Irregular Menstruation, Constant Injuries and Low Energy in the Female Athlete

by Manreet Sangha, DPT >> Request an Appointment

Female athletes are frequently put under unique physical demands and societal pressures concerning not only their performance, but also their image. Because of these outside influences, they are at an increased risk of developing physical disproportion called the Female Athlete Triad.

The Female Athlete Triad refers to an unbalanced relationship between an athlete’s energy levels, bone mineral density and menstrual function. It can be present in female athletes of all ages and levels – from adolescents going through puberty to the elite athlete. When these instabilities disrupt an athlete’s internal activity, it can lead to multiple health concerns, such as osteoporosis/osteopenia, eating disorders and menstrual dysfunction.

Adolescents with the Triad can present with various menstrual abnormalities including amenorrhea, oligomenorrhea and problems with ovulation. Irregular bone development, osteopenia and osteoporosis are also indicators of the Triad. In addition, failure to maintain the adequate nutrition and caloric intake required to balance rigorous physical activity will cause energy availability to be minimal. Female athletes with a history of stress fractures, numerous pathological fractures, overuse injuries and/or menstrual irregularities warrant screening for the Triad. In other words, if one, two or all three parts of the Triad are suspected, action should be taken.

Features of the Female Athlete Triad can vary and last for weeks to months. Symptoms may include:

  • Decreased energy during school, work or exercise
  • Irregular or absent menstrual cycle
  • Stress fractures
  • Difficulty concentrating in school or at work
  • Unexplained drop in performance
  • Changes in eating habits
  • Altered sleeping patterns
  • High stress levels


Early screening, identification and intervention is vital in order to avoid long term complications. The root cause of vitality deficiency must be determined and reversed, so the initial approach to the Triad should focus on elevating and stabilizing energy levels. In most cases, diet and exercise modifications are the first steps to managing this balance.


Physical therapists have the skills necessary to identify signs and symptoms of the Female Athlete Triad and begin multidisciplinary care. They are also experts in understanding the implications that the Triad may have on prescribed exercises.

During the initial assessment, a physical therapist will obtain the patient’s complete history with particular focus on diet, sport/exercise type, frequency and intensity, menstrual history, medication and supplements, including contraceptives, body image and history of injuries. The patient will be taken through a series of tests to determine an individualized and most appropriate plan of care. Once the patient’s symptoms are managed, a physical therapist will design an individualized return-to-activity program that encourages a safe, progressive level of activity in order to achieve optimal performance.

It is also highly recommended that the patient undergoes an evaluation by a registered dietitian. Here at Evolution, we have a Sports Certified Registered Dietitian who is able help each individual athlete return to their previous and ideal level of activity.

If you, or a female athlete you know, is displaying signs of the Triad, come visit us for a consultation. And here are some helpful changes you can make to your diet.

>> Request an Appointment

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