The female athlete triad: a current concepts review

Abstract

Female athletic participation continues to grow throughout the world. This has many positive effects on health and well-being, but it has also led to a unique set of health problems. The female athlete triad was first described in 1992 by the American College of Sports Medicine, consisting of disordered eating, amenorrhoea and osteoporosis. An updated position stand was released in 2007 that modified the components of the triad to energy availability, menstrual function and bone mineral density. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, diagnosis and treatment. Each of the components of the triad exists on a continuum from healthy to pathological. Low energy availability, from either dietary restriction or increased expenditure, is the factor that leads to the pathological states of menstrual function and bone mineral density. Athletes especially at risk are those in sports requiring leanness or low body weight. Prevention and early recognition of triad disorders is crucial to ensure timely intervention and treatment. Treatment is centered on restoring energy availability to adequate levels (30 kcal.kg^-1.d^-1) to re-establish normal metabolic functioning. All those who work with female athletes must remain vigilant in the education, recognition and treatment of athletes at risk. Continued research and knowledge of the triad disorders aids the development of prevention and treatment strategies to allow women to continue to enjoy the benefits of regular exercise and physical activity throughout their lives.