Share this article on:

2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference Held in San Francisco, CA, May 2012, and 2nd International Conference Held in Indianapolis, IN, May 2013

De Souza, Mary Jane PhD*; Nattiv, Aurelia MD; Joy, Elizabeth MD, MPH; Misra, Madhusmita MD§; Williams, Nancy I. ScD*; Mallinson, Rebecca J. PhD*; Gibbs, Jenna C. PhD; Olmsted, Marion PhD; Goolsby, Marci MD**; Matheson, Gordon MD, PhD††

Clinical Journal of Sport Medicine: March 2014 - Volume 24 - Issue 2 - p 96–119
doi: 10.1097/JSM.0000000000000085
Consensus Statement
Blog Link

Abstract: The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves 3 components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with 1 or more of the 3 Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement represents a set of recommendations developed following the first (San Francisco, California) and second (Indianapolis, Indianna) International Symposia on the Female Athlete Triad. It is 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 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad 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. This consensus paper has been endorsed by The Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians, and other health care professionals, the American College of Sports Medicine, the American Medical Society for Sports Medicine, and the American Bone Health Alliance.

*Penn State University, Department of Kinesiology, University Park, Pennsylvania;

University of California Los Angeles, Los Angeles, California;

Intermountain Healthcare, Salt Lake City, Utah;

§Harvard Medical School, Boston, Massachusetts;

University of Waterloo, Waterloo, Ontario, Canada;

University of Toronto, Toronto, Ontario, Canada;

**Hospital for Special Surgery, New York, New York;

††Stanford University, Stanford, California.

Corresponding Author: Mary Jane De Souza, PhD, FACSM, Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802 (

Expert Panel: In addition to the authors above, the Expert Panel members were Michelle Barrack, PhD, RD, California State University Northridge, Northridge, California; Louise Burke, PhD, Australian Institute of Sport, Australia; Barbara Drinkwater, PhD, FACSM, Washington; Connie Lebrun, MD, University of Alberta, Edmonton, Alberta, Canada; Anne B. Loucks, PhD, Ohio University, Athens, Ohio; Margo Mountjoy, MD, McMaster University, Guelph, Ontario, Canada; Jeanne Nichols, PhD, San Diego State University, San Diego, California; Jorunn Sungot Borgen, PhD, Norwegian School of Sport Sciences, Oslo, Norway.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors report no conflicts of interest.

Received December 09, 2013

Accepted December 31, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.