Understanding the Female Athlete Triad: The Hidden Health Challenge in Active Women

At Tugun Osteopathy, we often see women who love to move runners, surfers, dancers, gym-goers, and athletes of all levels. While exercise brings countless physical and mental benefits, it’s important to recognise that more isn’t always better when it comes to training and energy balance.

One condition we’re particularly mindful of in active women is the Female Athlete Triad a syndrome involving three interconnected components:

1. Low energy availability (with or without disordered eating)

2. Menstrual dysfunction

3. Low bone mineral density (weakened bones)

Understanding how these systems interact is key to maintaining long-term health and performance.

1. Low Energy Availability

This occurs when the energy an athlete takes in (through food) doesn’t match the energy they expend (through training and daily activity). Sometimes it’s intentional for performance or body composition goals and other times it’s unintentional, simply due to a busy lifestyle and high training load.

When energy intake is too low, the body begins conserving energy by reducing non-essential functions including reproductive and bone health.

2. Menstrual Dysfunction

Menstrual irregularities, such as missed or absent periods (amenorrhea), are a common sign that the body is under stress. The hormonal changes that occur with low energy availability can disrupt normal menstrual cycles.

While it might seem convenient to have fewer periods, it’s actually a red flag that your body isn’t getting what it needs to function optimally.

3. Low Bone Mineral Density

Reduced eostrogen levels and nutrient deficiencies can lead to weaker bones, increasing the risk of stress fractures and long-term bone health issues such as osteopenia or osteoporosis.

For younger athletes, this can affect peak bone development and for adult athletes, it can make recovery from injuries slower and more difficult.

Why This Matters for Osteopathy and Athletic Performance

As osteopaths, we often see the musculoskeletal consequences of the Female Athlete Triad before the underlying cause is recognised things like:

• Recurrent stress fractures

• Persistent fatigue or muscle tightness

• Slow recovery after training

• Irregular cycles or hormonal symptoms

Our approach goes beyond treating the injury. We look at the whole picture- training load, nutrition, stress, sleep, and hormonal health, to help restore balance and prevent future problems.

Supporting Recovery and Prevention

If you or someone you know might be showing signs of the triad, early recognition is key.

Recovery involves:

• Restoring energy balance - adjusting food intake and/or training volume

• Monitoring bone and hormonal health

• Collaborating with allied health professionals such as osteopaths, dietitians, and GPs

At Tugun Osteopathy, we can support you through manual treatment, load management advice, and by working collaboratively with your broader healthcare team.

The Takeaway

The Female Athlete Triad isn’t just about missing periods it’s about understanding the delicate balance between training, nutrition, and recovery.

With the right support, athletes can regain health, prevent injuries, and return to sport feeling stronger and more energised.

If you’re an active woman experiencing irregular cycles, bone pain, or persistent fatigue, we can help.

📅 Book an appointment at Tugun Osteopathy to discuss how we can support your performance and wellbeing.