Amenorrhea, estrogen deficiency, and low energy availability are associated with a rapid loss of bone mass and an elevated risk of musculoskeletal injuries. These disturbances have traditionally been considered to be secondary to energy deficiency and a suppressed hypothalamic pituitary–gonadal axis. Menstrual cycle disturbances are common in women performing prolonged strenuous exercise at competitive levels. Adjusting the menstrual cycle with HC would not provide any further benefit to the athlete’s competitive capacity. Fluctuations in endogenous testosterone levels were correlated with greater fatigability and muscle damage after the competition. A multivariate analysis demonstrated the protective role of testosterone against muscle damage and severe fatigue. Testosterone, estradiol, and the testosterone/estrogen ratio were significantly correlated with muscle fatigue and were found to be indirect markers of muscle damage. Furthermore, statistical differences were found in squat-jump and hand-grip test results after the ultramarathon. A repeated-measures analysis demonstrated significant differences in hematological values of CK and LDH pre-race as compared to immediately post-race and after 24/48 h. Strength measurements were obtained using the squat-jump and hand-grip test. Different variables were studied, including hematological parameters, body mass index, and body composition. Eighteen female ultra-endurance athletes were recruited to participate in the study. However, the influence of plasmatic sex hormones and the effects of different types of hormonal contraception (HC) on the modulation of physical performance in adult females remain to be fully clarified. In adult males, there is a clear association between physiological levels of endogenous sex hormones and physical performance. In recent years, increasing numbers of women have participated in extremely long races.
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