Women’s Travel Health: Periods and Prevention

Hive

Image: Hive

Adventure travel means lots of different things to different people.  For most, it means being a physically active and often times, in a remote or wilderness location.  Most women outdoor athletes and adventure travelers often have a similar problem, dealing with menses.  I have to admit that I have never known, personally, the problems of periods.  Often times, the physical demands and disruption of schedule frequently encountered in travel are large obstacles.  I have a lot of respect for those adventurers and travelers who undertake such journeys, especially while dealing with monthly health issues, such as menstruation.

Like with most things, I always find a refresher and a brief “read-up” on terms and issues helpful before undertaking a task.  Before this jumps into practical advice, a few terms, definitions and biology might be helpful. 

Stages and Control of Menstrual Cycles:

A woman’s monthly cycle can be divided in three basic stages:  menstruation, follicular phase and luteal phase.  The menstrual phase is the time in which active uterine bleeding occurs.  The follicular phase, largely controlled by estrogen, involves egg formation in the ovary.  Once released, the unfertilized egg becomes part of the luteal phase and secretes large amounts of progesterone.  This progesterone causes a build up of tissue inside the uterus, in preparation for egg fertilization and implantation.  After about 2 weeks, if fertilization does not occur this month, a rapid drop in estrogen and progesterone will cause this “built up tissue” to release and flow out of the body, as menstruation.

How Birth Control Pills Work:

Nateone

Image: Nateone

Most “birth control pills” use a combination of both estrogens and progesterones to prevent egg release and regulate menstrual cycles on a 28-30 day time frame.  Through a complex system of feedback inhibition of other hormones, the end result is preventing an egg from being released.  No egg means no pregnancy.  A typical pack of OCP’s (oral contraceptive pills) only contains active medicine for about 21 days, even though women take 28-30 pills per month.  The last 7 days of the pill-pack are inactive, meaning they contain no estrogen or progesterone.  This sudden withdrawal from these hormones is what signals your body to begin menstrual flow.  Four days later, when the next month’s pack is started, the estrogen and pregesterone cause the menstrual flow to stop and the cycle begins again.

How This Helps Travelers:

A 2 week rafting trip, remote mountain hiking and honeymoons are times when most women do not want to have a period.  In fact, most women I know never really want a period, but are especially looking to avoid it during their travels.  By understanding how the OCP’s work, we can use them to our advantage.

For those women already taking birth control pills, a realistic option is to simply skip the last 7 tabs of a monthly pack and simply start a fresh pack, the next day.  This will effectively prevent you from having a period that month.  This is how some of the newer OCP’s are able to offer only 3 or 4 periods, per year.  They have eliminated the inactive pills from a monthly pack and are supplying estrogen/progesterone continuously for 3 or 4 months.  Most researchers agree that skipping three or four months of periods is fine, but one should not skip more than that. 

Other Options:

nuvaring_compressedNuvaRing is a self-implantable contraceptive device that can be used to skip periods, as well.  A small, drug coated, plastic ring is placed by the woman, inside the vagina for three weeks.  Typical use involves keeping the ring inside the vagina for 3 weeks, then removing it at the beginning of week four.  The removal of the ring causes mensis during the last week of the 4 week cycle, when there is no ring being used.  At the end of mensis, a new ring is re-inserted for three additional weeks.  Simply using the ring for three weeks and immediately placing a new, fresh ring will prevent mensis that month.  This usually buys 8 weeks of no period, in a very easy to use manner and does not require taking a pill everyday, making it a great option for forgetful people.  Also, the ring uses a lower amount of estrogen and typically has less side effects (nausea) than oral pills. 

Injectable contraception, such as Depo-Provera, can prevent periods for up to three months.  Typical use is one injection, in the arm or gluteus, taken every three months.  This is also an effective form of birth control.  Mid-cycle spotting can occur and menstrual irregularity after stopping use is common.

Problems:

Choosing to skip a period is not entirely without risk.  Mid-cycle spotting can occur, which is exactly what is trying to be prevented.  This is generally caused by a body’s inability to react to the new levels of circulating hormone.  Should full menstrual type bleeding occur, one can stop taking the OCP’s for three days and then restart. 

Nausea and vomiting can occur with use of estrogen/progesterone OCP’s, even more so when used for longer periods of time.  Taking the pills at the same time each day and eating a snack after the pill can help.  Crackers or plain bread seem to work well.

There is an association with estrogen/progesterone contraceptive pills and blood clot formation (Deep vein thrombus, DVT).  This risk is increased in women who smoke and even more likely in women over the age of 35 years, who smoke.  Simply, those who smoke need to stop, especially if they are taking OCP’s or any form of estrogen/progesterone for hormonal effects.  For smokers over the age of 35, another method of management is advised, as the risk of DVT is too great.

A woman’s choice to use or not use contraception is a very private and personal matter.  There are many effective methods that can be used to control when a woman does and does not get a monthly period.  Like with anything, each situation is unique and what works for some people may not work well, for you.  As always, this is intended to help the female traveler open a discussion with their personal healthcare provider about menstrual regulation and options that are right, for them.

Resources:

Delaying your Period with Oral Contraceptivesat MayoClinic.com

Menstrual Cycle at Wikipedia.org

Seasonale and SeasoniqueOCP’s (Four periods per year)

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