Abstract
CLINICAL PRESENTATION & EXAM: A patient with Relative Energy Deficiency in Sport (RED-S) will often present symptoms of low energy availability (LEA), reduction in body weight (BW), fat mass (FM), and resting heart rate (RHR). In addition, there is disruption with gastrointestinal (GI) function and the menstrual cycle. RED-S symptoms typically start as LEA, then progress into decreased nutrient intake which can lead into the symptoms listed previously. Patients that experience RED-S are typically female athletes and tend to experience the symptoms during their sports season. Female athletes are more prone to RED-S because of the Female Triad. The Female Triad presents symptoms as LEA, menstrual disturbances with or without disordered eating, and low bone mineral density (BMD) or osteoporosis. ANATOMY & PATHOLOGY: RED-S is energy deficiency relative to balance of dietary energy intake and the energy expenditure required to support homeostasis, health, activities of daily living, growth and sporting activities. The Female Triad was first described in 1993 and again by ACSM in 1997 as a clinical syndrome involving disordered eating, amenorrhea, and osteoporosis, which was frequently being observed in physically active female athletes. Both syndromes impair physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. DIAGNOSTIC TESTING & CONSIDERATIONS: The diagnosis of RED-S and the Female Triad begins with a medical history and followed by a physical exam. The athlete may be asked about their level of fatigue, overall weakness, or if their menstrual cycles have been irregular. The athlete will be asked about past sport and training history, including hours of training per week, training loads, and/or a recent drop in performance. A high-risk diagnosis includes extreme weight loss and symptoms of other serious medical conditions. A moderate risk includes a significant weight loss along with irregular periods and stress fractures. A low risk is associated with the appearance of a healthy body and diet practices. The results from the medical history and the physical exam will determine the risk the athlete is for RED-S and/or the Female Triad. TREATMENT & RETURN TO ACTIVITY: The treatment of RED-S (female triad) should focus on a healthy diet, and an appropriate amount of rest to exercise ratio. Monitoring of BMD, menstrual cycle, gastrointestinal function, BW, FM, and resting HR should occur to ensure the patient is within normal levels before returning to activity.
Recommended Citation
Campbell, Maryn S.; Spindler, Lindsay; and Ruot, Chuck
(2025)
"Relative Energy Deficiency in Sports (Female Triad),"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
17, Article 168.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss17/168
Included in
Health and Physical Education Commons, Medical Education Commons, Sports Sciences Commons