Table 5

Female athlete triad: clearance and return-to-play guidelines by medical risk stratification51

Cumulative risk score*Low riskModerate riskHigh risk
Full clearance0–1 point
Provisional/limited clearance2–5 points□ Provisional clearance
□ Limited clearance
Restricted from training and competition≥6 points□ Restricted from training and competition-provisional
□ Disqualified
  • Reprinted with permission from BJSM.

  • *Cumulative risk score determined by summing the score of each risk factor (low, moderate, high risk) from the cumulative risk assessment (table 5). Clearance/RTP status for athletes moderate-to-high risk for the triad: provisional clearance/RTP—clearance determined from risk stratification at time of evaluation (with possibility for status to change over time depending on athlete's clinical progress); limited clearance/RTP—clearance/RTP granted, but with modification in training as specified by physician (with possibility for status to change depending on clinical progress and new information gathered); restricted from training/competition (provisional)—athlete not cleared or able to RTP at present time, with clearance status re-evaluated by physician and multidisciplinary team with clinical progress; disqualified—not safe to participate at present time. Clearance status to be determined at future date depending on clinical progress, if appropriate. Athletes diagnosed with anorexia nervosa who have a body mass index (BMI) <16 kg/m2 or with moderate-to-severe bulimia nervosa (purging >4 times/week) should be categorically restricted from training and competition. Future participation is dependent on treatment of their eating disorder, including ascertainment of BMI >18.5 kg/m2, cessation of bingeing and purging and close interval follow-up with the multidisciplinary team.