Posted on June 6, 2019

By Katherine Vadasdi, MD, director of the ONS Women’s Sports Medicine Center


It is well known the students of all ages benefit from sports and exercise. However, when girls and young women become too intense with training and overly restrictive with their diet, their health may be at serious risk.

Relative energy deficiency syndrome (RED-S), more commonly known as Female Athlete Triad Syndrome, occurs from a gross imbalance between the nutritional needs of a maturing female body and the amount of energy that is expended during sports or exercise.  Triad refers to three resulting conditions: disordered eating, amenorrhea, or the cessation of menstruation, and osteoporosis.

Many girls who develop this disorder try to lose or maintain a low body weight to improve their athletic performance.  Sadly, the opposite is more likely to happen.  Athletes with RED-S become more easily fatigued and their concentration is diminished.  If a girl doesn’t have enough fat on her body,  the muscles will be starved to supply energy to the body, making them weaker.

At a time in life when girls should be building bone mass that will support them throughout life, girls with RED-S have lower levels of estrogen. When combined with poor nutrition,  her bones to become thin and possibly deformed. Girls with early onset osteoporosis are more vulnerable to season-ending stress fractures, broken bones and other injuries. Internal organs, including the heart, also suffer.

Intense exercise and caloric restriction can decrease the hormones that regulate the menstrual cycle. This may compromise her reproductive system later in life.

Schedule an appointment with an ONS women’s sport medicine specialist or call (203) 869-1145


The girls at greatest risk for developing RED-S tend to participate in sports that classify athletes by weight, or those where there is a perceived advantage in appearing thin. Low self-esteem, a tendency toward perfectionism, and stress from school, peers or at home are compounding risk factors.


Because RED-S has physical and psychological factors, the most effective treatment is a team effort among doctors, coaches parents, nutritionists and professional counselors.

If you suspect someone you know is at risk for female athlete triad syndrome, it is important for her to see a sports medicine specialist who can recognize the signs of the disorder.  Left untreated, the toll on her body will have lasting effects that in extreme cases, can lead to death.

Girls can be protected from developing this serious condition if they are empowered to set realistic expectations for themselves. Moreover, they need to be educated about the healthy nutritional and hydration requirements for their level of daily activity. They should also understand the importance of sleep and rest to allow the body to recover. Stress management techniques such as meditation, yoga or other calming activities will help them build healthy coping skills that will be useful for a lifetime.

Schedule an appointment with an ONS women’s sport medicine specialist or call (203) 869-1145