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The Dangers Of Female Athlete Triad Syndrome

Dr. Katherine Vadasdi, Director, Women’s Sports Medicine Center, Orthopaedic & Neurosurgery Specialists
Dr. Katherine Vadasdi, Director, Women’s Sports Medicine Center, Orthopaedic & Neurosurgery Specialists Photo Credit: ONS

It is well known that students of all ages benefit from sports and exercise, but when girls and young women become too intense with training and overly restrictive about what and how much they eat, they may be putting their health at serious risk.

Relative energy deficiency syndrome (RED-S), more commonly known as Female Athlete Triad, occurs when there is a gross imbalance between the nutritional needs of a maturing female body and the amount of energy that is expended during sports or exercise. Triad refers to three resulting conditions: disordered eating, amenorrhea, or the cessation of menstruation, and osteoporosis.

Many girls who develop female athlete triad try to lose or maintain a low body weight to improve their athletic performance. Sadly, the opposite is more likely to happen. Athletes with RED-S become more easily fatigued and their concentration is diminished. If a girl doesn’t have enough fat on her body, it will be the muscles that get starved to supply energy, making them weaker.

At a time in life when girls should be building bone mass that will support them throughout life, girls with RED-S have decreased hormones. They have lower levels of estrogen, which, when combined with poor nutrition, causes the bones to become thin and possibly deformed. Early onset osteoporosis makes the girls more vulnerable to season-ending stress fractures, broken bones and other injuries. Internal organs, including the heart, also suffer.

Intense exercise and caloric restriction can also lead to a decrease in the hormones that regulate the menstrual cycle. This can lead to a compromised reproductive system later in life.

The girls at greatest risk for developing RED-S tend to participate in sports that classify athletes by weight, or those where there is a perceived advantage in appearing thin. Low self-esteem, a tendency toward perfectionism, and stress from school, peers or at home are compounding risk factors.

Because RED-S has physical and psychological factors, the most effective treatment is a team effort among doctors, coaches, parents, nutritionists and professional counselors.

If you suspect someone you know is at risk for female athlete triad, it is important to get her to see a sports medicine specialist who is trained to recognize the signs of the disorder. Left untreated, the toll on her body will have lasting effects that in extreme cases, can lead to death.

Girls can be protected from developing RED-S if they are empowered to set realistic expectations for themselves, and if they are properly educated about healthy nutritional and hydration requirements for their level of daily activity. They should also understand the importance of sleep and rest to allow the body to recover. Stress management techniques such as meditation, yoga or other calming activities will help them build healthy coping skills that will be useful for a lifetime.

For more information about sports medicine at ONS, visit