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2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad

Joy, Elizabeth MD, MPH, FACSM1; De Souza, Mary Jane PhD, FACSM2; Nattiv, Aurelia MD, FACSM3; Misra, Madhusmita MD4; Williams, Nancy I. ScD, FACSM2; Mallinson, Rebecca J. PhD2; Gibbs, Jenna C. PhD2; Olmsted, Marion PhD5; Goolsby, Marci MD6; Matheson, Gordon MD, PhD, FACSM7; Barrack, Michelle PhD, RD8; Burke, Louise PhD, FACSM9; Drinkwater, Barbara PhD, FACSM10; Lebrun, Connie MD, FACSM11; Loucks, Anne B. PhD12; Mountjoy, Margo MD, FACSM13; Nichols, Jeanne PhD, FACSM14; Borgen, Jorunn Sundgot PhD15

doi: 10.1249/JSR.0000000000000077
Nutrition and Ergogenic Aids

The female athlete triad is a medical condition often observed in physically active girls and women and involves three components: 1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone mineral density. Female athletes often present with one or more of the three triad components, and early intervention is essential to prevent its progression to serious end points that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement presents a set of recommendations developed following the first (San Francisco, CA) and second (Indianapolis, IN) International Symposia on the Female Athlete Triad. This consensus statement was intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the female athlete triad and to provide clear recommendations for return to play. The expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts.

1Intermountain Healthcare, Salt Lake City, UT; 2Pennsylvania State University, University Park, State College, PA; 3University of California, Los Angeles, Los Angeles, CA; 4Harvard Medical School, Boston, MA; 5University of Toronto, Toronto, Ontario, Canada; 6Hospital for Special Surgery, New York, NY; 7Stanford University, San Francisco, CA; 8California State University Northridge, Northridge, CA; 9Australian Institute of Sport, Australia; 10Washington; 11University of Alberta, Edmonton, Alberta, Canada; 12Ohio University, Athens, OH; 13McMaster University, Guelph, Ontario, Canada; 14San Diego State University, San Diego, CA; and 15Norwegian School of Sport Sciences, Oslo, Norway.

Address for correspondence: Elizabeth Joy, MD, MPH, Intermountain Healthcare, 36 S. State St., 17th Floor, Salt Lake City, UT 84111; E-mail:

Copyright © 2014 by the American College of Sports Medicine.