Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
Review

The female athlete triad: It takes a team

Jaya Mehta, MD, Bithika Thompson, MD and Juliana M. Kling, MD, MPH
Cleveland Clinic Journal of Medicine April 2018, 85 (4) 313-320; DOI: https://doi.org/10.3949/ccjm.85a.16137
Jaya Mehta
Department of Internal Medicine Mayo Clinic, Scottsdale, AZ
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bithika Thompson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Juliana M. Kling
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    The components of the female athlete triad are linked. Energy availability and menstrual dysfunction play causative roles in bone mineral density pathology. Within each component of the triad a spectrum of dysfunction exists, with all 3 components exhibiting serious health end points including low energy availability, functional hypothalamic amenorrhea, and osteoporosis.

Tables

  • Figures
    • View popup
    TABLE 1

    Eating disorders: Restrictive and binging/purging

    Restrictive eating disorder
    Symptoms
     Amenorrhea
     Constipation
     Headaches
     Fainting
     Dizziness
     Fatigue
     Cold intolerance
    Physical findings
     Acrocyanosis
     Dry skin
     Hair loss
     Bradycardia
     Orthostatic hypotension
     Loss of muscle mass and subcutaneous fat
     Lanugo
    Binging/purging eating disorder
    Symptoms
     Bloating
     Fullness
     Lethargy
     Gastroesophageal reflux disease
     Abdominal pain
     Sore throat
    Physical findings
     Knuckle calluses
     Dental enamel erosion
     Salivary gland enlargement
     Cardiomegaly (in setting of ipecac toxicity)
    • View popup
    TABLE 2

    Diagnostic tests for the female athlete triad

    Low energy availability
    Overt signs:
     body mass index < 17.5 kg/m2
     or body weight < 85% of expected
    Calculation (with aid of daily food logs and accelerometer): Embedded Image
    Resting metabolic rate
    Triiodothyronine (T3) level
    Low bone mineral density
    Dual-energy x-ray absorptiometry (DEXA) if any of the following:
     Oligomenorrhea or amenorrhea ≥ 6 months
     Disordered eating or an eating disorder ≥ 6 months
     Stress fracture or other fracture from minimal trauma
    Interpretation:
    Low bone mineral density
     Ages 5–19: Z score ≤ –2.0
     Age ≥ 20: Z score between –1.0 and –2.0 with a history of nutritional deficiency, hypoestrogenism, stress fracture, or other secondary risk factor fracture
    Osteoporosis
     Ages 5–19: Z score ≤ –2.0 plus clinically significant fracture
     Age ≥ 20: Z score ≤ –2.0 plus secondary cause of osteoporosis
    Menstrual dysfunction
    Rule out pregnancy and outflow tract obstruction
    Oligomenorrhea: > 35 days between menses
    Amenorrhea: Absence of menses
    Laboratory tests to consider:
     Follicle-stimulating hormone
     Prolactin
     Progesterone challenge
     Thyroid-stimulating hormone, thyroxine (T4)
PreviousNext
Back to top

In this issue

Cleveland Clinic Journal of Medicine: 85 (4)
Cleveland Clinic Journal of Medicine
Vol. 85, Issue 4
1 Apr 2018
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The female athlete triad: It takes a team
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
Please verify that you are a real person.
Citation Tools
The female athlete triad: It takes a team
Jaya Mehta, Bithika Thompson, Juliana M. Kling
Cleveland Clinic Journal of Medicine Apr 2018, 85 (4) 313-320; DOI: 10.3949/ccjm.85a.16137

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
The female athlete triad: It takes a team
Jaya Mehta, Bithika Thompson, Juliana M. Kling
Cleveland Clinic Journal of Medicine Apr 2018, 85 (4) 313-320; DOI: 10.3949/ccjm.85a.16137
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget

Jump to section

  • Article
    • ABSTRACT
    • DEFINITION HAS CHANGED: ONLY 1 OF 3 COMPONENTS NEEDED
    • THE COMPONENTS ARE COMMON
    • THE COMPONENTS ARE LINKED
    • SCREENING
    • DIAGNOSING THE TRIAD
    • EARLY INTERVENTION IS ESSENTIAL
    • RETURN TO PLAY
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • Make no bones about it!
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • High-output heart failure from arteriovenous dialysis access: A structured approach to diagnosis and management
  • Direct oral anticoagulants: Challenging prescribing scenarios in everyday practice
  • IgA nephropathy: Update on pathogenesis and treatment
Show more Review

Similar Articles

Subjects

  • Adolescent Medicine
  • Endocrinology
  • Mental Health
  • Obesity
  • Preventive Care
  • Women's Health

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2025 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire