Female athletic triad

Authors: J. Novák
Authors‘ workplace: Univerzita Karlova v Praze ;  Lékařská fakulta v Plzni ;  Ústav sportovní medicíny a aktivního zdraví ;  Vedoucí: doc. MUDr. Aleš Kroužecký, Ph. D.
Published in: Prakt. Lék. 2021; 101(4): 187-193
Category: Reviews


The female athlete triad (the triad) is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density – osteoporosis. In extreme cases, a low proportion of adipose tissue is evident, often accompanied by a below-average body mass index, amenorhea is present, as well as bone stress syndrome, which progresses to a stress fracture. It affects girls and women in various sports with a high volume of training load, both of an endurance nature and focused on the aesthetic impression of their own sports performance. The basic reason is the long-lasting relative energy deficiency in sports activities (RED-S), when the imbalance between energy intake and energy expenditure is intentional. From the athletes’ point of view they want to optimize body weight. Long-term energy deficiency despite hard training efforts negatively affects sports performance. An athlete who is about to intentionally adjust her body composition to reduce weight should seek professional nutritional advice. Time-limited weight loss programs should be accompanied by a return to an energy-balanced diet with full energy availability. Triad treatment includes an adequate calorie-rich diet needed to restore a positive energy balance.


athletic triad of sportswomen – energy availability – relative energy deficiency – menstrual dysregulation – stress bone syndrome – nutritional counseling


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