Women's Travel Health

Pap smears are recommended every two years, so if you are travelling for an extended period of time, make sure your checks remain current. Depending on your age, it is a good idea to have a breast examination at the same time.

Tampons and sanitary pads can be difficult to obtain in many less developed countries. Always take an adequate supply. Some women prefer to take a re-usable menstrual cup if staying for extended periods in developing countries.

Time zone changes or a disrupted routine can affect your cycle and cause irregular bleeding. It usually settles down and should not be a cause for concern. Prolonged or heavy bleeding should be reviewed by a doctor.

Some women stop having periods while travelling. If there is any possibility of pregnancy, perform a pregnancy test as soon as possible.

Travellers taking the combined oral contraceptive pill (COC) should be aware that it may become ineffective in cases of:

• Diarrhoea, vomiting, or severe nausea.
• Antibiotics.
• High doses of vitamin C (contained in some jet lag pills).

Missing a pill by more than 24 hours.

The ‘seven-day rule’ is a simple way to ensure you are not at risk of pregnancy when taking the COC.

It takes seven days for the COC to prevent ovulation. If you get sick during your travels, or you miss a pill, use extra contraception methods or abstain from sex during the period of illness and for the following seven days of active pill. Skip the sugar pills if necessary so that you take seven active pills in a row. Take a copy of your pill instructions with you for more detail. The progesterone-only pill, or ‘mini-pill’ must be taken at the same time every day. Even missing the mini-pill by more than a few hours can result in pregnancy. Depot and injectable progesterone, IUCDs and the vaginal ring are not affected by any of the above, and may be a better option for long-term travel. It may be hard to buy the COC in some countries so always ensure you have an adequate supply before you depart.

The contraceptive pill must be taken every 24 hours, and it is better to take it early rather than late.

It is often easier to keep to home time when taking the pill and to gradually adjust to local time on arrival. If you are more than 24 hours late taking your pill the ‘seven-day rule’ applies.

Emergency contraception, or the ‘morning after’ pill, is effective up to 72 hours after unprotected intercourse, but can be taken up to five days later. The emergency contraceptive pill is not an alternative to other forms of contraception. Emergency contraceptive medication usually consists of two tablets taken 12 hours apart, and is available over the counter in many countries. If you have not had a period within three weeks of taking emergency contraception, it is important to get a pregnancy test.

Unprotected intercourse also puts you at risk of sexually transmitted infections. These occur at higher rates in some countries. If you believe you are at risk of infection, seek medical help as soon as possible.  Condoms should always be carried as a backup. They are often hard to obtain at short notice and not always of good quality in some countries. Take your own supply with you.

Combined oral contraceptive pills increase your risk of deep vein thrombosis (DVT). Prolonged immobility can also increase your risk, as can living at high altitudes. When flying, avoid alcohol and sleeping tablets, keep well hydrated, and exercise your legs regularly. Consider wearing properly fitted compression stockings. Consider alternate forms of contraception if you have other risk factors for DVT, such as smoking, obesity, varicose veins, or aged over 35.

High altitude travel can also raise the risk of DVT for women on COC. Consider alternative contraception if you are planning to stay at over 3500 metres for several weeks. The combined pill is definitely not recommended if you are spending over a week at very high altitude (4500 metres or higher).

Unexplained pain or swelling in either calf muscle is a warning of DVT. Stop taking your contraceptive pills immediately and seek medical advice.

Aspirin has not been shown to be effective at preventing deep vein thrombosis. It is associated with an increased risk of gastrointestinal bleeding and should not be used to prevent the condition.