Female Athlete Triad

Featured Speaker

Colleen Dupuis, DO

Colleen Dupuis, DO

Colleen Dupuis, DO specializes in comprehensive, non-surgical treatments for a wide range of orthopedic and sports-related conditions, from routine sprains and strains to concussions, fractures, and arthritis.

About this Podcast

Sports Medicine Physician Colleen Dupuis, DO discusses the female athlete triad which is defined as the combination of disordered eating, amenorrhea and osteoporosis. This disorder often goes unrecognized. 


Caitlin Whyte: Welcome to Aspirus Health Talk. I'm Caitlin Whyte. The female athlete triad is a condition that often goes unrecognized by most women. To tell us more about this issue is Colleen Dupuis, a board-certified sports medicine physician. So Colleen, thanks for joining us today. Start off by telling us what is the female athlete triad.

Colleen Dupuis, DO: Hi, thanks for having me. The female athlete triad is a combination of female athletes having too low of energy availability for the amount of exercise that they are doing, having a menstrual dysfunction and then the third thing is having a low bone density 

Caitlin Whyte: And who are the type of women that get this?

Colleen Dupuis, DO: In general, we see it in endurance athletes, which might be our Nordic cross-country skiers, runners. A lot of times we'll see it in female athletes who tend to have a lower body mass for their performance, such as figure skaters, gymnasts, and dancers as well. 

Caitlin Whyte: What are some signs and symptoms that women can look out for?

Colleen Dupuis, DO: So one of the first things to look out for is making sure that you're getting enough food and energy intake compared to what your workouts are. A lot of times we'll see people become a little bit sluggish if they're not getting enough calories to make up for what they burn when they work out. So we look for kind of energy levels. We look for weight loss. We look for some chronic illnesses. Sometimes we'll see things like that.

Once that's kind of progressed, then we're looking really at women's menstrual cycles to kind of let us know how their body is holding up against this more intense form of exercise that they have started doing. And that can sometimes be in just period irregularities, where they might not be coming as frequently or they might be lighter than they had been as well as other range of it as a complete absence of having any kind of periods. 

Caitlin Whyte: So when it comes to female athlete triad, how can providers like yourself help?

Colleen Dupuis, DO: So the most important thing that we do is screen. We try and catch people early because if we can see that this is a problem early, it's a much more treatable problem. So talking to our athletes as they come in and asking them about their diet, are they having any kind of dietary restrictions? As their workout intensity increases, do they feel like their appetite goes up as it should? Or do they feel like they just haven't been eating any more than they had when they were in the off season? Asking those kinds of questions. 

Sometimes asking those hard questions about eating disorders. How do you feel about your weight? Have you ever tried to lose weight? What kind of mechanisms do you do to make sure that you're eating the right foods for your performance level and those kind of questions are some of the most important ones. 

Then making sure that we're screening for what their menstrual cycle is like, seeing what is regular for them, at what age did they start. Are they on any form of birth control that might be regulating their menstrual cycle? And so then we can't use that as one of our guides. 

And then last but not least is just asking about fracture history. Have you ever had a stress fracture? If so, you know, how many have you had? Do you know how you got it? Was there a reason behind it? Sometimes people will know, "Oh, I didn't do the correct progression into my training and it happened." And some people feel like, you know, they had been doing what they had always done and nobody screened them after for low bone density. 

Caitlin Whyte: And as we wrap up here, what are some tips you have for athletes to avoid this?

Colleen Dupuis, DO: For athletes, I think it's just important that they make sure that they're really looking at the amount of nutrition that they need for their level of performance. They should know that they're going to have times where their appetite is going to be greater and they really should listen to their body for that as well as paying attention to making sure that you're making up for some of the calories you lost during exercise, by having a post-workout snack or meal to regain some of those calories that were lost, usually that's best in the form of a little bit of carbohydrates and some significant protein. 

Also having them pay attention to their weight while not obsessing about it can be helpful. So maybe putting something down, saying, you know, "Weigh yourself once every two weeks. Don't look at the scale every day, just to make sure that you're maintaining your weight and it doesn't seem to be dropping without you even recognizing it."
If they have questions or concerns or show signs that they might be headed down the path of a female athlete triad, then usually I have the meet with a registered dietician to really go over what their normal diet is like as well as their exercise level, so they can see what they really might need for caloric intake in a day.

Caitlin Whyte: Thank you for joining us today, Colleen, and for telling us more about this lesser known condition. And thank you for listening to Aspirus Health Talk. For more information, visit us online at Aspirus.org. Please also remember to subscribe, rate and review this podcast and all of the other Aspirus podcasts. For more health tips and updates, follow us on your social channels. I'm your host. Caitlin Whyte. Stay well.