Research

Energy balance

Persistent low energy availability (EA <125 kJ/kg FFM/day) in female athletes causes functional hypothalamic amenorrhea (FHA), impaired bone mineral density, and increased risk of musculoskeletal injuries, collectively known as the Female Athlete Triad.

If you are a female athlete training frequently, ensure you are eating enough to support your activity level. Ignoring this can lead to missed periods, weaker bones, and more injuries, even if you don't have an eating disorder. Use screening tools like the LEAF-Q to check for early signs.

GoodSupportsHIGH confidence
persistent low energy availability (EA), with or without an eating disorder (ED) present, may pose a significant health risk to female athletes... If maintained for a longer period, low EA can cause functional hypothalamic amenorrhea (FHA)... Low levels of oestrogen increase the risk for stress fractures and osteoporosis... restricted eating behaviour and FHA may also increase the risk for muscular and joint overload.
Anna Melin et al. · British Journal of Sports Medicine · 2014

Why this rating

Observational validation study with objective clinical measures (DEXA, hormones, blood pressure) in a specific population.

Source

The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad

Anna Melin et al. · British Journal of Sports Medicine · 2014

DOI 10.1136/bjsports-2013-093240

cross_sectional · n=84Cited 401×
Read the paper
DOI resolved against Crossref · corpus check 2026-06-10

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