Are You at Risk for the Female Athlete Triad?

The female athlete triad is a collection of 3 characteristics that puts a female runner at risk for bone injuries—decreased bone density, menstrual irregularities, and disordered eating. When any one of these characteristics are present, problems can occur.

To determine whether you are at risk, ask yourself the following questions. If your responses indicate a possible abnormality, you should adjust your training, increase your caloric intake, and seek advice from your health care provider.

Menstrual History

• When was your most recent period? A normal cycle length is 21 to 35 days; the average is 28 days. Your most recent period should fall within this range.

• How much time usually passes from the start of one period to the start of another? Menstrual cycles that occur at intervals greater than 35 days are abnormal.

• How many periods have you had in the last year? Women should have 10 to 13 menstrual cycles in 12 months.

• What was the longest time between periods in the last year? An absence of a menstrual cycle for 3 months or longer indicates low estrogen levels and puts your bones at risk.

Dietary History

• Do you limit the amount of food you eat and restrict certain food groups? Female runners need to consume calories from all food groups and enough to support their daily needs. Restricting what you eat puts you at risk for nutrient and caloric deficiencies.

• Do you frequently skip meals? Skipping meals puts you at risk of consuming too few daily calories.

• Do you worry about your weight or body composition? Excessive worry suggests you are dissatisfied with your body image. This could be a symptom of a more severe problem.

• Do you use diet pills, make yourself vomit, or use laxatives? These are abnormal strategies to lose weight and suggest an underlying problem with body image.

Musculoskeletal History

• Have you ever had a stress fracture? Low bone mineral density is a key contributor to stress fractures.

• Do you have a family history of osteoporosis? A family history of osteoporosis increases your risk for osteoporosis. Be proactive with strategies to increase your bone mineral density.

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