The race against the female athlete triad

Laura on the track

It’s a common belief among female runners: The lighter you are, the faster you are. It’s also believed that menstrual irregularities, or loss of periods, are a healthy part of competitive training. Neither is true.

That’s precisely what Laura Duff, a senior at Colby College and an avid runner, wishes she knew when she was in high school.

It was during the summer before Laura’s senior year of high school that she became more aware of how she looked. “I don’t know what switched,” she says, “I just became very aware, and started to restrict my eating and be more controlling.”

“I wish I could tell my high school self that worrying about your body isn’t worth it”

While part of her diet was intentional, another part was simply due to the structure of high school. Long days of classes and cross-country practice with little scheduled time for snacks and lunch made it hard to focus on getting enough calories. Soon, her weight started to drop.

The more she ran, the less she weighed, and when she finally fell down to 98 pounds, she stopped getting her period. “At first it was great, because who wants periods?” she says. “But when my doctor said my bone density was at stake, that’s when I got really scared.”

When female athletes lose their periods, it’s a sign of deficiency in the body that can result in decreased bone density. This interrelationship of calorie intake, menstrual cycles and bone health is commonly called the female athlete triad, and if a girl goes long enough without treating it, she could be at risk for serious reproductive and bone health issues as soon as high school or college.

“When my doctor said my bone density was at stake, that’s when I got really scared.”

Laura’s DXA scan (dual-energy x-ray absorptiometry) showed that her bone density was lower than it should be, putting her at a dangerous risk for stress fractures and even early osteoporosis. She gained a little weight per her doctor’s suggestion, and her periods came back intermittently.

When she entered Colby College as a freshman, her goal to run all three seasons of every year came to a halt when she suffered various hip and leg injuries. “I was the second-highest scoring freshman and on a national qualifying relay team, and then I lost my season,” she says.

For more on Laura’s story, watch this CBS news report:

At this point, she turned to Boston Children’ Hospital’s Female Athlete Program, where Kathryn Ackerman, MD, MPH, looked more deeply at her bone density. “My hips were getting the healthiest impact from my running, so they were fine, but my spine and wrists were low in density,” she says. Ackerman deemed her a classic case of the female athlete triad and recommended that she gain even more weight.

“At first it seemed frustrating, because I had already gained 10 pounds. But having a doctor who understands more than just bone density and periods, and who really knows what it’s like to be in the athletic community was huge,” says Laura. “She knew what was going on in my mind and in my body, and I trusted her.”

“Ironically, I felt my best when I was heaviest, and that’s also when I started beating my personal records.”

Laura knew better than to gain weight by loading up on junk food and instead focused on eating when she was hungry, adding healthy snacks throughout the day and lifting weights to gain more muscle. When she reached a healthy 122 pounds, she started having regular menstrual cycles.

“Ironically, I felt my best when I was heaviest, and that’s also when I started beating my personal records. It was so empowering for me to realize that the healthier I was, the faster I could run.”

Laura today

“I wish I could tell my high school self that worrying about your body isn’t worth it,” she says. “I wish I knew that what I was doing would impact my college running career, and that I would lose three seasons to bone-related injuries. I’ve come a long way after treatment, but who knows how much more I could have improved, had I not had to recover from so much?”

Now, as a senior in college, Laura looks back at her running career with pride and nostalgia. She has beat her own personal records, recovered from multiple bone and muscle injuries and has brought her body to the healthiest place it’s ever been. A double major in women’s health and biology neuroscience, and a leader in feminist and activist groups on campus, Laura is on a fast track to bettering the lives of other women around the world.

After all, she’s already done so for herself.

To make an appointment with a sports medicine expert at Boston Children’s Hospital Female Athlete Program, call 617-355-3501. Visit to download our helpful guides on health issues for female athletes.

Want to interact with more world-renowned sports medicine experts and Olympians, and learn how to stay as healthy as possible while competing? Register for the Female Athlete Conference: Strategies for Optimal Health and Performance today.