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Home > The Female Athlete Triad (FAT): Understanding, Prevention, and Treatment

The Female Athlete Triad (FAT): Understanding, Prevention, and Treatment

The Unhappy Triad – A Complex Injury of the KneeBoyd W. Haynes III, MD

I’m well known in the Hampton Road area as an orthopaedic surgeon, but you may not know that my fellowship training is in Sports Medicine, and I have a great interest in caring for athletes. The female athlete triad is something you should know about because it highlights the vital interaction between physical activity, energy balance, and reproductive health. It is important to understand what FAT is, recognize the symptoms and address it early, as its consequences can extend beyond an athlete’s sporting career, impacting her long-term health.

The female athlete triad (FAT) comprises three key components:

  1. Disordered Eating: Female athletes often face pressure to achieve a specific body image for optimal performance. This may lead to disordered eating patterns, such as restrictive diets, excessive exercise, and unhealthy weight loss methods.
  2. Amenorrhea: Irregular or absent menstrual cycles, often due to low energy availability, can result from the body’s prioritization of essential functions over reproductive processes.
  3. Decreased Bone Mineral Density: Inadequate energy intake and estrogen deficiency can compromise bone health, increasing the risk of stress fractures, osteopenia, and osteoporosis.

Prevalence, Contributing Factors and Health Consequences

The prevalence of the female athlete triad varies across sports and age groups. Sports which emphasize leanness, such as gymnastics, dance, and endurance running, pose a higher risk. Contributing factors include:

  • societal pressures for an idealized body image
  • intense training regimens
  • inadequate nutrition education
  • lack of awareness among athletes, coaches, and healthcare providers

Left unaddressed, FAT can bring an increased susceptibility to injuries, stress fractures, fertility issues, and a higher likelihood of developing osteopenia/osteoporosis later in life.


Education – Athletes, coaches, parents (if the athlete is a teen), and healthcare professionals should receive comprehensive education about the triad’s components, risk factors, and consequences. Sometimes, this piece is the most crucial as the pressure to perform from all sides can be overwhelming for the athlete.

Nutritional Guidance – Nutritionists and dietitians play a vital role in guiding athletes toward balanced, nourishing diets that meet the energy demands of training. Encouraging intuitive eating and debunking myths surrounding ideal body types are to be applauded.

Psychosocial Support – Addressing psychological factors is essential. Coaches and parents (for teens) should prioritize athletes’ mental well-being, promoting self-esteem and body positivity.  If they don’t, maybe the coaches and/or parents need behavioral counseling with the athlete to promote a healthy relationship.


So, what do I do when I see that my female athlete patient is on their way to developing or has developed FAT?

I get everyone involved.  Mom & Dad (if I’m dealing with a teen), the coach, and other physicians and nutritionists will help get the athlete back on track. This collaborative approach ensures a holistic assessment and tailored treatment plan.

Nutritional Rehabilitation – Gradually increasing energy intake while maintaining a balanced diet helps restore hormonal balance and optimize bone health.

Training Modifications – I’ll adjust the intensity, volume, and frequency of training to allow the body to recover and to reestablish a healthy energy balance.

Psychological Intervention – OSC has a fantastic Psychologist, Dr. Andrew Martin, who can help with Cognitive-behavioral therapy and counseling to address disordered eating behaviors and body image concerns.

By prioritizing the well-being of female athletes, we can ensure their long-term health and success in both their athletic endeavors and their overall lives.


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