Women Travel

This is especially important since issues like contraception, pregnancy, safety and access to health care may not be addressed for women patients attending a travel clinic; and solutions for these problems may be especially difficult away from home

Contraception
Women traveling alone or with a partner need to consider their contraception issues. Even if they are not currently sexually active, contraception may be needed abroad. An oral birth control pill can help to prevent against pregnancy and against some diseases, (such as acne when using Diane 5). Enough pills should be brought for the whole trip. Some medical practitioners even recommend bringing 2-3 times the amount of all medications needed. Traveler's diarrhea is very common in travelers (it affects up to 50%) and may significantly decrease the absorption of the birth control pill. Many other medications may also do so, and woman taking any other medications should check for interactions with the birth control pill. Often over looked is the fact that even when taken correctly, the BCP gives less than 100% coverage, so women should always use an additional form of contraception. Barrier methods are essential in helping to prevent sexually transmitted diseases.

Emergency Contraception
Women traveling the world may become pregnant. Proper birth control methods, such as condoms and/or female condoms, should be arranged before you depart.

Morning After Pill
Many countries do offer emergency contraception i.e. the morning after pill. In Manitoba the "morning after pill" has been prescribed for women. The "morning after pill" includes several birth control pills, that when taken together, act to prevent the fertilization of an egg by sperm. Recently a formalized morning after pill has been developed- 'Plan B' which has greater effectiveness and less side effects than earlier versions of morning after pills.

Some Simple Facts about the Morning After Pill
The morning after pill has a greater chance of success if it is taken early, so a woman should not delay in asking for it and filling out a prescription from the pharmacy. It may be taken in the first 72hrs after unprotected intercourse.
The morning after pill is intended for women who might possibly become pregnant and will not affect prior pregnancies. Even if the morning after pill is used properly, it will not guarantee that a woman won't become pregnant. If a woman does become pregnant, their child will still be healthy, and having a pregnancy after using the morning after pill does not lead to birth defects. Taking the morning after pill may make a woman nauseous, similar to the early morning nausea of pregnancy.
This is because of the high amounts of estrogens. To counteract this, it is recommended to take some Gravol with the first morning after pill immediately and again in 12 hours, with the second pill.

Women Travelers seeking contraception:
The consortium for emergency contraception website will give travelers up to date information
about where they are going: http:/www.path.org/cec.htm
Emergency contraception website: http://not-2-late.com
Emergency contraception hotline: 1-888-NOT-2-LATE

Office of Population Research Emergency Contraception
http://ec.princeton.edu/worldwide/default.asp -this website provides information on emergency contraception
and is searchable by country.
Marie Stopes International
http://www.mariestopes.org.uk/abortion.html -provides information about emergency contraception, abortion, and sexual health by country.
The Centre for Reproductive Law and Policy
http://www.crlp.org/abortion1icpd.html -provides a list of countries where abortion is legal and explains what restrictions are in existence.
WHO Gender and Health Technical Paper
http://www.who.int/frh-whd/gaudH/Ghreport/gendertech.htm -article on gender and health.

Many other different methods of contraception exist.

Evra- the contraceptive patch
Evra is a new product for women that has been in the US for several months and recently has been introduced into Canada.
As a patch delivery system Evra is able to give women a continuous delivery of estrogen, as they would normally get from taking 21 daily contraceptive pills.
A new patch is put on every week for 3 weeks and then left off for one week. This has made it more convenient for women who, in the past, may have tended to forget to take their pills. There is even enough medication for 9 days. This means that there is enough forgiveness in the schedule even if a patch is left on for 2 days longer than scheduled, before being replaced.
These patches stay on well and cling even better than other patch systems like the nicotine, hormonal menopause patches or Duragesic (Pain patches) so young women can be active in swimming, hot tubs and all environments, without worries that the patch will loosen.

Who should not travel?
Healthy Pregnant women may travel, although the following groups are recommended not to travel:
Traveling is discouraged if:
-congenital or acquired heart disease
-history of blood clots
-severe anemia
-chronic lung disease
-obstetric risk factors

All pregnant women should be assessed early in their pregnancy, prior to their travel. PAP tests for all women are also recommended in order to screen for cervical cancer. Women going away for a year or more should get this done with their family doctor.

Vaccinations and Pregnancy
In general pregnant women should avoid vaccines that may have side effects that may affect them or the baby. The goal of immunizations and all preventative medical treatments are that the benefits of treatment should outweigh the risks of treatment and that no harm should be done. The following chart summarizes the characteristics of each immunization.

For further information on drugs in pregnancy, see: Organization of Tetrology Information Services: http://orpheus.ucsd.edu/CTIS/index.html

Suggestions For A Medical Kit For Women Travelers

Menstrual Supplies
-calendar
-supplies
- pad, moist towelettes, plastic bags
PMS medication (Ibuprofen, Mefanamic acid)
-medication for dysfunctional uterine bleeding
-premarin
-oral contraceptive pill
-Ibuprofen

Urinary Infections
-Ciprofloxicin 500mg PO BID x 3 days (also good for traveler's diarrhea)
-Macrobid 100mg PO BID x 7 days, if pregnant, urinary dipsticks

Vaginitis
Yeast infection (PH paper<4.5 likely to be a yeast infection)
-vaginal creams (Monostat)
-oral medication (Diflucan 150mg)
-mild soaps (Dove)
-change of breathable clothing

Bacterial Vaginosis (PH paper >4.7)
-metrogel cream, clindamycin cream, or metronidazole pills

Trichomonas (can be needed for women to diagnose themselves)
-metronidazole pill

Contraception
-chart to keep track of pills
-wrist watch timer to record when to take pills while crossing time zones
-male/female condoms
-spermacide
-pregnancy test
Emergency Contraception
-can discuss with doctor how to use the morning after pill
-available as Plan-B in Canada or use equivalent dose of birth control pills/gravol

Post HIV Prophylaxis
- if at high risk for unprotected sex.
This can be very expensive and people often get sick from the medication. Use updated recommendations

Pre-Menopause/Menopause
-vaginal dryness (estrogen cream)
-hot flashes
-estrogen replacement
-vitamin E
-Clonidine

Osteoporosis
-calcium
-vitamin D
-Fosamax

Pregnancy Supplies
-blood pressure cuff with stethoscope
-urine protein and glucose strips
-leukocyte esterase strips
-supplies for lactating mothers
-breast pumps/pads
-nipple cream

Personal Safety
-alarms
-pepper spray
-lessons in self-defense