The latest revisions to the Female Athlete Triad framework emphasise the importance of recognising energy deficiency in both female and male athletes, urging early intervention and multidisciplinary care to prevent long-term health consequences.
Recent updates to the Female Athlete Triad framework are sharpening how clinicians think about athletes who may be under-fuelling, missing menstrual periods or developing bone problems. The 2025 update, published in 2026 in Sports Medicine, keeps the Triad as a useful clinical model for girls and women in sport, while also recognising that Relative Energy Deficiency in Sport, or REDs, is the wider umbrella that can affect multiple body systems in both female and male athletes. The message for families and clinicians alike is that concerns about eating, training and growth should be taken seriously long before a young athlete reaches a crisis point. According to the new guidance, adolescent athletes need particular attention because low energy intake can interfere with puberty, bone-building and future skeletal health.
One of the clearest changes is the shift in language from low energy availability to energy deficiency. The authors argue that the old term is difficult to measure accurately in everyday practice and can miss the broader picture of how the body is adapting. The updated framework also makes room for several pathways into energy deficiency, including intentional weight loss, unintentional under-eating, food insecurity and compulsive exercise. That matters because an athlete may look healthy, maintain a stable weight or even perform well while still being medically compromised. The update also introduces the concept of metabolic compensation, describing the body’s energy-saving response through changes such as a slower resting metabolic rate and hormone shifts.
Another important addition is the inclusion of bone stress injury in the bone-health pathway. That reflects the close link between inadequate energy intake, menstrual disturbance, lower bone mineral density and overuse fractures. The reproductive side of the model has also been refined to show that a single menstrual bleed does not necessarily mean full recovery, especially if hormonal contraception is masking the return of natural cycles. For clinicians, the practical lesson is to look beyond the calendar: a period that appears to have restarted does not automatically mean the athlete’s endocrine system, nutrition and skeleton have fully recovered.
The accompanying REDs consensus from the International Olympic Committee broadens the lens further. It describes REDs as a syndrome caused by low energy intake relative to exercise demand, with consequences that can reach beyond reproduction and bone health to affect sleep, growth, mood, immunity and performance. The IOC guidance also stresses that this is not only a female issue and that male athletes and para-athletes can be affected as well. In practical terms, the consensus supports a multidisciplinary approach that includes medical, nutritional and psychological care rather than treating the problem as a simple matter of “eating more”.
For clinicians, the most actionable advice is to screen early and often, especially when an athlete’s weight, menstrual pattern, injury history, mood, training load or performance changes. The updated Triad papers recommend assessing eating-disorder risk directly, not just assuming the problem is accidental under-fuelling. They also warn against relying on weight alone, because athletes with a normal body mass index can still be energy deficient. Risk tools can help guide return-to-play decisions, but they are meant to support judgement, not replace it. The broader clinical message is straightforward: recovery should be measured by restored nutrition, healthier training, improved growth and bone health, and, where relevant, the return of normal spontaneous menstrual function , not by weight alone or by a single bleeding episode.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
