The Female (Athlete) Triad

As we covered in the last post, excess exercise jeopardizes your natural fertility. It doesn't just rob you of your period -- it compromises your fertility and even the strength of your bones.

A common cause of missing or irregular cycles is the Female Athlete Triad (or "Triad"). The Triad is an incredibly common occurrence in girls and women who exercise, particularly athletes. However, a woman does not have to identify as an "athlete" (or participate in high amounts of exercise) to be suffering from this common condition.

The Markers of Female Athlete Triad

The American College of Sports Medicine uses 3 markers to assess Female Athlete Triad:

(low energy availability)
(absent/irregular periods)
(weak bones low in minerals)
— American College of Sports Medicine
    characterized by inadequate nutrition, abnormal or unreliable eating habits, and/or "low energy availability" (explained more below).
    Absent, infrequent or highly irregular menstrual cycles.
    defined as brittle bones that are low in minerals and bone density and are often prone to fractures and breaks.

"Low energy availability" is often the result of regular, strenuous exercise without reliable, adequate energy or nutrient intake. It can also be found in girls and women who diet, restrict, binge or purge -- regardless of exercise habits. When such energy and nutrient-deficiencies occur, the body is unable to sustain its healthy, natural state of fertility because it perceives major threats to its first priority -- its own life.


Science has made an interesting connection between the Triad and the low leptin levels commonly found in affected individuals. Leptin is the "I've eaten, I'm full" hormone that contributes toward a person's sense of satiety. Leptin is normally secreted in proportion to the amount of energy available to the body. High leptin levels send signals to the body that it's in a safe "fed" state, directing it to keep on with normal functions as low energy reserves are not a current threaten. On the other hand, low leptin levels send signals to the body that it's in a dangerous "hunger" state, directing it to slow normal functions in an attempt to conserve and protect its low energy reserves. A low-leptin "hunger" state deflects the threats to its low energy reserves by slowing metabolism, reducing thyroid function (a vital component of proper female sex hormone operations) and decreasing sex hormone production and synthesis.

Low leptin levels have been found in the majority of girls and women afflicted by the Triad. This is problematic because a minimum level of leptin is necessary to promote the hormones necessary for fertility, ovulation, and a sustained, healthy pregnancy. Many women with low leptin have elevated levels of testosterone and androgens (male-dominant hormones). Low leptin levels prevent these male hormones from being properly converted into female hormones, namely estrogen. 

A lack of estrogen leads to irregular or frequently skipped cycles, eventually progressing to a complete lack of cycling (amenorrhea) that indicates a state of infertility. While some women may find it almost "convenient" to skip periods, this is a serious indication that the body is unhealthy. Not having a monthly cycle can cause stiffening and scarring of the uterine walls and have other serious, lasting implications on fertility that make it difficult to get pregnant in the future. Low bone density is another serious risk related to low estrogen and low leptin levels.

Women with low hormone function as a result of low leptin and low energy availability may also have low progesterone, another primary contributor to fertility issues. Low progesterone is major cause of infertility and miscarriage, as ample progesterone is required for ovulation and sustained pregnancy.  


When it comes to diet and exercise, we constantly get the "more exercise, less food" message. There are very few gyms or exercise programs that will tell you you're overexercising, and very few diets that will admit they're essentially starving you to achieve short-term results that make their program look successful.

There's something socially embarrassing and shameful about not having the "self-control" associated with a rigid diet and/or exercise regime. We feel like we must exercise (more) and eat "healthier" (too often interpreted as less). We may feel unsatisfied with our appearance or find ourselves being overly obsessed about our food choices. Many women try to compensate, change, control or "punish" themselves through diet, exercise, and other unhealthy food or exercise behaviors that start to take over their minds and lives.

This is no way to live. We need to respect the one bodily home we have. We aren't likely to think it's ok to abuse the bodies of others -- we need to take the same stance as it applies to our own body.

If you're harming or abusing your body (knowingly or unknowingly), it will warn you. Not cycling regularly, not being able to conceive, or frequent miscarriages may be signs that your body is not getting the adequate food, nutrients, and/or rest it needs to sustain full-spectrum health and fertility.




American College of Sports Medicine - The Female Athlete Triad

NCBI Study - Prevalence of the Female Athlete Triad in High School Athletes and Sedentary Students

Special thanks to Terri Ward, NTP of who graciously shared her research paper, The Roles of Hypoleptinemia in the Female Athlete Triad and Leptin Replacement Therapy, which served as a source and inspiration for this post. Terri is an whole-foods nutritionist and speaker in Tualatin, Oregon. She is currently pursuing a Master's in Human Nutrition and Functional Medicine at the University of Western States. Please check out Terri and her services at