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Fertility & The Female Athlete Triad

Have you met a woman who counts calories to lose weight? What about a woman who runs or lifts weights daily but doesn't refuel post-workout? Can you think of a woman who severely restricts her calories and swears by excessive exercise? When the energy consumed from food doesn’t replenish the energy burned by the body, there is potential to lose weight. When there isn’t enough energy consumed to supplement vital organs and bodily functions, there is a problem.

What is the female athlete triad?

Sometimes, unknowingly, individuals take an unhealthy approach to getting healthy. When this approach begins to affect energy levels, menses, or bone density the risks increase exponentially. The female athlete triad is a combination of low energy availability, menstrual dysfunction, and decreased bone mineral density. It a serious medical condition that has potential to cause lifelong impacts.

You don’t have to be an athlete to be affected by the triad.

The first component is low energy availability. Energy levels are reduced when individuals use more energy than they consume. This can range from accidental, not eating enough after a hard workout, to intentional, the use of diet pills, laxatives, or enemas. These low energy levels can cause changes in menses, a decrease in self-esteem and the development depression and anxiety.

Energy deficiency is a leading cause of amenorrhea.

The next component is menstrual dysfunction. Intense exercise with lack of efficient caloric intake can cause hormonal changes that affect the menstrual cycle. Menus can become irregular or stop altogether. This is known as amenorrhea. It can cause a variety of issues ranging from infertility (the inability to get pregnant) to hypoestrogenism (a decrease in normal levels of estrogen).

Skeletal demineralization begins during the onset of amenorrhea.

Decreased bone mineral density is the final component of the triad. A combination low estrogen levels and inadequate nutrition can lead to osteoporosis. Osteoporosis is when the bones become weak and fragile. These changes can increase the risk for stress fractures and broken bones. Unfortunately, this is not always reversible.

What are the effects on fertility?

When a woman is trying to get pregnant, it is important to consume a variety of nutrients from a variety of whole food sources. Eating this type of balanced diet will supplement the organs used to grow another life inside of it and make the hormonal changes it needs to for a pregnancy to occur. After conception, it will continue to meet the nutritional needs of the baby and the mother.

The triad will make getting pregnant or even sustaining a healthy pregnancy much more difficult.

If a woman does not eat enough food while she is trying to conceive her body may go through hormonal changes that disrupt her normal ovulation pattern making it more difficult to become pregnant. If she becomes pregnant and continues to limit her food, she is at risk for malnourishment and muscle deterioration while her unborn baby is at risk for fetal growth restriction, neurological disorders, congenital defects, and low birth weight.

Menstrual dysfunction can interfere with the ability to get pregnant. An irregular cycle can cause a woman to miss or miscalculate ovulation. A lack of menses can prevent ovulation from occurring.

Osteoporosis doesn’t affect fertility however it does bring some risks when it comes to pregnancy.

Decreased bone density coupled with the added weight from pregnancy can substantially increase a mother’s risk for fractures and broken bones. If the mother’s diet is lacking in calcium, the unborn baby will begin to take stored calcium from her bones. This will further decrease bone density in the mother.

How do you overcome the triad?

Most medical bodies agree that prevention, early detection, and intervention are vital for women who are affected by the female athlete triad.

Prevention can be accomplished through education and observation. Understand the risks associated with the condition and be aware of what is going in to your body. If you notice a friend or relative observing signs of the triad educate them on the risks.

Early detection is important to reduce the risk of irreversible damages. Know the signs and symptoms to observe in yourself or others:

  • excessive fatigue

  • loss of menses

  • weight loss

  • stress fractures

  • signs of an eating disorder

Those who are affected by the female athlete triad should consult a medical professional. A professional can help address nutrition, exercise, menstrual cycles, fertility, and any psychological barriers that may be interfering with a healthy sense of self. In the meantime, focus on meeting energy needs through a well-balanced diet. This will help to restore energy levels, promote healthy bones, preserve normal menstrual function, and encourage bone formation.

Do you have any experience with the triad? If you have any questions or comments on exercise & fertility send me a message or leave a comment. I would love to hear from you!


ACOG (2017). The Female Athlete Triad. Committee Opinion, 72, 1-8. Retrieved from:

Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sungot-Borgun, J., & Warren, M.P. (2007). Medicine & Science in Sports & Exercise, 39(10), 1867-1882. Retrieved from:

NCBI (1992). National Research Council (US) Subcommittee on Nutrition and Diarrheal Diseases Control; National Research Council (US) Subcommittee on Diet, Physical Activity, and Pregnancy Outcome. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases: Part II: Diet and Activity During Pregnancy and Lactation. Washington (DC): National Academies Press (US); 3, Physiology of Normal Pregnancy and the Effects of Undernutrition. Retrieved from:

NHI. (2018). Pregnancy, Breastfeeding and Bone Health. National Institutes of Health Osteoporosis and Related Bone Diseases. National Resource Center, 18-7881, 1-3. Retrieved from:

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