Contraception and menstruation can be a challenge for travelling women, especially on a long overseas trip. You may be used to taking the combined oral contraceptive pill which makes the monthly ‘curse’ lighter and more predictable.
But your GP won’t prescribe more than a six-month supply and you can’t always be sure whether it will be available on your travels. And after the two recent pill scares, you may be wondering just how safe it is to take the pill at all. So what should a woman do in the gynaecological department before setting off on a long overseas trip?
Those who need contraception and choose a hormonal method would be wise to get settled with it well before leaving home. As with arranging immunisations, this should be done months before your departure, since the longer you have to prepare, the more time you have to find your ideal contraceptive.
And there is plenty of time for a rethink if you have any troublesome side-effects. Women taking the pill for the first time, for example, need a couple of months before they can be sure whether it suits them or not. And if you are using this method primarily for period control, it may be more trouble than it is worth to start it just before your departure. (Those who are comfortable with their regular pill though could choose to run three packets together so that they only need have four periods a year.)
Although the pill is available in most countries, your regular brand may not be. The progestogen-only ‘mini-pill’ is certainly hard to find in many Asian countries. In Japan, for example, ‘normal’ steroid hormones, although available, were only licensed as oral contraceptives three years ago; they are very expensive there (equivalent to about £1,000 per year), and are regarded with suspicion, as well as being hard to find (the International Clinic in Tokyo might be able to help). It is probably best to ensure you have enough supplies for your entire time away – that may be by way of a private (paid) prescription from your GP.
The combined pill has come in for some harsh treatment by journalists recently. The pill is a combination of oestrogen and progestogen, an artificial form of a natural female hormone, progesterone. While these preparations give excellent contraceptive cover and have many health benefits, it has been established that the oestrogen component does increase the risk of blood clotting.
It has also been shown that women who take the newer ‘third generation’ pills, (which produce fewer side effects and are excellent in controlling acne and spots), have a higher risk of thrombosis than women on the older ‘second generation’ pills. The new Yasmine pill also seems to carry a relatively high risk of clots, although it is too early to assess the absolute risk.
Unless there are good reasons to be on a higher-risk pill, women who fly frequently may therefore decide to choose a second generation pill (containing the progestogens levonorgestrel or norethisterone, eg. Microgynon or Ovranette) rather than a third generation pill (containing desogestrel or gestodene, eg. Femodene, Cilest or Marvelon), or consider other methods of contraception.
This might be wise if long-haul travel is planned and especially if the traveller is a smoker, overweight, or if there is a family history of thrombosis. These conditions multiply the risks, so you should pay special attention to the precautions and prevention strategies summarised below if any apply to you. The progestogen-only ‘mini pill’ is safe from the point of view of clots and so is Levonelle-2, the emergency contraceptive.
The clot risk is still small whatever pill is taken, although clearly the consequences for the few women who have suffered a clot can be, and have been, disastrous. The press hasn’t helped us to put the situation into context or to fully understand the potential risks. Indeed the picture of how many women are actually affected is only emerging very slowly, since good, solid research takes years to complete.
If you are planning an extended trip, it may be worth considering using a progesterone implant (Implanon) which gives three years’ cover, or an intrauterine contraceptive device (IUD) which gives three to five years’ cover, depending upon the device used. Alternatively an intrauterine contraceptive system (Mirena) gives five years of contraception and monthly bleeding usually ceases.
Injectable ‘depo’ contraceptives have the advantage that they give contraceptive cover for 12 (Depo-Provera) or eight (Noristerat) weeks, and after some months of use, they usually have the pleasant side effect of stopping or considerably reducing menstrual loss. You can discuss the pros and cons of each method at a family planning clinic or with your GP.
