Travel medicine planning often skips contraception

When women visit travel medicine clinics before a trip, analysis of their pre-journey health needs often doesn’t cover contraception options and availability, a new paper warns.

Women who visit these clinics are told about vaccines and infectious diseases they might encounter, but it’s also important to discuss contraceptive methods, emergency options and potential gynecological issues, writes Dr. Sarah Borwein of the TravelSafe Medical Centre in Hong Kong in the Journal of Travel Medicine.

“We routinely recommend travelers carry self-treatment for travelers’ diarrhea, for example, but do not routinely recommend that women carry self-treatment for urinary tract or yeast infections, both which occur commonly during travel, are very unpleasant, and can be difficult to find treatment for,” Borwein told Reuters Health in an email.

“There are many options for contraception and managing ‘female issues’ during travel,” she added. “Not liking the pill is not a reason to skip contraception.”

Borwein says every travel medicine appointment should include consideration of contraception. Although few data exist about unintended pregnancies associated specifically with travel, travel medicine experts report that a significant number of travelers engage in casual sex, she said. Pre-travel appointments should include discussions about sexually transmitted infections, pregnancy, contraceptive methods, menstrual issues and complications such as urinary tract or yeast infections, she added.

For example, Borwein writes in her paper, contraceptive pills may be forgotten in luggage or left in hotel bathrooms, and it may be difficult to buy the pills in some countries. Furthermore, travel disrupts normal routines, which can lead to inappropriately timed or forgotten doses. Plus, stomach issues on the road may lead to vomiting or diarrhea and reduce the absorption and efficacy of the pill.

Borwein also points out that oral contraceptives are associated with an increased risk of venous thromboembolism, or blood clots in veins, and air travel itself adds to that risk. According to some studies, oral contraceptive use combined with air travel increases the risk 14-fold, she added. At the same time, non-smokers without other risk factors don’t typically need to stop oral contraception before air travel. Regular hydration and compression socks for long flights will be helpful.

On the plus side, the pill reduces menstrual bleeding, pain, acne and pelvic inflammatory disease. Pill packs can also be used back-to-back to skip an inconveniently timed menstrual period, which some travelers appreciate, she said.

Other contraception options include progesterone-only pills, Depo-provera injections, barrier methods such as condoms and diaphragms, and long-acting reversible contraceptive methods such as intrauterine devices and under-the-skin implants.

Importantly, Borwein noted, condoms are the only method that protects against sexually transmitted infections. But their failure rate for preventing pregnancy is 13%, so they should be combined with another contraceptive method.

Borwein also urges women and doctors to discuss emergency contraception for travel, to prevent pregnancy after an episode of unprotected sex or contraceptive failure. In some cases, it may be appropriate for travel medicine doctors to provide female travelers with an emergency dose, she added.

“Travel can be a time of adventure, increased risk-taking and increased sexual activity,” said Dr. Luu Ireland of the University of Massachusetts Memorial Medical Center in Worcester, who advises women with complex medical conditions about contraception.

“It is important to think about contraception during travel since dealing with a pregnancy may prove even more difficult abroad,” Ireland told Reuters Health by email. “It may be difficult to initiate prenatal care or deal with early pregnancy symptoms like morning sickness or bleeding ... (and) abortion services may be difficult, if not impossible, to obtain abroad.”