Since the implantation of Title IX in 1972, high school sports participation by girls has increased more than 800%. Because of this increase in sports participation, gender specific disorders and injuries have become apparent. A triad of disorders, referred to as the female athlete triad, has immerged as a group of disorders unique to female athletes. The triad includes amenorrhea, eating disorders, and osteoporosis.

Amenorrhea is the lack of a menstrual cycle. Primary amenorrhea is when menses has not every started. Secondary amenorrhea is when a girl starts menses and then stops menstruating. In sports, this can be due to the imbalance of energy into the system (food and drink) and energy utilized. The menstrual cycle is important because of the circulation of hormones that are protective to bones. Without menses, these protective hormones are not available in the quantities needed to promote bone building.

There is a spectrum of disordered eating including restrictive eating, food avoidance and calorie deficiency to the extremes of anorexia and bulimia. Any and all of these on the spectrum are dangerous. Anorexia nervosa is defined as weight loss of 85% of body weight. Women or girls suffering from this will have an intense fear of fatness and an abnormal perception of their body. Bulimia is defined as the recurrent purging for two times per week for 3 months. Both anorexia and bulimia may lead to amenorrhea. Women or girls suffering from an eating disorder are self critical of their body image.

Osteoporosis is defined as bone with less density and occurs when bone resorption exceeds bone formation. Both amenorrhea and disordered eating can lead to osteoporosis.

Treatment requires a multidisciplinary approach. This includes the collaboration of physicians, dietitian, psychologists, psychiatrists, families, coaches and athletic trainers. The underlying driver of poor body image anxiety and depression, and this should be identified and treated. Increasing caloric intake by 300 calories per day should be initiated to determine of the amenorrhea can be reversed. If it cannot be reversed as a result of dietary changes, birth control supplementation should be considered.