Almost half of women who do sport in Spain are at risk of suffering from the female athlete triad

Women who perform more than three hours of exercise a week can suffer from what is called the female athlete triad, that is, a set of three disorders related to the deterioration of bone health, menstrual alterations and energy deficiency.

Research led by the Universitat Oberta de Catalunya (UOC) calculates that in Spain 40% of female athletes are at risk of presenting this condition. "All physically active women are susceptible to the female athlete triad, regardless of the sport practised, although men can also be affected," explains Laura Esquius de la Zarza, a researcher at the FoodLab – Interdisciplinary Group in food, nutrition, society and health, and attached to the UOC's eHealth Centre.

In the study, published in open access in the Journal of the International Society of Sports Nutrition, 1,154 women participated, from recreational practitioners to elite athletes from the High Performance Centre (CAR, for its Catalan acronym) of Sant Cugat del Vallès (Barcelona), aged between 15 and 45.

"There are factors that increase the risk of suffering from the female athlete triad, such as participation in aesthetic sports, disciplines focused on leanness or weight-category sports," highlights Ana Torres Dos Ramos, first author of the study whose doctoral thesis, supervised by Esquius de la Zarza, focuses on these disorders.

According to the authors, pressures on weight and appearance from the sporting environment, together with the exposure of athletes' bodies in certain competitive contexts, increase the risk of body dissatisfaction and, with it, disordered eating behaviours.

In this sense, the study shows that 24.3% of the athletes presented a risk of suffering a subclinical (incipient) eating disorder and 7.3% of recording a clinical eating disorder. However, "energy deficiency can develop through various pathways, such as intentional weight loss, without the existence of eating pathology, or involuntary insufficient intake," points out Esquius de la Zarza, a professor at the UOC's Faculty of Health Sciences.

How to prevent irreversible damage

The results can be considered representative of Spain as a whole. "The study had a large sample of physically active women comprising all levels of sporting participation —recreational, regional, national and international—. The analysis of demographic data confirmed a homogeneous distribution throughout the national territory, with representation from all Spanish provinces," underlines Torres Dos Ramos.

The data from the research, in which the CAR of Sant Cugat del Vallès and the Consorci Sanitari de Terrassa also participated, are in line with previous European research and confirm the real magnitude of the problem in Spain.

"40% of physically active women are at risk, an alarming figure that can translate into clinical and subclinical menstrual alterations —such as functional hypothalamic amenorrhoea—, low bone mineral density, infertility and a higher risk of stress bone injuries, among other health consequences. In the most serious cases, bone damage can be irreversible," lists Esquius de la Zarza.

To prevent these disorders, the authors recommend paying attention to the menstrual cycle and incorporating menstrual education programmes from an early age aimed at both sexes. Furthermore, access to up-to-date, quality information on the need for adequate food intake that covers all energy requirements is essential.

"The sporting and personal environment of athletes must be aware of the damage that certain pressures related to weight and body size can cause. It is necessary to eradicate gender stereotypes and beliefs far removed from evidence, such as the misconception that sporting performance or competitive success depends on body weight, as well as weight control practices that are discouraged and counterproductive," argues Torres Dos Ramos.

Underrepresentation in sports research

The next step of the research involves analysing all the information gathered in this work to provide useful results to health and physical exercise professionals. The aim is for them to become aware of the female athlete triad and its implications, given its high prevalence and the serious consequences it can have for health.

The researchers also denounce the underrepresentation of women in research in physical activity and sports sciences. "It has been reported that 6% of publications focus exclusively on women and a large part of current guidelines are based on studies conducted with male participants, whose results are generalised without considering the anatomical, physiological and endocrinological differences between sexes," maintains Torres Dos Ramos.

As the authors indicate, scientific evidence supports an approach based on equity in sport and exercise, committed to the eradication of gender stereotypes, prejudices and discriminatory practices, which would allow for the questioning of hegemonic discourses on women's bodies and moving towards a vision that accepts and celebrates body diversity.

This research is aligned with the UOC’s Planetary health and well-being and contributes to the following UN Sustainable Development Goals (SDG): 3, Good Health and Well-Being; 4, Quality Education; and 5, Gender Equality.

Reference article

Torres Dos Ramos, A., Bellver, M., Esquius, L., Martínez Pastor, I., Barea Monte, A., & Andrés, A. (2025). Prevalence of physically active females at risk for the female athlete triad in Spain, Journal of the International Society of Sports Nutrition, 22:1, 2590641. https://doi.org/10.1080/15502783.2025.2590641

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