From detection to management: the gap between screening tool validity and health-care provider preparedness for female athlete triad and red-s: a systematic review

  • Dally Rahman
    Universitas Andalas
    Indonesia
  • Jeki Haryanto 
    Universitas Negeri Padang
    Indonesia

Abstract

The female athlete triad and its broader conceptualisation as relative energy deficiency in sport (RED-S) describe the interrelated health and performance consequences of low energy availability, encompassing menstrual dysfunction, impaired bone health, and disordered eating. Despite growing recognition, questions persist regarding how female athletes are screened, how frequently the condition occurs, and how prepared health-care and support staff are to manage it. This systematic literature review synthesised evidence on the screening, prevalence, and health-care management of the triad and RED-S in female athletes. The review followed the PRISMA 2020 framework, searching Scopus, PubMed, and Science Direct for English-language research articles published between 2017 and 2026. The searches identified 1,093 records; after the removal of duplicates and records excluded by eligibility limiters and screening, 15 studies were included in the final synthesis. Three themes were derived: the development and validation of screening instruments, the prevalence of and factors associated with triad and RED-S components, and the knowledge and preparedness of health-care providers. Findings indicate that self-report screening tools such as the Low Energy Availability in Females Questionnaire are widely used yet perform inconsistently across sports, that risk indicators are highly prevalent, and that awareness among providers remains limited. The review underscores the need for context-specific screening protocols and structured, nursing-inclusive education. Future research should prioritise longitudinal and interventional designs and standardised health-care pathways.

Keywords
  • Female athlete triad
  • Relative energy deficiency in sport
  • Low energy availability
  • Screening tools
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