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Advice for women travellers


Menstruation

Emotional upset, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. Irregular menstruation is a very common problem affecting women travellers, excessive exercise and the stress of travel may cause infrequent periods, if this is the case it may lead to confusion over the timing of oral contraception and great anxiety of unplanned pregnancy. Dysmenorrhoea may also be aggravated by travel.

Contraception for travellers

Women travelling or living for prolonged periods abroad should be advised to find out what contraceptive services are available to them in the country/countries they are visiting. The International Planned Parenthood Federation (IPPF) and the Family Planning Association of Britain can provide extra information.

The Combined Oral Contraceptive Pill

Stomach upsets and severe diarrhoea reduce absorption and may leave inadequate protection. If vomiting occurs within three hours of taking the Pill a barrier method should be used as well, throughout the stomach upset and for seven days after it has ended i.e. 'the seven day rule'.

Oral contraception can be used to suppress menstruation

This is achieved by taking the pill continuously, without the usual seven-day break in between packets. A reminder to take extra packets to allow for this should be stressed. However, this method is not advisable for women taking biphasic or triphasic pills because the dose in the first seven pills is too low to prevent possible breakthrough bleeding.

The Progestrogen only Pill (POP)

For women taking the progestrogen only Pill the same rules apply as with the combined Pill. It is slightly less effective, 96 - 98%, and must be taken at the same time each day - this can pose problems when crossing time zones. However, it does have the advantage of not being affected by antibiotics.

Injectable methods of contraception (Depo-Provera and Noristerat)

Injectable contraception is not affected by time zones, gastrointestinal upsets and antibiotics.

Contraception and antibiotics (including doxycycline when used for malaria prevention):

While doxycycline is not a liver enzyme inducer, it could temporarily inhibit the enterohepatic circulation of ethinylestradiol. Additional contraceptive measures are therefore advised for the first 3 weeks when doxycycline is used for malaria prophylaxis. This does not apply to progesterone only contraception (see Journal of Family Planning and Reproductive Health Care (2005); 31(2):139-151)

Condoms

Reliable condoms are often hard to find in the poorer parts of the world. If the condoms carry the British Kite Mark or the new European CE mark it means that they have been tested to a strict safety standard. Rubber perishes with age, and heat, and should be discarded if it displays any signs of being brittle, sticky or discoloured.

Diaphragms/caps

They should be stored in a cool dry place in an airtight container, severe heat can perish rubber. Spermicides may loose their efficacy if not stored in cool, dry containers. Creams may melt and be difficult to apply and pessaries, which are designed to melt at body temperature, impossible to use.

Sanitary hygiene

Tampons and sanitary towels are unobtainable in parts of Africa, Asia and South America, and they are scarce luxuries in many of the former eastern block countries. Locally made menstrual supplies are usually available although the standard varies. Travelling women should be sensitive to the cultural and religious attitudes towards menstruation. In some countries it is forbidden to enter places of worship while menstruating and some cultures will not allow women to touch or even walk near food. To avoid such situations discreet use of and disposal of sanitary towels and tampons would be advisable.

Personal safety and security

When travelling, particularly alone, leave an itinerary of your trip with a responsible person contacting them at pre-arranged times and dates. Ostentatious displays of money, jewellery, luggage and dress can encourage the wrong type of attention. When travelling be aware of where your luggage, particularly hand bags, are at all times. Do not leave them unattended or hanging on the back of chairs in restaurants.
Choose your accommodation carefully:-
  • try and pick accommodation which is in a safe area i.e. not bang in the middle of the local red light district
  • request a room near the lift or stair well not on the ground floor
  • inspect the door locks and window fasteners
  • never open the door to your room until you have identified the caller
  • do not identify yourself on the telephone until the caller has done so
  • keep your money and valuables close by you at night.
Be alert, listen to the advice of locals and fellow travellers, develop a street sense, try not to be in the wrong place at the wrong time. In a confrontational situation a woman traveller is rarely a physical match for a man.
The following rules can help:
Don't turn a scary situation into a dangerous one if you can help it (e.g. it would be unwise to launch into a physical attack if the man confronting you is just after your money - hand it over and avoid finding out what he may do if provoked.) Don't panic or show fear or let the person confronting you to get the upper hand, try to gain psychological advantage throwing him off his balance i.e. compliance. If you do find yourself in physical danger try to anticipate the aggressors next move and plan ahead for it. As the innocent party in the confrontation you have the advantage of surprise, if you are forced to strike back physically, make sure it is a crippling blow that gives you a chance to escape. If you are worried about your ability to gauge dangerous situations and to defend yourself then consider joining a women's self defense course before travelling.

Personal safety when travelling alone

Insist on inspecting your accommodation before agreeing to stay. If unhappy with the room request a change or where possible move to different accommodation. The lone woman traveller will often be flouting convention simply by her presence. Unfortunately women in the developing world don't have the independence that their western counterparts take for granted. For this reason, their presence, especially unaccompanied, will generate interest within local people of both genders. Male dominated Muslim countries such as the Middle East, North Africa, Pakistan and parts of India and South America are frequently seen as difficult places for women to visit. How you dress is an easy method of self-preservation and the most immediate symbol of respect. Dress codes differ greatly from country to country and to get them wrong would put you at an immediate disadvantage. A culture's standard of dress has a lot to do with what parts of the body are considered to be sensuous or provocative. As a general rule tight and skimpy clothes are inappropriate for most countries outside of Europe and North America. Clothing should be conservative and presentable, loose fitting and comfortable. Arms and legs should be covered, especially when visiting places of worship and national monuments. Throughout the Arab world and in other Muslin countries, hair should be covered by a head scarf. When travelling try to be inconspicuous yet confident avoiding confrontational challenging situations with men by adopting an assertive, dismissive manner. Remember many men can see eye contact as a 'come-on'. The use of dark sunglasses will limit this problem. Be prepared to answer questions about yourself particularly if single and travelling alone. The often-asked questions of your marital status and family, are ones of genuine interest. To avoid the unwanted attentions of some men the use of a few white lies about 'your husband' and a fake wedding ring are a useful pretence.
     
     
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