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Contraception for Travellers

Introduction

Contraception can be difficult to obtain in many countries and certain types of contraception may not be available. Before travel, you should consider if your current contraception is suitable for your trip and check if it will be available in the country or countries you are travelling to.

If you are planning on changing the type of contraception you use, you should allow enough time in advance of your trip to try out your new method to make sure it is suitable. There is more information available on the following websites:

Unprotected sex can put you at greater risk of catching sexually transmitted infections (STIs). Even if you do not plan to have unprotected sex, feeling more relaxed, alcohol and/or drug use or experiencing loneliness during travel can cause you to behave in unplanned ways. You should therefore take a supply of condoms with you when travelling.

Oral Contraception

Delaying your Period

There may be occasions when travelling that you might want to delay your period (menstruation). This can be done by taking the combined oral contraceptive pill (COCP).

  • More information on how to take the COCP to delay your period is available on the NHS Inform website.

If you are not already taking the COCP, it may be possible to obtain a prescription for the COCP so that you can delay your period when you need to.

  • You should contact your GP, practice nurse, pharmacist or contraception clinic to discuss this option further.

You cannot delay your period through taking the progestogen only pill (POP).

Crossing Time Zones

Oral contraceptives (commonly known as "the pill") should be taken at the same time each day. If you are crossing time zones during travel, you will need to consider when you will take your pill.

  • Specific information on the timeframe margins between taking your pill can be found in the patient information leaflet that comes inside your medication packet.

The following contraceptive methods are not affected by crossing time zones:

  • injection (Depo-Provera, Sayana Press or Noristerat)
  • implant (Nexplanon)
  • intrauterine system (IUS) ‘hormonal coil’
  • intrauterine device (IUD) ‘copper coil’
  • vaginal ring (NuvaRing)
  • patch (Evra)

Antibiotics

Most types of antibiotics don’t affect contraception. The antibiotics rifampicin and rifabutin can affect the oral contraceptive pill and reduce the protection from it. You do not need to use additional contraceptive precautions if you are taking doxycycline (an antibiotic often used for preventing malaria).

  • More information is available on the NHS Inform website.

If when you are travelling, you have to take antibiotics for any reason and they cause you to experience vomiting or diarrhoea symptoms, then you will need to take extra contraceptive precautions. More information on this can be found in the vomiting and diarrhoea section below.

The following contraceptive methods are not affected by antibiotic use:

  • injection (Depo-Provera, Sayana Press or Noristerat)
  • implant (Nexplanon)
  • intrauterine system (IUS) ‘hormonal coil’
  • intrauterine device (IUD) ‘copper coil’
  • vaginal ring (NuvaRing)
  • patch (Evra)

Vomiting and Diarrhoea

Experiencing vomiting and/or severe diarrhoea (having at least 6 to 8 episodes of loose or watery stools (poo) over 24 hours) may interfere with the absorption of your contraceptive pill. The advice on what to do varies depending on the type of pill that you are taking.

If you are taking the combined oral contraceptive pill (COCP):

  • If you vomit within 3 hours of taking your pill you should take another pill as soon as possible.
  • If you continue to vomit or have severe diarrhoea, you should also use a barrier method of contraception (such as condoms) and continue using these throughout your stomach upset and for a minimum of 7 days after you recover.
  • You should always refer to the package insert leaflet for specific instructions for your brand of COCP.

If you are taking the progestogen only pill (POP):

  • If you vomit within 2 hours of taking your pill you should take another pill as soon as possible.
  • If you continue to vomit or have severe diarrhoea you should also use a barrier method of contraception (such as condoms) and continue using these throughout your stomach upset and for a minimum of 2 days after you recover.
  • You should always refer to the package insert leaflet for specific instructions for your brand of POP.

The following contraceptive methods are not affected by gastrointestinal upset:

  • injection (Depo-Provera, Sayana Press or Noristerat)
  • implant (Nexplanon)
  • intrauterine system (IUS) ‘hormonal coil’
  • intrauterine device (IUD) ‘copper coil’
  • vaginal ring (NuvaRing)
  • patch (Evra)

Other Methods of Contraception

Long term contraception

Some contraceptive methods provide long term protection, lasting for months or years.  These methods include the contraceptive:

  • injection (Depo-Provera, Sayana Press or Noristerat)
  • implant (Nexplanon)
  • intrauterine system (IUS) ‘hormonal coil’
  • intrauterine device (IUD) ‘copper coil’

Before you leave, you should check that the method you are using will continue to be effective for the duration of your planned trip. If your method of contraception needs to be updated before you travel, you should allow enough time in advance of your trip to make sure your new contraception method is suitable.

Condoms

Safe and reliable condoms may be difficult to find in some countries. You should look for condoms that have the British Kite Mark or the European CE mark as these have been tested to ensure quality.

Used properly, condoms can provide effective contraception and protect you against STIs. However you should be aware that latex condoms are easily damaged if they come into contact with oil-based lubricants such as petroleum jelly (e.g.Vaseline), baby oil and suntan lotion. Condoms also perish with age and heat, and should not be used if they are out of date or show any signs of being brittle, sticky or discoloured.

Diaphragm/Cap with Spermicide

Excessive heat can perish rubber and reduce the effectiveness of spermicides in a diaphragm / cap if they are not stored correctly.

  • After removal, contraceptive diaphragms or caps should be washed in clean water that would be considered safe enough to bathe in using a mild unscented soap.
  • The cap should be dried off thoroughly and then stored in an airtight container in a cool, dry place.

Emergency Contraception

This is often referred to as the ‘morning after pill’. However, the copper-coil (IUD), which is the most effective form of emergency contraception (EC), can also be used.

In many countries, there can be great difficulty in obtaining emergency contraception and you should consider the availability of contraception services in the countries that you plan to visit.

  • Where would you obtain replacement contraceptive pills if yours were lost or stolen?
  • Where could you obtain emergency contraception if you have unprotected sex or your usual method has failed?

As it can be difficult to obtain EC, you might want to consider taking a supply of stand-by emergency contraception with you. You should discuss this option with your GP, practice nurse or usual contraception provider.

In the UK, emergency contraceptive pills can be obtained from GP surgeries, family planning and sexual health clinics, pharmacies and some emergency room or minor injury units.

  • You should be aware that they will only supply you with EC if you need to take it immediately and would not be able to provide you with EC to take with you abroad.

Deep-vein Thrombosis Risk

If you are taking the combined oral contraceptive pill (COCP) or using a patch or vaginal ring for contraception, then you have an increased risk of developing a deep-vein thrombosis (DVT or blood clot) during any travel which is over 4 hours in duration. This is due to the long periods in which you will be sat in a confined space and unable to move around (immobile). You can reduce your risk of developing a DVT or blood clot during travel by exercising during your journey and using anti-embolism stockings.

Altitude and Combined Hormonal Contraception

If you are travelling to an altitude of 4,500m or higher and are taking the combined oral contraceptive pill (COCP) or using a patch or vaginal ring for contraception, you have an increased risk of developing blood clots (thrombosis). In this instance, you should contact your GP or usual contraceptive provider in advance of your trip so that you can discuss your risk and consider swapping to a different contraceptive method if necessary.

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