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Athlete Scenario: I am a high school cross country runner, I run 25-35 miles per week and play recreational soccer 3 times per week. I haven’t had my period in 4 months, my times were getting faster, but it now seems to be getting harder to maintain the same pace. My shins ache as well and I’m often needing to ice my shins after meets and games.

This athlete is showing the 3 interrelated RED Flags to Female Athlete Triad.

1.  Low Energy Availability

2.  Low Bone Density

3.  Menstrual Disturbances

Energy availability (EA) is the energy remaining for regular body processes AFTER accounting for energy used during exercise.  Low EA is more prevalent in aesthetic and weight sensitive sports; gymnastics, dance, running, swimming.

Typically in high school and collegiate settings, athletes that are struggling are first identified by their athletic trainer, teammates, or coach who are most aware of their training levels, performance, and eating habits.  Typically, signs of the athlete showing triad-related concerns are progressive weight loss, disordered eating behaviors, chronic fatigue, impaired growth, hormonal disruptions, and irregular moods.  Other concerns are complaints about declining performance or overexercising behaviors, as well as overuse injuries including increased stress fractures.

So, what do you do if you suspect Female Athlete Triad?  The athlete needs to be assessed and managed by a healthcare professional knowledgeable in the Female Athlete Triad and a Sports Dietitian can help identify appropriate foods and/or supplements to imporve EA.  Laboratory workup will be important as unfavorable blood cholesterol is typically increased, which increases cardiovascular risk and low B vitamins as well as Vitamin D and calcium are common.


1.  Improve EA with energy dense snacks and/or beverages.

2.  Decrease energy expenditure with taking at least 1 extra day off per week.

3.  Ensure calcium and vitamin D needs are met.

4.  Consult with a Sports Dietitian to improve EA and address any disordered eating behaviors.



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