Caring for the female athlete: A guide for athletes, parents and coaches

Female-AthleteSince the passage of Title IX of the Education Amendment of 1972, the number of girls competing in high school sports has increased from 295,000 to nearly 3.2 million, and more women are playing collegiate sports than ever before. As these numbers continue to rise, and girls and young women become more empowered through sports, awareness of the health issues specific to female athletes has become increasingly important.

Dr. Kathryn Ackerman, medical director of Boston Children’s Female Athlete Program, and the program’s sports dietitian, Laura Moretti, share need-to-know information and offer strategies to keep young athletes healthy, on and off the field.

Get your nutrition on

Maintaining a healthy diet includes three key elements: a balanced intake of macronutrients (fat, protein and carbohydrates), micronutrients (vitamins and minerals), and avoiding fad diets, Moretti says.

The Athlete's Plate-Female Athlete_Boston Children's Thriving blog
The Athlete’s Plate

Moretti, a certified sports dietitian with the Female Athlete Program, feels strongly about educating her patients on the energy needs required to support their optimal health and performance. She helps athletes optimize their intake of macronutrients by using the below recommended ranges, referred to as “The Athlete’s Plate”:

  • fruits, vegetables, and whole grains (45-65 percent)
  • lean protein (10-35 percent)
  • healthy fats (20-35 percent)

Micronutrients, such as calcium and vitamin D, help reduce the risk of osteoporosis and osteopenia (bone loss and weakening). Though these conditions are mostly seen in adults, girls and young women need to follow a bone-healthy diet to build strong bones, prevent fractures and reduce the risk of early-onset osteoporosis. Milk, cheese, yogurt, rice milk, soy milk, fortified orange juice and leafy greens are all part of a bone-healthy diet. Download the nutrition guide. 

The hydration-dehydration trap

Dehydration is a common problem in young athletes, so drinking water before, during and after exercise is important to optimize performance and health. Symptoms of dehydration include feeling extra hot, tired, weak, nauseated or having a rapid rise in heart rate.

To maintain hydration while exercising, drink water every 15 to 30 minutes while doing the activity. Sports drinks are generally not necessary, though some athletes like to use them during vigorous exercise lasting longer than 90 minutes.

Menstrual cycle

For most girls, the onset of their periods (called menarche) occurs between the ages of 11 and 13, and approximately 98 percent of girls have their first period before they are 15 years old. Normal cycles occur about every 28 days, and some cramping and bloating may occur.

Athletes, especially those in sports that emphasize leanness, such as running or dance, may think that loss of menstruation is a healthy and sustainable means to increase performance. This is not the case: a disruption of normal menses can increase injury risk, negatively affect performance and jeopardize participation in future competitions.

“In the Female Athlete Program, we always ask about menstrual cycles, as we consider them another vital sign,” Ackerman says. “We care about menstrual cycles because they can be an indication of good energy balance and can be a screening tool for the female athlete triad.” Learn more about menstrual cycles.

Bone health 

Fact: Girls accumulate 90 percent of peak bone mass by the age of 18, and regular physical activity helps maximize bone mass even into adulthood.

Athletes, particularly those participating in weight-bearing sports, typically have a higher bone mineral density than non-athletes. However, excessive exercise and over-training can result in a negative energy balance and loss of normal periods, which puts a female athlete’s bone health at risk.

Fortunately, healthy eating habits and careful attention to training regimens can ensure long-term athletic success. Download the bone health guide.

Avoid overuse, cross train

Ackerman explains it is important for female athletes to not focus on one sport and encourages participating in cross-training and injury prevention exercises.

“Often athletes are in one sport and not getting the cross-training and strength training they need,” she says. “For example, basketball players should engage in strength training to minimize ACL injury risk by strengthening up their hamstrings, improving their glute strength, and learning proper landing biomechanics.”

Warning signs

If your female athlete is experiencing any of the following warning signs, Ackerman suggests reaching out to your child’s pediatrician or a member of Boston Children’s Female Athlete Program for assistance.

  • weight loss
  • irregular periods
  • disordered eating
  • signs of depression
  • anxiety

“Another warning sign is when your female athlete starts to look like she isn’t having fun in her sport,” she adds. “If she is really stressed and you notice a change in eating habits or increase in injury rate, it is time to re-evaluate the athlete’s interest in the sport.”

Key message: ‘Remember you are awesome.’

“I talk to superstar student athletes and the expectations for them have gotten so high that people sometimes have a hard time remembering to appreciate them,” Ackerman says. “We need to remind female athletes how excellent they really are and that they are doing a good job juggling it all.”

Female Athlete Conference

The upcoming Female Athlete Conference, June 9-10 at Babson College, will address these issues and other important topics affecting girls and young women playing sports. Female athletes, coaches, trainers and anyone involved in the evaluation and management of female athletes are encouraged to attend.

“At Boston Children’s, we have so many great resources for female athletes to get more informed about their health and performance,” Ackerman says. “I love seeing our patients taking advantage of these resources and feeling empowered as they become healthier and have more successful seasons.”

Learn more about the Female Athlete Program and the upcoming Female Athlete Conference.

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Kathryn Ackerman, MD, MPH, is a sports medicine physician, director of Boston Children’s Female Athlete Program and assistant professor in Medicine at Harvard Medical School.





Laura Moretti, MS, RD, CSSD, LDN, is a board-certified sports dietitian with a specialty in the treatment of athletes struggling with disordered eating and female athlete triad.