If you're someone who played sports or participated in a vigorous physical activity from a young age, then you may recall a time when a doctor or healthcare provider grilled you about your periods and whether or not you were eating enough. These questions are valid, considering many athletes grow up thinking that irregular periods are regular, and disordered eating is common. But these two health symptoms can be indicative of a more serious health condition called "female athlete triad syndrome."
This syndrome typically appears in young people who exercise intensely, and is marked by three symptoms: low energy availability, menstrual dysfunction, and low bone mineral density. Technically, you don't have to menstruate in order to meet the criteria for the syndrome, and male athletes can experience it too. For this reason, "female athlete triad" was recently renamed "relative energy deficiency in sports" or "REDS." Basically, REDS is what happens when your energy output surpasses your energy input to a point where it negatively affects your mental and physical health.
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It's pretty much impossible to say how common female athlete triad is, simply because the behaviors and symptoms associated with it are so normalized among athletes. Given the pressures that athletes face to perform at their peaks, it's common for them to develop eating disorders, which can then lead to irregular periods and osteoporosis. But many women don't realize they have REDS until their 20s and 30s when they're seeing a doctor for other health issues.
REDS can have long-term health consequences that show up throughout adulthood, explains Abby Bales, PT, DPT, CSCS, founder of Reform Physical Therapy, who works with athletes. "Lack of energy presents itself at different times in a female athlete's life, but also in male athletes," she says. For example, having low bone mineral density can lead to more frequent and severe injuries like stress fractures or bone breaks, she says. (Bone density peaks at age 25, and then declines or levels off after that, FYI.) And not getting a period for many years can make it harder to get pregnant. Some people might also be at risk of premature heart disease as a result of REDS. Understanding how your activity level growing up impacts your health later on will ultimately help your doctor treat these issues.
The good news is that REDS can be managed with treatment; the goal is to get a person's energy levels up and steer their period back to normal if possible. Treatment might include cognitive behavioral therapy to address disordered eating, learning more about nutrition and what will provide adequate fuel for activities, and decreasing physical activity, according to the American College of Obstetrics and Gynecology. Some people might need to take calcium or vitamin D supplements to help with bone mineral density, too. Another thing people can do to be proactive about bone health is to prioritize strength-training and lifting weights, which is shown to improve bone density, Dr. Bales says.
If this all sounds like it applies to you, it's wise to have a really open dialogue with your Ob/Gyn or trusted healthcare professional about your cycle, your past health history, and its overall effect on your body, Dr. Bales says. And remember that it's okay to point out when something seems abnormal. "In normalizing the infrequency of periods... we undermine women's health for the rest of their lives," she says.