This is an inter-related problem consisting of amenorrhea (no menstruation), disordered eating and osteoporosis, a potentially lethal combination.  Female athletes, particularly those participating in individual sports, may feel significant pressure to excel where leanness and a low body weight are seen as advantageous.

Abnormal eating patterns include food restriction or fasting, bingeing and purging, or the use of laxatives and diet pills.  In combination with decreased body weight and excessive training, this can lead to menstrual disturbance, and in turn, low estrogen levels.  Women with disordered eating, estrogen deficiency and menstrual dysfunction are predisposed to osteoporosis.  Female athlete triad sufferers are at a significant risk for stress fractures

Several studies have shown that stress fractures occur more commonly in women who have stopped menstruating or have irregular periods than those who have a regular menstrual cycle.  Athletes with menstrual disturbances have lower estrogen levels and this may lead to lower bone mineral densities.  Estrogen deprivation may affect the bone’s ability to adapt to stress.

There is some evidence that beginning to menstruate at a later age may be a factor in stress fractures.  Another issue for young female athletes is abnormally low levels of estrogen and poor nutrition during adolescence.  This can lead to lower bone mass, which may be irreversible after a certain age.

Go to our Nutrition section for more in-depth information on Eating and/or Exercise Disorders and Osteoporosis.