The Female Athlete Triad

John Furia, MD


Medscape General Medicine. 1999;1(1) 

In This Article


The number of women affected by disordered eating or by the complete Triad is not known, although there is evidence to suggest the problem is quite common.[6] Studies of female runners have demonstrated a direct relationship between distance run per week and incidence of amenorrhea.[7,8] In one study, the incidence of amenorrhea among women running more than 70 miles per week was 43%.[8]

Although the Triad can occur in any athlete, certain groups are at particularly high risk. Endurance athletes, such as distance runners and swimmers, because of the significant energy deficits that go along with their activities,[7,8,9,10,11] have high-energy demands which deplete caloric reserves and set the stage for metabolic and endocrine abnormalities. Drummer and colleagues reported a prevalence of disordered eating in 15.4% of collegiate swimmers.[10] In a small study, Rosen and associates reported that 62% of collegiate gymnasts had seriously abnormal eating patterns.[12]

Athletes who participate in sports where appearance is considered important, such as figure skaters, divers, and gymnasts, are also vulnerable.[9,11] A recent example is US gymnast Christy Henrich, who died in 1994, after a 5-year battle with anorexia and bulimia, believed to have been exacerbated by an American judge who told her she would have to drop some weight in order to qualify for the 1988 Olympic team. At 4'10" tall and 22 years of age, she reportedly weighed 61lbs. at the time of her death.

Sports with weight categories (ie, horse racing, martial arts, and rowing) and subjective judging to determine performance carry a higher risk as well.[9,11] For all of these athletes, there is often a conscious or subconscious pressure to control their weight.[9,11]

One of the cheerleaders was noticeably thin. I asked the mother if she had noted any disordered eating. "No," she responded.
"That young women is, however, overly self-conscious about her body weight."