While “low energy availability” (LEA) affects both active males and females, we’ve observed a rising occurrence among women in these transitional stages. Perimenopause and menopause entail significant physiological shifts, often leading to misconceptions about body size and dietary habits. Many women, attributing their body changes to overeating instead of hormonal fluctuations, unintentionally adopt restrictive eating habits and engage in excessive exercise.

This behavior can potentially induce LEA, posing detrimental effects on bone health and overall well-being.

Understanding Low Energy Availability:

LEA refers to the body lacking sufficient energy to support essential physiological functions for optimal health. In simpler terms, it means not eating enough to sustain your body’s functions and the amount of exercise performed.  This imbalance prompts the body to conserve energy, resulting in cognitive (brain) fog, decreased energy levels, muscle building challenges, bone weakening, as well as compromised performance and hormone production. LEA can also disrupt menstrual cycles and sleep patterns.

All of these symptoms closely resemble symptoms of perimenopause and menopause. Exercise physiologist, researcher, author, and nutrition scientist, Stacy Sims PhD, likens this phenomenon to a phone operating in low battery mode, where processes slow down due to insufficient energy; only now the organs are organs functioning at reduced capacity rather than the apps. 

Identifying LEA:

Dr. Stacy Sims suggests that low energy availability involves consuming fewer than 30 calories per kilogram of lean body mass but recommends that women who engage in regular training aim for 45-50 kcal per kg of body weight. To determine if you’re experiencing low energy availability, consider this example: An active woman weighing 68 kg (150 lbs) with 19% body fat who burns around 500 calories daily at the gym would need to consume approximately 2,500 calories a day to surpass the 45 calorie/kg FFM benchmark.

This may sound high, as it challenges the prevailing notion that women should restrict themselves to 1200 calories daily – a damaging message propagated by diet culture, which may sabotage the physiology of most women, especially active or athletic women.

Impact of LEA on Bone Health:

After reaching peak bone mass around the age of 20, bones become a crucial storehouse of minerals, particularly calcium and phosphorus. Bone maintenance relies on the coordinated activity of bone-forming cells (osteoblasts) and bone-resorbing cells (osteoclasts). These cells are heavily influenced by factors such as hormones, stress levels, and nutrition. During periods of low energy availability, when the body does not receive sufficient energy from food, vital functions take precedence over bone maintenance. Consequently, bone remodeling may be compromised, resulting in a negative bone balance where bone resorption surpasses bone formation.

This imbalance can weaken the bones, increasing the risk of fractures. If left unaddressed, it may progress to osteopenia (loss of bone mass or bone mineral density) and, eventually, osteoporosis (when bone mineral density and bone mass decrease even further or when there are structural changes to bone tissue).

Additional Factors and how we can help:

Perimenopause and menopause mark significant transitions in a woman’s life. During these phases, estrogen deficiency exacerbates bone loss, heightening the risk of bone-related issues. Being in a state of low energy availability (LEA) can further worsen this problem, increasing the likelihood of developing osteoporosis. To mitigate these risks, it is recommended that women continue strength and resistance training (as well as plyometrics) and ensure adequate nutrition.

A good starting point is to maintain three balanced meals consisting of non-starchy vegetables, complex carbohydrates, and ample protein, with snacks as needed, especially around workouts. Additionally, incorporating calcium-rich foods, as well as sources of Vitamin K and Vitamin D, can provide further support for bone health.

Experience personalized nutrition support tailored for women navigating perimenopause and menopause with our dedicated team of nutritionists. Schedule an appointment today by calling our office at 206-853-0534  or click here. Additionally, if you’re currently grappling with perimenopause or menopause and seeking guidance, consider joining the Starkel Nutrition Peri+Menopause program. Discover how to navigate and care for your individual journey with expert guidance and support.

By Emina Suta, MS, RDN, IFNCP
Registered Dietitian Nutritionist | Functional Nutrition Certified Practitioner


  1. Wasserfurth P, Palmowski J, Hahn A, Krüger K. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. Sports Med Open. 2020 Sep 10;6(1):44. doi: 10.1186/s40798-020-00275-6. PMID: 32910256; PMCID: PMC7483688
  2. Dr. Sims. (August, 2023). Are You Draining Your Body’s Battery Power?https://www.drstacysims.com/blog/are-you-draining-your-body-s-battery-power
  3. Sims, S and Selena Yeager(2022). Next Level: The Performance Advantage of Multisport. Rodale Books. Chapter Nine.