The Female Athlete Triad

By Nikki Heslin

As women runners, we benefit from many health benefits compared to our sedentary female counterparts (e.g. lower risk of cardiovascular heart disease). However, we also run the risk of falling into the female athlete triad. The triad refers to the relationship between amenorrhoea, osteoporosis and eating disorders.

Amenorrhoea refers to not menstruating without menopause, which can occur in female athletes due to a reduced body mass or body fat percentage. Osteoporosis results from an inadequate calcium intake promoting the body to draw on its reserves in the bone, making them porous and brittle. This condition increases the likelihood of bone breakage (stress fractures) during daily life, including our daily runs! Eating disorders generally refer to anorexia and bulimia. Both disorders are more common in women than in men, and there is some dispute as to athletics being a risk factor for the development of eating disorders. People with anorexia have a very reduced caloric intake with some periods of not eating at all. Bulimia refers to a "binge & purge" cycle, where a high caloric binge is followed by an attempt to purge the recently ingested food, such as vomiting or laxatives.

Some researchers have suggested that eating disorders are a symptom of amenorrhoea. Decreased oestrogen levels due to amenorrhoea promotes calcium uptake from the bones, decreasing the bone mineral density (BMD) and therefore increasing the risk of osteoporosis.

It should be noted that it is common for athletes who run long distances to experience amenorrhoea during their heavy training and competitive season. This may be due to reduced body fat percentage during that time.

If you are concerned about your BMD, you can get it checked by your physician (not sure about it being covered by the NHS though). Remember, that weight-bearing exercise such as running generally helps to decrease the risk of osteoporosis. However, female athletes experiencing amenorrhoea should be aware of the risk of osteoporosis. If you are concerned that you may have an eating disorder, see your physician as soon as possible, or visit websites (e.g. to find out more information.

Whether or not you are experiencing any of the complications mentioned, it is still advisable for women to ingest at least 3 servings of dairy foods a day, (e.g. 1 glass of skim milk, or a serving of yoghurt – low-fat if you prefer). The research supporting the use of calcium supplements for women with low BMD is lacking. In any case, nutritionists usually suggest improving our diets to ensure we have the adequate amount of vitamins and minerals rather than rely on supplements.

So, celebrate being a female runner today with a nice chunk of cheese or perhaps some crème fraiche dessert!

Stay Healthy and Happy Running!