivators of others are NOT exercising for hours every day. Even if they're not at the level of this syndrome, those who give exercise such a large place in their life are not good role models in practice: their way of life is not possible or desirable for most of us. Report
This is information we all could use. Thanks for sharing! Dee Report
This is unfortunate, granted I am a female athlete, but I believe that you should participate in a few events per year, enough to keep motivated, and I try to eat a balanced diet. I attempted the low-carb thing, and couldn't get through a 30 minute work-out. So, carbs are NOT enemies. But veggies really help me sleep better. My goal is to stay healthy and motivate others around me. It's a rare gift to make a goal and achieve it! Report
I think it comes down to practicing better or more self soothing techniques. Learning how to accept yourself with flaws and limatation and love yourself...just as you are without expecting perfection or holding unrealistic expecations. To treat yourself well with constant respect and assurances so the subconscious mind doesnt NEED validation from competition and has no guilt for falling short to repeat Flagelant behavior or the beating up of self.
A good performace becomes a natural byproduct of a good self image rather than a perfect performance being needed to uphold a fragil (and yet could be very high, just not strong) self image. When perfection isnt met...its perceived as proof of failure and there comes the drive to push even more. Report
I heard about it a long time ago when I was a rather althetic pre-teen. I didnt know having an established eating disorder like anerexia, balemia, or obsessive calorie/fat restriction- was a prerequisit defining condition...a common factor yes but not conditional. Each of those things can be FATAL all on their own.

See, (maybe I am wrong Im going from 25 yr old memory here) I was under the impression that the being "under nurished" in Female ATS was result of over exercising (cals in vs cals out, cals out wins) or from whatever else contributors but the result is completely without essential oils and fats...under-nurished......and THEN that from being under nurished with continued very high ATP (energy production) requirments......that caused the secondary amenorrhea and severe Osteoporosis because **without nutrition the body uses ITSELF for its energy.**

Female ATS being severe and rather acute lowered constitution and extreme supseptability to injury (bone) where further performance or competition may result in fatality or permenant bodily system damage.
Being obsessive about diet...
Being obsessive about exercise...
Being obsessive about physical self image, or performance...
Without Balance there is disorder...yes if any one thing goes too far it can manifest as a FATAL DISORDER, but Female ATS is when one's excessively extreme althletic lifestyle uses up a significantly more amount of (uses itself for) nutrients than the body is able to stock or readily supply.......(which is usually directly related to one's diet,) this accourance frequently repeated enough to weaken the body...possibly beyond repair. So pile on an eating disorder too...(potentially fatal even without frequent demands of high ATP)....and thats definatly a recipie for disaster. Report
Guess this will never be a problem for me! Pat Report
This is very similar to exercise bulimia; instead of purging by vomiting or laxatives, the person overexercises to try to get rid of the extra calories (or occasionally trying to burn as much as they take in during the day). I suspect we need to teach our kids that they don't need to be "the best" athlete, dancer, student, etc. They just need to do their best and enjoy what they're doing. I think as adults we're also prone to this disorder. I know that at times I start thinking along the lines of "I need to burn at least half my caloric intake each day," but then I remember that I'm not in some sort of competition with anyone else and that no matter how many calories I burn in a day, my body may choose to respond differently than I'd like it to. Report
I suffer from this disorder but I just can't seem to stop myself. I go through good days where I'm ready to battle it but then something comes along and I refuse to stop. It does interfere with my social life, family and friends and I hate what it does to them. Can I ever become normal again? It all started during my competitive figure skating career. I am still very competitive as a runner and cyclist. Report
I never knew what this was all called. thanks for the information. While in the army I developed an eating disorder do to the need to meet weight requirements and be at the peek of fitnis. I actualy was incouraged by a squade leader to develpe the eating disorder and after several years my injury rate increase severly . I actually tore ligamrnts just doing a daily run, no other trama caused the injury. I have been trying to understand what happened in my past to help me live a healthier life, again thanks so much fo this information. Report
I do health promotion. Keeping a copy of this excellent article.
My thoughts & prayers are with those who have family or friends struggling with this. Report
Thanks for the information Nancy!!! Report
Thanks for an interesting article as well as discussion in the postings. I think that we have great societal pressures on being "the best" whatever it is and this affects men, women, girls, boys, in all of our roles from competitors (sports) to parenting. How over scheduled are our children? Are the heavy schedules for their good or for the parents' good? And what happens when we don't become the best? Major contributor to making self esteem issues worse IMHO. Anytime our efforts impact the way our bodies function internally (such as hormonal changes), we need to step back and say "wait a minute here" - this is a major warning signal that we need to notice and seek help for. Report
Thanks for the information. Report
I think my sister-in-law may have this. Don't know about the menstral cycles, but she's pretty damn skinny, she doesn't eat sugar or carbs or dairy or anything processed. She's been obsessive about food since I've met her (first it was no meat, then it was all meat, then it was no sugar including alcohol although now alcohol is back in). And she's been obsessive about fitness as well. She's really into yoga now and reads all kinds of yoga spiritual books, but I just don't buy that she's doing it to become centered, because she's still really competitive and uptight. And she does some ridiculous yoga, like hours in a hot room. Report
I think anything that is done to the extreme and causes long-term problems is unwise, but I don't think this is a "women's" problem. I think mean can go there as well. Report
Thanks for the info. I've never heard of this disorder Report
My youngest daughter has this. She has been showing signs of anorexia since she was 10. At 15 she went to Duke medical Center's eating disorder clinic. She was doing well until last April no she is not making healthy choices again. It is not easy for her because she also has IBS ( constipation) where her Gastro Dr's want her to workout and run to help move her she digestive system. It's a catch 22 with her. She has lost 23 ounds in over four 5 months and she really was at the bottom of her healthy weight. Report
Thanks for posting this information. It is may prevent someone from going into a deadly competition! Report
Why is this article written as though it's exclusively women who get so obsessed with a sport that it becomes unhealthy? Surely men can have the same condition, right? We don't talk about "female colds" and "male colds". Report
Great article! I wish more people knew that too much exercise and not enough food was unhealthy. So often, if we see someone who exercises all the time and appears thin, we think, "wow, that person is so healthy," but it's not always true... Report
well i realy did enjoy this article . it was very informative and interesting. my family gets very cross with me because although i am way over weight i get obsessed and over do things, that is why i dont diet i just cut down. and that does feel better cutting down than dieting. Report
I suffered from this condition as a cross-country runner in high school. Even after I recovered from my ED and got back to a healthy weight, it took over a year for my period to return. I had to take birth control pills in order for my body start producing estrogen again on its own. Report
i may know someone who could fit this description. Not sure how her menstral cycle is - but sever calorie restriction as a personal trainer. It does concern me. Thank you for shedding more light on such an extreme condition. Report
I don't really think of myself as having this problem. I think we can also get a little focused on the numbers when we are trying to lose weight, to the point where it maybe isn't normal. However, I never ate below an unhealthy amount, and I was always very vigilant about consuming healthy foods and getting all my nutrients.

That being said, my weight loss did cause my periods to stop because of low estrogen levels. It has been months since I stopped my weight loss, and I am still trying to fix that problem (don't worry I have seen a doctor and am working on it). This does make me worry that it could also have affected other areas of my health. Report
This is a first... I mean I have heard of the many disorders out there but I did not know about this! That is crazy, there should not be so much pressure on individuals to be what society calls, "acceptable". Great piece of info... Report
I have heard of this sort of thing, but never knew it had a name. Thank you for the very informative post! Report