NB: Don’t scroll past gentleman, this can also affect males, it is also referred to as “relative energy
deficiency.”

As it states a triad (three) common in the female and consists of:

• Low bone mineral density (BMD)
• Mensural abnormalities (missed or scanty flow)
• In the presence or absence of eating disorders (bulimia, anorexia nervosa)

These when they occur show an underlying physiologic disturbance in normal body processes and by
then already at hormonal level. Only occurrence of one of the above warrants evaluation for the female
athlete triad.

Common Sports: soccer, netball, gymnastics, swimming etc.

Problem:
Abnormal weight management practices (making weight through abnormal eating habits) or low energy
intake compared to exercise expenditure.

The output is an energy deficiency or negative energy balance which impacts negatively on the
metabolic processes and the hormonal profile. The common organs that are initially affected are the
weight bearing bones (stress fractures and increased risk of sustaining a fracture from low BMD), female
reproductive system (amenorrhea or a scanty flow).

These when sustained progresses to affect various organs as there is no energy to adequately fuel the
body’s metabolic processes.

Athlete specific negative manifestations:
Anemia and reduced aerobic capacity (cardiovascular and Hematologic), frequent injuries and fractures,
muscle cramping and easy fatiqueability (energy production and musculoskeletal), underweight or low
BMI and chronic fatique syndrome (metabolic). All these will negatively affect your performance and
result in inability to reach your peak as an athlete.

Treatment:

1. Full medical evaluation by a sports physician including blood tests to look at your hemoglobin and
   hormone profile (thyroid, estrogen, progesterone etc) and any indicated tests.
2. Identifying cause (less intake or high expenditure) and correcting it
3. Treatment is multi-disciplinary (nutrition, psychological support, iron supplements, oral
   contraceptives and bisphosphonates (NB: Bisphosphonates not to be consumed by women of child
   bearing age) and supplementing any deficiencies.

This is a correctable disorder and the key thing is prevention or early recognition and treatment with
good practices of managing the training load, nutrition and psychological assessment.
As the BFA medical we encourage all teams and in particular the women football teams to screen
athletes for this female athlete triad and refer for prompt treatment to aid improved athlete
performance and normal bodily function.