By Osteopath, Nicole Owen-Tighe

This one’s for all our super sporty female champions out there!

The ‘Female Athlete Triad’ – maybe you’ve heard the term loosely thrown around but not sure what exactly it means or how it could affect you, your loved one or a team mate. It is something that if left undetected can have devastating consequences on sporting performance but also the female body later in life. This is a conversation that needs to be had more often in our sporting community and is something that we can all learn more about to be on the lookout for warning signs and symptoms.

The Female Athlete Triad is a common manifestation of ‘Relative energy deficiency in sport’  or RED-S. It’s characterised by a combination of low energy levels (with or without disordered eating), menstrual dysfunction and low bone mineral density. Without a correct training program that is personalised individually and covers training regime, nutrition, recovery and mental wellbeing; athletes can fall into the trap of being mismanaged by themselves or a coach without them even knowing.   

So how exactly can the “Female Athlete Triad” set the body up for failure?

  1. Menstrual dysfunction is a common consequence of energy deficiency in female athletes. When the female body lacks energy stores, there is a reduction in the levels of hypothalamic-pituitary hormones (including oestrogen) released in the body. This leads to a disruption and potentially an absence of menstruation (amenorrhea). This has the potential to cause infertility in the future.
  2. Low energy stores can cause a reduction in bone mineral density. As energy production decreases, so does bone protein synthesis and mineralisation, which are the processes responsible for maintaining bone strength and mineral density. This not only increases the risk of bone injuries (eg, fractures), it also increases the likelihood of developing early onset osteoporosis.
  3. The combination of low energy stores, menstrual dysfunction and low bone mineral density is common in sports where leanness is favourable including gymnastics, ballet, long distance runners or triathletes.

This can all happen easily and fly under the radar with many athletes putting their symptoms down to just “feeling tired.” Be on the watch for potential disordered eating patterns, or simply an imbalance in energy intake and energy expenditure. Athletes need to understand how much fuel their body requires to maintain high levels of physical activity, and how often they should be training.

What happens to sporting performance if it goes undetected?

If an athlete continues to train or compete with low levels of energy, it can drastically impact their sporting performance. Potential outcomes include:

-Decreased endurance and earlier fatigue
-Decreased muscular strength
-Decreased coordination, concentration and impaired judgement
-More frequent illness
-Increased likelihood of irritability and depression

All of these factors contribute to increase the risk of musculoskeletal injury, including muscle strain, joint sprain and fractures, in addition to a prolonged length of recovery. The importance of athletes scheduling training correctly cannot be understated. Athletes will often need professional help with this; collaborate with your coaches or health care professionals to plan appropriately and avoid experiencing any ongoing fatigue on the body from over-training.

If this is something you think you might be experiencing and would like to talk to someone about how they can help you with any injuries or take control of your training and recovery, contact Camberwell Sports and Spinal Medicine to consult with one of our helpful practitioners whose goal is to help you get back on track to perform at your very best.


Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014; (48); 491-497.

Nazem TG, Ackerman KE. The Female Athlete Triad. Sports Health. 2012;4(4):302-311.

Javad A, Tebben PJ, Fischer PR, Lteif, AN. Female Athlete Triad and its Components: Towards Improved Screening and Management. Mayo Clinic Proceedings. 2013; 88 (9); 996-1009