Especially for Teens
TFAQ003, June 2019

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The Healthy Female Athlete

What are some of the benefits of playing sports?

Playing sports is a great way to get the exercise you need while practicing physical skills. It is good for both your body and your mind. It also gives you a chance to make friends, have fun, and compete. But even with all of these benefits, you should be aware of certain health problems that can come with being a female athlete.

What health problems should I know about if I play sports?

  • Injuries. Girls who play sports are very active at a time when their bodies are still growing and changing. You may be more likely to injure yourself because your body hasn’t finished developing yet.
  • Hormone changes. Intense physical activity can affect your hormone levels. Hormones are the chemical messengers in your body. Female hormones, like estrogen and progesterone, help regulate your menstrual period. Estrogen also is needed to help keep your bones strong. Changes in estrogen levels can affect your overall physical development, your period, and your bone health.
  • Changes in eating habits. Some girls who play sports develop an intense focus on their weight. There’s often a lot of pressure from your coach or parents to succeed if you play sports. You may feel responsibility to your teammates. You may feel a need to be “perfect.” This type of thinking can put you at risk of developing bad eating habits called “disordered eating.”

What is disordered eating?

Disordered eating is an unhealthy way of eating that can happen when people try to lose weight. Examples of disordered eating include the following:

  • Fasting
  • Skipping meals
  • Extreme dieting
  • Making yourself vomit
  • Using diuretics, laxatives, or stimulants

Disordered eating is not the same thing as an eating disorder, such as anorexia nervosa or bulimia, but it can be serious. Disordered eating also puts you at risk of a true eating disorder.

What is the female athlete triad?

The female athlete triad refers to three problems that often are found together in girls who play sports:

  1. Weight loss or being underweight (often because of disordered eating)
  2. Irregular or missed periods
  3. Low bone mass (weakened bones)

What causes the female athlete triad?

A woman’s weight, estrogen levels, and bone mass are all related. Fat is the tissue in your body that stores energy. If you lose too much fat, your body will make changes to try to save energy. You will lose muscle mass and your estrogen levels will decrease. Decreasing estrogen levels can affect your periods and put you at risk of weakened bones and stress fractures.

Your immune system also may be affected, and you may get sick more often. In fact, if your body’s systems aren’t working as they should, your athletic performance could suffer.

What are the symptoms of the female athlete triad?

The following can be warning signs for the female athlete triad or other problems:

  • Irregular or missed periods
  • Changes in weight, especially a lot of weight loss
  • Feeling like you have less energy
  • Excessive focus on your weight
  • Feelings of guilt if you don’t exercise
  • Limiting your food intake, fasting, or purging
  • Eating in secret
  • Stress fractures

What changes in my period should I be concerned about?

As a teen, your menstrual cycle may not always be regular. It can be hard to tell if a change in your cycle is normal or not normal. But there are a few changes in your menstrual cycle that may signal that something is wrong. If you have any of the following changes, see your doctor:

  • You get a period more frequently than every 21 days.
  • The time between periods is longer than 45 days.
  • Your periods last longer than 7 days.
  • Your periods were regular and now are irregular.
  • You haven’t had a period in 3 months.

Sometimes an athlete’s body fat and estrogen levels are so low that she doesn’t start her period. If you are age 14 years, you are an athlete, and you’ve never had a period, talk with your doctor.

What is low bone mass?

Bone mass is the amount of healthy tissue that is in your bones. Having enough bone mass keeps your bones strong. Most of your bone mass is created when you are a child and a teen. It is affected by nutrition and estrogen.

This is where healthy eating comes in. You need to eat enough healthy foods to create energy to grow bone mass. Healthy eating also affects estrogen levels. Estrogen helps keep bones healthy. If you are having regular periods, your estrogen levels are probably good. But once you start missing periods, your estrogen levels may decrease and bone loss may occur.

Eating healthy means getting a combination of proteins, carbohydrates, and fats. Every day you should eat grains, fruits, vegetables, protein, and dairy. Protein helps grow and repair muscles. Carbohydrates fuel your daily activity. Fats help your immune system function well, and they help your body use important vitamins.

Can these problems cause permanent damage?

Yes. Low levels of estrogen may affect your future reproductive health. You may have problems getting pregnant later in life. Low levels of estrogen may lead to low bone density and osteoporosis. This may lead to broken bones.

Who can I talk to if I think that playing sports is harming my health?

If you have any warning signs of the female athlete triad or other problems, you should talk to your parents and your coach. You also should see your doctor.

Sometimes it is hard to talk to your parents or a coach. You may feel like you cannot change your behavior without disappointing them. It is OK to want to be a good athlete, but not at the expense of your health. Your parents and coach should understand this. Your long-term health and safety are most important.

You, your parents, coach, doctor, and a sports nutritionist can work together to come up with a plan for you to stay healthy and keep playing sports.

How can sports-related health problems be treated?

Treating the female athlete triad involves eating the right kinds and amounts of food to support the physical activity that you do. You may need to eat more healthy foods and maybe spend less time training. You may find it hard to train less, but it is important to try. You may find that your sports performance improves when your nutrition is better and your body is healthier.

You also need to weigh enough to have periods to protect your reproductive system and bones. Other ways to keep your bones healthy may include getting 1,300 mg of calcium from calcium-rich foods and 600 international units of vitamin D every day. Good sources of calcium include dark, leafy greens, dairy foods, and canned salmon and sardines. You can get vitamin D by eating fatty fish like salmon or trout or by being in the sun for 15 minutes a few days a week. If needed, you can see a sports nutritionist to get help with your diet.

What can I do to stay healthy as an athlete?

Ask your doctor what a healthy weight for you is, and don’t go below that weight. Eat enough calories and healthy foods. Know how to recognize disordered eating and get help if you start behaving this way. Pay close attention to your periods and tell your doctor if you notice changes.

Should I stop playing sports if I have any of these health problems?

Probably not. Exercise and sports are good for you. But you may have to change your level of activity and your eating habits.


Anorexia Nervosa: An eating disorder that causes a person to severely restrict food so they lose weight. People with this disorder fear weight gain and have a distorted body image.

Bone Loss: The gradual loss of calcium and protein from bone, making it brittle and more likely to break.

Bulimia Nervosa: An eating disorder in which a person binges on food and then forces vomiting or abuses laxatives.

Calories: Units of heat used to express the fuel or energy value of food.

Diuretics: Drugs or substances that increase the production of urine.

Estrogen: A female hormone produced in the ovaries.

Immune System: The body’s natural defense system against viruses and bacteria that cause disease.

Laxatives: Products used to empty the bowels.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined from the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Osteoporosis: A condition of thin bones that could allow them to break more easily.

Progesterone: A female hormone that is made in the ovaries and prepares the lining of the uterus for pregnancy.

If you have further questions, contact your obstetrician–gynecologist.

TFAQ003:This information was designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Please check for updates at to ensure accuracy.

Copyright May 2019 by the American College of Obstetricians and Gynecologists

American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998