Although most health problems related to travel are not specific to women there are some special issues that should be considered prior to travel. A gynecological check-up at least 6 weeks before departure, including a Pap smear & breast examination, is recommended prior to any extended travel.


MENSTRUATION
Tampons & sanitary pads can be extremely difficult to obtain in many less developed countries. Always take an adequate supply.


Irregular bleeding can occur due to hormonal changes as a result of time zone changes or disrupted routine. This usually settles down. It could represent pregnancy however & if there is any chance of this it should be confirmed as soon as possible.


CONTRACEPTION
Oral contraceptive pill


Those taking the oral contraceptive should be aware that it may be ineffective in cases of:


* Diarrhoea, vomiting or severe nausea
* Antibiotics (including the antimalarial doxycycline).
* High doses or vitamin C (in some jet lag pills).
* Missing a pill by more than 12 hours.


In such cases apply the "7 hormone days" rule, namely: use condoms during illness/medication course & for next 7 active pill days.


Time zone changes
It is better to keep home time for taking the pill while in transit & gradually adjust to a convenient local time when settled in the new time zone. Never be more than 12 hours late taking the pill.


Missing a period
For those who may prefer not to menstruate whilst travelling there is the option of taking the oral contraceptive pill continuously.


There are two types of pills-


1. Fixed dose (monophasic) regimens: Omit sugar pills & start immediately on the active pills in the next packet. This will delay a period by three weeks.
2. Triphasic or biphasic regimes. Omit sugar pills & take the last 7 days of active pills from a spare packet, then take sugar pills. This will delay period by one week.


The 3 monthly injection (Progesterone) is another option & should be discussed with your doctor.


Altitude travel
The "pill" increases the risk of blood clot formation, most commonly in the calf muscles or lungs. These can occur due to long periods of immobility such as on long plane or bus trips. They are also more likely to occur at high altitude.


Short-term travel at altitude poses no special problems. Those staying more than 4 weeks at high altitude (3700m or over) should discuss alternative contraceptive methods with their doctor.


Other contraceptives
* Diaphragms should be washed in purified water & stored away from direct heat.
* The 3 monthly injection (Progesterone) can be carried unrefrigerated & may be an option.
* Condoms should always be taken. In some countries they are often hard to obtain at short notice.


Emergency contraception
While safer sex or abstinence is recommended, sometimes emergency contraception ("morning after pill") is required. This must be commenced within 72 hours of the unprotected sexual intercourse. Discuss this with your doctor.


PREGNANCY
Travelling to less developed countries is not generally recommended in pregnancy. Live vaccines, such as polio, yellow fever, rubella should not be given. Malaria can be more severe in pregnancy & poses special problems for the foetus. Some antimalarial drugs are not safe in pregnancy.


Some antibiotics should be avoided in pregnancy & the use of iodine water purifiers is also not advised.


Insurance may not cover pregnancy & airlines are reluctant, & may refuse, to carry passengers more than 35 weeks pregnant.


INFECTIONS
Candida infection or Thrush is common in hot, humid environments & is exacerbated by tight clothing & synthetic materials. Antibiotics, including the antimalarial doxycycline also predispose to thrush. Medication for the treatment of thrush is not always readily available.


CYSTITIS
Cystitis & urethritis are quite common during travel & a urinary alkanizer such as Ural or Citravescent can be helpful. The Travel Doctor-TMVC can discuss a treatment course of antibiotics with you.


CULTURAL/SOCIAL ISSUES
Inappropriate dress & behaviour may be regarded as offensive and/or indecent in many parts of the world – particularly in holy places. Bare shoulders, tight fitting pants or shorts may provoke reactions best avoided. Find out what is acceptable in countries you plan to visit.


When travelling alone it is important to take extra care such as avoiding being out alone after dark, avoid hitchhiking, & ensuring that someone at home is aware of your whereabouts.