The Female Athlete Triad

John Furia, MD


Medscape General Medicine. 1999;1(1) 

In This Article


The criteria for diagnosis are menstrual irregularities, disordered eating, and osteoporosis. Recognition of the Female Athlete Triad may be difficult. Athletes with disordered eating habits are generally good at hiding their behavior. It is not uncommon for these athletes to eat alone or spend time in the bathroom immediately after meals.

Usually it is a close friend, teammate, coach, or parent who spots the abnormal behavior. Rarely does the athlete volunteer any information. Indeed, when confronted, the athlete usually denies that a problem exists.

If a component of the Triad is identified, the athlete requires a thorough medical evaluation. In particular, the athlete needs to be screened for the other components of the Triad.[9]

Begin with a good history. The athlete should be questioned as to any increase in quantity and intensity of exercise. Has there been an increase in aerobic exercise beyond the normal practice sessions? Such behavior is not uncommon and is a method of increasing caloric consumption.

Assess the athlete's emotional condition. Have there been feelings of inadequacy or self-doubt? Has there been any conflict on the team? Does she seem preoccupied with eating behavior ?

Take a good menstrual history. How long since the last menses? Has the patient been sexually active? Is pregnancy a possibility?

Examine the patient for loss of tooth enamel, poor dental hygiene, and foul breath, which can occur with severe malnutrition secondary to bulimia.

Have there been recent stress fractures which might indicate below-normal bone mineral density?