Sports and exercise are healthy activities for girls and women of all ages. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term damage to health, or even death. It can also hurt athletic performance or make it necessary to limit or stop exercise.

Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the "female athletic triad."

The three conditions are:

1. Disordered eating
   Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise keeps the body from getting enough nutrition.
2. Menstrual dysfunction
   Poor nutrition, low calorie intake, high-energy demands, physical and emotional stress, or low percentage of body fat can lead to hormonal changes that stop menstrual periods (amenorrhea).
3. Premature osteoporosis (low bone density for age)
   Lack of periods disrupts the body's bone-building processes and weakens the skeleton, making bones more likely to break.

Females in any sport can develop one or more parts of the triad. At greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running or rowing).

Fashion trends and advertising often encourage women to try to reach unhealthy weight levels. Some female athletes suffer low self-esteem or depression, and may focus on weight loss because they think they are heavier than they actually are. Others feel pressure to lose weight from athletic coaches or parents.

Female athletes should consider these questions:

• Are you dissatisfied with your body?
• Do you strive to be thin?
• Do you continuously focus on your weight?

If the answers are yes, you may be at risk for developing abnormal patterns of eating food (disordered eating), which can lead to menstrual dysfunction and early osteoporosis.

Recognizing the female athletic triad is the first step toward treating it. See your doctor right away if you miss several menstrual periods, get a stress fracture in sports, or think you might have disordered eating.

Give the doctor your complete medical history, including:

• What you do for physical activity and what you eat for nutrition.
• How old you were when you began to menstruate and whether you usually have regular periods.
• If you are sexually active, use birth control pills, or have ever been pregnant.
• If you have ever had stress fractures or other injuries.
• Any changes (up or down) in your weight.
• Any medications you are taking or symptoms of other medical problems.
• Family history of diseases (i.e., thyroid disease, osteoporosis).
• Factors that cause stress in your life.

Your doctor will give you complete physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases, a bone density test will be recommended.

Treatment for female athletic triad often requires help from a team of medical professionals including your doctor (pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a psychological counselor.