Travelling in africa and in world in general isn’t particularly hazardous to your health but women’s health issues are relevant wherever you go. And can be a bit more tricky to cope with when you are on the road.

Practicalities

It’s a good idea to take with you all the sanitary towels/pads/napkins or tampons you think you will need. Women all over the world menstruate, but they often have different way of dealing with it. In many countries, especially in urban areas, tampons and sanitary towels and pads are of good quality and are relatively easy to find. However in rural areas , tampons can be difficult or impossible to find and may be expensive or of poor quality. Sanitary towels are generally easier to obtain , but again you may not be able to find the quality or variety that you’re used to.

Disposal of used tampons and sanitary towels is a major concern , especially if you are travelling in remote or environmentally sensitive areas. It’s an issue that doesn’t only affects travellers, but you become more acutely aware of it when waste disposal systems are inefficient or nonexistent ,as goes for much of africans countries. There’s no easy answer to this problem, although from an environmental point of view the best- but no necessarily the most practical.  Option is to burn them. If you are in a rural areas, other options are to bury them deep in the soil carefully or carry them out with you and dispose of them carefully later.

Alternatively you could consider reusable items, such as washable sanitary towels. Which are available from specialist shops selling environmentally friendly product friendly products. Or tampons made from sea sponger which can be washed out in cold water and replaced. Again, there are practical problems, as both these options rely on you having access to adequate water and washing facilities- often in short supply when you you’re on the road.

Another option you could investigate is a rubber cap device which is worn in the vagina, similar to an upside down diaphragm. You need to remove it every six to twelves hours, give it rinse and replace it. Between periods you carry it in a cotton bag in your luggage.

You’ll appreciate that cleanliness is even more important when you are travelling, and  you’re going to want to wash your hands carefully before and after changing tampons. Remember that most infective agent in the vagina come from your own bowel. Toxic shock syndrome is rare but serious disease that can be associated with the use of tampons and, theoretically anyway, may be more likely in travellers. It’s thought to be caused by bacteria entering the blood stream from vagina. The risks are very low, however, if tampons are used hygienically.

MENSTRUAL-FREE TRAVEL

If all this sounds too daunting for words ( for example, if you’re going on trek in a remote areas) it possible to take measures to temporarily prevent menstruation. Incase you think you will need or want to stop your periods for any reason while you are away, it’s a good idea to discuss this with your doctor before you go.

If you’re taking the combined oral contraceptive pill, you could carry on taking the pill without the usual break.( or skip the seven days of inactive pills).Although it’s not advisable for more than three cycles at time and, if you’re unlucky you may have some breakthrough bleeding.

For a short trip, norethisterone (a progesterone) can be used to postpone menses. You need to start taking it three days or so before menstruation is due to begin and continue until the end of the holiday (for up to two to three weeks); menstruation occurs again two to three days after stopping. The dose is 5mg three times a day and side effects are rare but not suitable for long term use. It’s not a contraceptive.

Alternatively, an injected progesterone contraceptive produce light, infrequent periods or more none at all in most women. It great for when you’re travelling, but you need to have injection every eight to twelve weeks and the effects on periods is initially unpredictable.

PERIODS PROBLEMS WHILE YOU ARE TRAVELLING.

If you normally get periods pains and premenstrual bloating, you may find these are worse while you are travelling, for a variety of reasons, including physical and psychological stress unaccustomed heat and pronged immobility ( on long bus or plane journey). If you know that you are prone to these problem, take a good supply of a painkiller or any other remedies that you know work for you. You consider starting the oral contraceptive pills before you leave

Alternative or complementary remedies include evening primrose oil,which can be taken in capsule form or as the oil and vitamin B6, magnesium or calcium supplements. Herbal treatments that have been found to be helpful include Ginger and cinnamon tea is used in chinese medicine for menstrual problem.

You often find that your periods disappear or become irregular when you are on road, probably because of the mental and physical stresses of travelling and change to your usual routine. Other causes are pregnancy, drastic weight loss and hormonal contraceptive problems. Obviously the most important cause to exclude is pregnancy.

! New severe period pains can be a result of  infection eg sexually transmitted or tubal pregnancy ( if there’s a chance you may be pregnant), so seek urgent medical advice in this case.

If there’s no chance you are pregnant, there is usually nothing to worry about. Although if you don’t have period at all for more than three to four months it’s a good idea to get check up. Periods usually get back to normal once you have finished your travelling.

Light or absent periods are great, but you can find that your periods become heavier or more frequent while travelling. so to cope with this possibility take more supplies of towels or tampons than you think you’ll need.

!If you are having heavier periods than usual, you may develop anaemia- if possible, boost your diet with fresh fruits and green vegetables, or consider taking a multivitamin and iron supplements.

Heavy bleeding is often due to hormonal problems. If you suffer heavy persistent bleeding for more than seven days which show no sign of lessening and you are in a remote area and unable to get medical advice, you could try the following treatment. This is only for emergencies and you should not take it if there is any chance you may pregnant or if you have a history of gynaecological problems or are otherwise unwell-you must seek medical advice in all these cases.

If you can find it, take norethisterone ( a progesterone tablet) 5mg three time a day for 10 days. In case you are prone to unpredictable bleeding you might want to discuss taking a supply of norethisterone with you while travelling. Bleeding should stop by the end of the course and you should expect to have a period after about seven days of finishing the course. If the bleeding does not stop, you will need to seek medical advice urgently.

Abnormally heavy bleeding or long periods can be an indication of problem of problem with the cervix or womb; eg pelvic inflammatory disease, fibroids, miscarriage. So you should try to find a doctor to get it checked out as soon as possible.

MENOPAUSAL AND POSTMENOPAUSAL TRAVELLERS

Hot flushes can be worse while you are travelling as hot weather, spicy meal and any other sort of emotional upset can trigger them. It’s probably worth discussing this with your doctor before you go do you cna work out ways of dealing with it. For example if you are not taking hormonal replacement therapy, this may be an option to consider.

When you are travelling, you could try simple measures to keep cool.This includes wearing loose cotton clothing, not overexerting yourself, resting during the heat of the day and evening.Taking cool drinks and eating small frequent meals may help.

Dry, itchy skin can be a problem at and after menopause. The physical hazards of travelling can exacerbate this, so it’s worth taking particular care to protect your skin from sun and wind by using sunscreen and moisturiser.

Cystitis can occur at any age but is very common after menopause, and travelling can make an attack more likely. You’ll probably already know if this is a problem for you.

TRAVELLING ON HORMONAL REPLACEMENT THERAPY

As for the any medication, it’s best to take all you’ll think you’ll need with you. If you have implant, will it be due for renewal while you are away? If you’re swimming, or you’re going to be travelling in the heat, sweating may mean your patches stick less well. So you could consider changing to a tablet or gel preparation before you go.

If you’re taking a preparation that induces bleeding it may be possible to change to a different one that induces periods every three months instead of every month if a period is going to inconvenient while you are travelling. Periods can be postponed by manipulating your progesterone dose. But this can sometimes lead to heavy bleeding. So it’s best to discuss this with your doctor before leaving.

Hormonal replacement therapy makes you slightly more prone to thrombosis (blood clots) in your leg veins or lungs. This occur if you are immobile for long time, for example on long flight or bus journey; take regular walks and, when you’re sitting wriggle your toes and flex your calf muscles. Alternatively you could wear support stocking or tight. Drink plenty fluids-water as dehydration makes clotting more likely. If you’re going to be at high altitude for any length of time, it’s a good idea to discuss this with your doctor before you leave because this makes you more prone to blood clots.

If you have been on HRT for sometimes and you develop heavy or irregular bleeding while you are away. It could indicate a problem with the lining of your womb (eg thickening called polyps or even early cancer). You should seek medical advice as soon as possible.

BREAST LUMPS

If you notice an irregularity or lump in your breast while you’re on road, see if it disappears after your period. Incase it’s still there, and you’re going to be away for sometimes, seek medical advice so that it can be checked out. If you’re postmenopausal, it’s a good idea to have it checked out as soon as possible

CYSTITIS

This is an infection in the bladder, often caused by bacteria that normally live in the bowel. It’s a very common condition in women, probably because the urethra, the tube leading to the bladder, is short in women (compared with men, who relatively rarely get cystitis). This makes it easy for bacteria to enter the bladder. Also this is why bladder infections often occur after intercourse, and are more common in women who use the diaphragm for contraception.

You’re more likely to get cystitis when you’re on the road because you often have to hang on for longer, and you may drink less. The answer is to drink plenty  of fluids and empty your bladder at regular intervals.

Symptoms of cystitis include;
  • need to empty your bladder more frequent but passing small quantities of urine,
  • pain or discomfort on emptying you bladder and
  • lower abdominal discomfort
If you think you have cystitis
  • Drink plenty of fluids to help flush the infection out; citrus fruits juice or cranberry juice can help relieve symptoms
  • If available, an alkalinizing agent like potassium citrate, sodium bicarbonate or sodium citrate can help to relieve discomfort there are various brand names available over the counter.
  • Incase symptoms persist without improvement for more 24 hours despite these measures, you may need a course of antibiotics.

If you have the symptoms described earlier, you almost certainly have cystitis and it will almost respond to one of the antibiotics listed as follows. In case it does not, or if the symptoms recur quickly, you should seek medical advice. Urine test can be done to clarify what’s causing your symptoms.

Although traditionally longer course are used, there is good evidence that single dose treatment is just as effective. It’s also more convenient when you’re travelling. Single dose treatment options(avoid all three in pregnancy) include trimethoprim 600mg OR norfloxacin 800mg OR ciprofloxacin 500mg. Other antibiotics (suitable In pregnancy) include amoxicillin 3g take two doses 12 hours apart( if not allergic to penicillin). OR nalidixic acid 1g four times daily for seven days.

!if cystitis is left untreated, there’s a risk of the infection travelling up to the kidneys, which causes a much more serious illness. Symptoms of kidney infection include a high temperature, vomiting (sometimes) and pain in the lower back-you should seek medical attention in this case.

About a third o women with symptoms of cystitis don’t have an infection ( it may be a sort of irritable bladder’s syndrome). So it’s worth trying some simple non antibiotic measures first.

Also remember that ‘cystitis’ can be caused by a sexually transmitted infection, so you should get this checked out if you are concerned, especially if  you have any other symptoms like an abnormal discharge.

! If you know that you are prone to cystitis arrange to take a couple of courses of treatment with your medical kit before travelling.

THRUSH(VAGINAL CANDIDIASIS)

This common condition is due to an overgrowth of vaginal yeast, usually the species called candida ulbicans. Which is present normally in the vagina and on the skin. Symptoms include itching and discomfort in the genital areas and , often a thick white discharge.

A variety of factor, including diet, pregnancy and medication, can trigger the infection, which is normally kept at bay by the acid conditions in the vagina and the normal balance of organisms.

  • Heat
  • The oral contraceptive pill
  • Antibiotic and
  • Wearing tight trouser or nylon underwear can all make an attack more likely, so it’s no surprise that it’s even more common while travelling.

There’s no evidence that it’s a sexually transmitted infection, although it does make sense to treat your regular partner with an antifungal cream on the genital areas for five days.

To help prevent thrush while travelling, wear cotton underwear and loose-fitting trouser or a skirt, and maintain a reasonable cleanliness regime. It better to note that some soap can cause vaginal irritation, and upset the normal acid environment of the genital area, so are best avoided.

If you do get thrush, the most effective and convenient treatment is a single dose of a antifungal pessary(vaginal tablets) eg clotrimazole 500mg. Short courses of three to fourteen days  are available(eg econazole nitrate 150mg for three nights), but are less convenient. Alternatively you can use an antifungal cream(eg clotrimazole 1% OR econazole nitrate 1%) inserted high in the vagina(eg tampons) instead of pessary. You should use this treatment even during menstruation. Antifungal cream can be used in addition to a pessary to relieved vulval itching. A vaginal acidifying gel may help prevent recurrences.

!if you know that you are prone to thrush, take a supply of pessaries or cream with in your medical kit while you are travelling.

Other options, if you’re in remote area and can’t obtain medication, include using natural yoghurt to soothe and help restore the normal balance of organism in the vagina. You can use plain yoghurt directly on the valve or dip a tampon in it and insert in the vagina. Sitting in or washing with a weak solution of vinegar or sodium bicarbonate may help.

If thrush is really being a nuisance, you might want to try some non-specific strategies such as cutting down the amount of sugar and alcohol your diet, and drinking more of plain live yoghurt.

OTHER VAGINAL INFECTIONS

Although thrush(yeast infection ) is probably the best known cause of vaginal problems, and the some women are most likely to self-diagnose, it’s worth remember that it probably accounts for only 20-30%of all vaginal infections which a relatively small proportion. If think you have got thrush, but it’s not getting better with treatment, it may be another infection.

If you’ve got a vaginal discharge that is not normal for you (eg more copious, abnormal colour, smelly) with or without any symptoms:

  • Seek medical advice: you need a lab test to see what is causing it so that the most appropriate treatment can be prescribed.
  • Remember that sexually transmitted infections (for example gonorrhea) are an important cause of vaginal discharge. If you think you may be at risk, read the following section on sexually transmitted infections.
  • If you’ve had thrush before and you think you may have it again, it’s worth self-treating yourself, see previous section.
  • It’s best not to self-medicate with antibiotic because there are many causes of vaginal discharge which can only be differentiated with a lab test. The treatment details given here are for guidance only, after the diagnosis has been made.
The important causes of vaginal discharge are trichomoniasis and bacterial vaginosis.

Bacterial vaginosis is the most common cause of abnormal vaginal discharge. Although it’s more likely if you are sexually active, there no evidence that it is transmitted by intercourse. It’s not caused by any one organism. Instead there’s a general change in the whole vaginal environment, with the good guys, the lactobacilli that normally keep the vagina healthy, being replaced by a variety of other bad guys species. It can cause a wide range of symptoms, but the most common are odour fishy smelly and discharge white- grey. Treatment is with an antibiotic, metronidazole 500mg three times a day for seven days.

Trichomoniasis

It’s a sexually transmitted infection of the vagina caused by the organism trichomonas vaginalis. It often occurs together with other sexually transmitted infections. Symptoms include discharge thick yellowish, itchiness and sometimes discomfort on passing urine. Just to confuse things,  about 50% of women with the infection don’t have any symptoms. Men rarely have any symptoms, but partner must be treated to prevent reinfection.

Treatment is with antibiotic, metronidazole either as single dose 2g stat OR 250mg three times daily for seven days.

PREGNANT TRAVELLERS

The days of seeing pregnancy as an ‘indisposition’ are long gone, and many women either choose or end up  travelling while they are pregnant, without any adverse effect on mother or fetus. However, there are some important consideration to bear in mind if you are planning to travel while you are pregnant which I have summarized in this section. I stress that this to give you an idea  of the issues that may be involved-you should seek expert medical advice well before you plan to go any trip.

! If you’ve had complicated pregnancies before or you’re expecting twins, it would be best to postpone your trip.

WHEN?

Most doctor would suggest that the best time to travel in pregnancy is during the middle 12 weeks. This is when the risk of complication is less, the pregnancy is relatively well established and your energy levels are getting back to normal.

Before the 12th weeks, there is a  relatively with high chance of miscarriage. This could require treatment with a surgical procedure like a scrape of the womb lining and possibly a blood transfusion. Or it could be tubal pregnancy, which occur in about one in 200 pregnancies and nearly always requires surgical treatment- it’s an emergency situation. In addition many women experience morning sickness in the first three months (sometimes it may longer). This could make travelling less than enjoyable. Occasionally, it can be severe enough to require treatment in hospital. More mundane, but just as incapacitating for travelling, is need to empty your bladder more frequent as the enlarging womb takes up more room in the pelvis and presses on the bladder.

In the last three months, major complication s such as premature labour, blood  pressure problems and problem with placenta can all occurs, so you would probably not want to risk a trip of any length during this time.

!Note that most airlines prohibit flying after the 36 weeks of pregnancy. (sometimes this can be waived if you have a doctor’s doctor certificate to say that there are no complication). This is because they don’t want to risk a woman going into premature labour on a flight, not because there’s thought to be any intrinsic danger to the pregnancy.

IMMUNISATIONS AND MALARIA PREVENTION

Your best bet is to make sure you’re up to date with all your vaccinations before you get pregnant. Generally, it’s best to avoid all vaccination in the first 12 weeks of pregnancy, as there’s a theoretical risk of harm to the fetus they might increase the chance of miscarriage. In addition, so-called live vaccines should be avoided at anytime during pregnancy. Although sometimes the risk of the illness outweighs the harm the vaccine may cause. Live vaccine includes yellow fever and oral typhoid.

Note that an inactivated polio vaccine can be used instead of the usual oral live vaccine in pregnant women if necessary. A tetanus booster can be given safely in pregnancy, and tetanus protection is conferred to the newborn.

Hepatitis A  is a common illness in travelers that can be prevented by vaccination. In pregnancy it can be much more serious illness. So vaccination with the immunoglobulin injection or the new, more effective, vaccine is an important preventive step. And you should take special care with food and water.

Taking antimalarial is considered safer than risking the disease in pregnancy. However, it’s worth stressing that you should seek medical advice well before any trip, as most doctors would advice against going to malarial area while pregnant. If necessary, chloroquine and proguanil are considered safe in pregnancy, although a folic acid supplement may be need to be given with proguanil. Mefloquine can be used in the last 24 weeks of pregnancy, if travelling to a area of with a known high incidence of chloroquine resistance. If prevention fail, quinine is known to be safe in pregnancy for emergency treatment.

SPECIAL CONSIDERATIONS

All the preparation discussed in that section earlier apply to pregnant women too, but there are some special considerations too.

Be prepared, especially if this your first pregnancy. It’s a good idea to read up on pregnancy before you go so you have an idea of what to expect eg, tiredness and heartburn among other and be familiar with any with any minor problems that may arise. Discuss these with your doctor, and work out strategies for coping in advance.

Discuss with your doctor, but all pregnant women should avoid unnecessary medication. Don’t take any medications while you are away unless you know for certain that they are safe in pregnancy. It’s good idea to take a well stocked medical kit with you, having discussed fully with your doctor medication for common problems. This will help to be clear on what you should take and what shouldn’t take while you are away.

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