| | | | The Female Athlete Triad

Author / Ben Skutnik

With the recent fitness revolution came a major realization: women are pretty badass. The gym scene had been littered with beefed up bros since cavemen started lifting stone plates but it wasn’t really until the last 15 or so years that the strong female was celebrated by everyone. Whether it is Stefi Cohen crushing a QUADRUPLE-bodyweight squat at The Arnold, or the soccer mom cranking out pull ups at your local microgym, fit women are here to stay. And while they can do everything a man can do, sometimes better, there still are unique considerations that must be made when designing training plans for women. The most important being: the Female Athlete Triad. This article is to help educate coaches, and the women out there grinding, on how they can Empower Their Performance without succumbing to these issues.

The Triad

The Triad is the relationship between three seperate, but interrelated, issues and their potential outcomes,specific to training women: energy availability, menstrual activity, and bone mineral density. While these issues aren’t guaranteed to manifest into negative outcomes, several factors can easily go unnoticed and end in catastrophe. The three major red flags would be disordered eating, functional hypothalamic amenorrhea (FHA), and osteoporosis. Moreover, if one of these outcomes starts to develop, they will likely influence the factors relate to the other two and vicious cycle begins. So what exactly are you looking for?

Disordered Eating

Disordered eating is more than the stereotypical purging after a meal (bulimia nervosa) or restricting food (anorexia nervosa). While those are clinically diagnosable eating disorders, there is more to disordered eating. Disordered eating is any abnormal behaviors surrounding your feeding habits. So there’s the first issue…because what is normal these days? Some may see packing six meals and eating every three hours to be abnormal. Some might see cutting weight for a competition, even though you look better than everyone you know, to be abnormal. Hell, even we talk about “earning your carbs”! This is why we like to classify it as a lack of energy availability. You’re energy intake should line up with your goals and training. If you’re trying to cut, and you have the extra weight to lose, then there is nothing abnormal about slightly restricting calories. If you didn’t workout, there is nothing abnormal about limiting your carb intake, as long as you still get your overall caloric needs. Part of being an athlete is being abnormal, so it’s important to calibrate what “normal” is when you’re living life on the guardrails. What isn’t normal is setting up food as a reward for exercising, making drastic shifts in weights, or any sort of extreme behavior when it comes to fueling.

Functional Hypothalamic Amenorrhea (FHA)

It’s a long name just to say you lost your period. Quick blanket statement: MOST women of childbearing age should have a regular period. The length of the cycle is highly individualized, and there are some women with other conditions preventing them from ovulating. But, if you’re reading this, and you or one of your athletes is of age and not having a period, regardless of their in-gym performances, they should talk to a medical professional. Maybe they are fine, but you’re talking about the main biological marker for health in women. Better safe than sorry. Guys have it easy; every morning you wake up you get an “indicator” of how ready you are in terms of performance. Women don’t get morning wood, and they’ve got to wait a month or so to find out if things are going alright.

To compound it, many women are on some form of contraception that seems to “regulate” their cycle. Though we often assume bleeding means you’ve ovulated, it isn’t always the case. And what can impact your period? Too much stress, lack of sleep, dehydration, calorie restriction, among other factors. When I swam in college, it was assumed that the women’s team would lose their periods around December (when training got pretty intense). Chalk that one up to ignorance. But we know more now, but that mindset is still pretty prevalent in the training space. Women, take control of your health. And coaches, educate yourself. Especially the guys out there. It’s 2019 and if you think this shit is too taboo to talk to your athletes about, then you’ve got to reassess if coaching (i.e. caring for your athletes) is for you.


Osteoporosis is condition where the bones have lost their necessary mineral density and become brittle and frail. This is the leading cause for broken bones in the elderly; it’s not the falls that break the hips, it’s the broken hip that makes them fall. But this isn’t just found in older populations. In women, a decreased level of estrogen can also create an internal environment where this becomes an issue. Other factors include, as you might have guessed, poor nutritional habits and being underweight or inactive. Well, if you’re an athlete you’re likely active. But, if you’re underweight or malnourished…say, because you have developed a disordered eating pattern…you increase this risk as well. While this is the less severe of the three, it doesn’t mean it should go unnoticed, especially if your athlete is constantly getting stress fractures when they run, doing a heavy load of plyometrics, or if your combat athletes continuously break fingers or toes during striking. These are all signs that indicate bone mineral density could be an issue.

Avoiding the Triad

Though it seems like this is a huge deal, the steps needed to avoid succumbing to these outcomes are pretty simple. First, listen to your body. If you aren’t a high-level competitive athlete who makes their livelihoods off your training, take some rests days now and then. A day or two of rest will help decrease whatever stress responses your body is generating, and allow for it to heal itself. But, if you can’t do that, you can always fuel your body properly. Even if you need to train for hours a day, ten to twelve times per week, your body will be able to avoid a lot of this if you just eat right. And lastly, bang weights instead of the pavement. These issues are seen most often in your endurance athletes, largely due to the fact that their training typically doesn’t include heavy resistance training. Even if you are a world-class marathoner, you shouldn’t be avoiding the weight room. Heavy compound lifts (squats, deadlifts, presses) will stress the bones enough to help them rebuild stronger, and will elicit hormonal responses to help keep your internal environment healthy and thriving.

Bottom Line

Whether it’s for a competitive sport of just for fun, the best thing you can do if you are woman who is training for anything is follow Power Athlete. It’s no coincidence that the way to avoid The Triad falls directly inline with the training and nutrition advice that we prescribe to thousands of people daily. Why? Because we’re about performance. And, if you’re unhealthy, you can’t perform well. Regardless of whatever it is you heard before, you’ve got to eat, you’ve got to recover, and you’ve got to be smart about your training. The days of going in and burning it down every day are gone (unless you’re following Johnnie Football right now). If you aren’t confident in how to do any of the things discussed above, then let go of the reigns and let us guide you down the road to greatness.


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Ben Skutnik

Ben grew up a football player who found his way into a swimming pool. Swimming for four years, culminating in All-American status, at a Division III level, Ben grew to appreciate the effects that various training styles had on performance and decided to pursue the field of Exercise Physiology. After receiving his M.S. from Kansas State University in 2013, Ben moved on to Indiana University - Bloomington to pursue a PhD in Human Performance. While in Bloomington, he spent some time on deck coaching swimming at the club level, successfully coaching several swimmers to the National and Olympic Trials meets. He also served as the primary strength and condition coach for some of the post-graduate Olympians that swam at Indiana University.

Currently, Ben is finishing his PhD while serving a clinical faculty member at the University of Louisville, molding the minds that will be the future of strength and conditioning coaches. He also helps support the Olympic Sports side of the Strength and Conditioning Department there as a sports scientist.


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