Protecting women's health in sport: the role of low energy availability in the Female Athlete Triad and RED-S.

Background: The metabolic and physiological risks of the Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S) remain widely under-recognized in athletic populations. Low Energy Availability (LEA), often driven by disordered eating (DE) and eating disorders (EDs), serves as the primary driver of multi-systemic impairments. Materials and methods: This narrative review synthesizes evidence from 151 studies identified via the Scopus database. The selection process involved a careful screening of 1,589 records, focusing on the interrelationships between energy availability, disordered eating, menstrual function, and bone mineral density across various female athletic populations. Results: The synthesis confirms that LEA leads to profound endocrine disruptions, in which weight stability often serves as a deceptive metabolic mask for underlying impairments. A significant correlation exists between disordered eating behaviors and the onset of LEA, creating a cycle that compromises hormonal integrity. Menstrual dysfunction serves as a vital clinical barometer; the resulting hypoestrogenism disrupts bone remodeling, leading to site-specific skeletal vulnerability-particularly in the lumbar spine. Furthermore, psychobehavioral factors, such as Body Image Overestimation, were identified as potent predictors of energy deficiency. Conclusion: Protecting the female athlete requires a proactive, multidisciplinary framework involving medical professionals, coaches, and families. Effective management must prioritize restoring energy balance to normalize menstrual function and safeguard long-term skeletal health. Future research should focus on targeted nutritional strategies and screening tools to detect early signs of LEA and disordered eating.