Is there such thing as too much exercise? The Female Athlete Triad explained

Can you ever get too much exercise? Is a strict diet and rigid exercise routine ever a bad thing? When does it get to be unhealthy? Does that toned and athletic build ever get to the point of affecting our health long term?

These seemingly healthy practices of a healthy diet and frequent exercise are healthy practices that we females all strive for. But with the media spewing out images such as fitness inspiration where women have excessively lean bodies with high muscle tone and low body fat, striving for this look can lead to health problems.

Women who participate in high levels of physical activity combined with negative caloric balance are at risk for developing a low body-fat percentage and therefore experiencing a condition known as the female athlete triad. The female athlete triad consists of three major conditions: amenorrhea (loss of a menstrual period), low energy availability with or without disordered eating and low bone mineral density1. Female athletes who have low energy availability are more likely to have decreased estrogen levels and subsequent menstrual dysfunction and bone loss, which can result in long-term consequences if not treated with a proper diet to retain body fat and a decrease in exercise2.

Women and girls participating in activities, which emphasize leanness, are the most at risk. Activities such as gymnastics, ballet, diving, figure skating, aerobics, running, weigh lifting and wrestling are a few sports that emphasize weight and body composition and can lead to the female athlete triad5.

Sub-optimal fueling can lead to both short term and long term consequences. If an athlete does not consume enough energy to meet her physical expenditures she will suffer from:

  • Dehydration

  • Depletion of glycogen stores

  • Low blood sugar

  • Abdominal pain

  • Increased fatigue

  • Constipation

  • Insufficient intake of nutrients for a normal metabolism2

If there are not enough nutrient intakes over a long period of time then the athlete will experience:

  • Suppressed immune system

  • Low libido

  • Hair loss

  • Brittle nails

  • Premature osteoporosis2

The energy availability hypothesis suggests that the primary regulator of female reproductive function is the availability of energy, not body fat or stress.

Women with extremely low body-fat percentages are at higher risk for developing reproductive system dysfunctions. Amenorrhea is the most common effect from low body weight, resulting in irregular menstrual periods.

According to the American College of Sports Medicine, a 20 year-old woman who experiences no menstrual cycle during her critical teenage growth period may have bone mass typical to a 70 year-old woman5. There is a four times greater incidence of stress fractures in women who do not have enough nutrient intake over an extended period of time4. It is important to address bone health as peak bone mass is established before the age of 30.

Treatment for the female athlete triad means addressing the underlying cause of the triad, low energy availability. According to Elizabeth Joy, MD, Medical Director of Clinical Outcomes Research at Intermountain Healthcare, through modifications in diet and exercise training, energy status can be normalized and a normal menstrual cycle will return4. Regaining a normal body weight will restore negative energy balance, cause a return of a menstrual cycle and improve bone health. Restoring weight gain within 95% of previous weight will tend to restore normal hormone levels1.

To put it simply, female athletes should meet adequate caloric needs to balance their energy expenditures in order to have available energy reserves and should consume a nutrient-dense diet of protein, carbohydrates and fats along with vitamins such as iron, vitamin D and calcium.

The desired look to be thin and lean in no way enhances athletic performance. Rather than focus on the lean and svelte look as seen in a Nike ad, we should strive to fuel our bodies in order to preform in the types of movement that makes us happy. Aim for balance and the body will reward you with the energy and vitality needed to lift that heavy dumbbell with grace and run those extra five miles.

1 Brown, J.E. (2010). Nutrition through the Life Cycle. (4th ed.) Cengage Learning, Belmont, Ca.

2 NCAA Sport Science Institute (2014). The Female Athlete Triad. Retrieved from

3 Bernardot, Dan. (2012). Advanced Sports Nutrition. (2nd ed.). Champaign, IL. Human Kinetics.

4 Joy, Elizabeth. (n.d.) Treatment of the Female Athlete Triad. NCAA. Retrieved from

5 American College of Sports Medicine (2011) The Female Athlete Triad. Retrieved from

#athletehealth #femaleathletetriad #fitnessnutrition #womenshealth

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