The last thing we need as we head to our unconventional life of freedom, is to be brought back to a structured reality of being bogged down by bottle feeds, nap schedules, and diaper bags. Sorry…there is just no room for babies in my backpack!
Although it teeters on the edge of TMI, I vowed to write an investigative report of birth control options for women who want to travel long term. With Harry quickly shooting down my (only half serious) proposition of a vasectomy, to some degree I knew I was on my own for determining what my plan was for birth control options while on our RTW. In my research, I found it was difficult to find firsthand accounts and advice for long term birth control. I was unfortunate to have to explore a bunch of options; however it provided me with lots of knowledge to bring to my readers. This post is long, but full of information and tips that I think was important to share. I hope that my story helps guide others in finding the right choice for them.
My Story I was currently on the NuvaRing which I LOVED! I didn’t have to take pills every month and under the consultation of a pharmacist, I was able to manipulate my cycle in order to avoid having a period during special events like vacations and anniversaries. The NuvaRing, however, requires refrigeration and from what I have learned is not available worldwide. It is also an expensive form of birth control even with insurance. Despite my very hard attempts to continue this form of birth control (I needed two physicians, two pharmacists, and one nurse practitioner to finally convince me), the NuvaRing just wasn’t a viable option. So here is my firsthand account of my decision making process:
1. IUD – This was the option I tried first. A fast, outpatient procedure to have anywhere from to 3, 5 (Skyla or Mirena which are hormone based), or 10 years of pregnancy protection (Paragard which is Copper based) sounded good to me. I chose Mirena and scheduled the appointment. This may not happen to most women, but during the procedure, my doctor told me my cervix was too small for the device. It eventually may fall out. She told me my only option was to go the birth control pill route which WAS NOT TRUE! I later found out that the Skyla IUD would have been a better option as it is smaller and the insertion tube narrower. My office didn’t carry it, so they didn’t suggest it. (Seems kinda shady, right?) Skyla is FDA approved for women who have not yet had children. Mirena is typically intended for women who have already had a child since their cervix has been expanded. I also had learned from a nurse practitioner later, that there is a pill that women can take prior to an IUD placement that will dilate your cervix to make insertion easier. I wonder had my doctor prescribed me this pill, or was willing to try Skyla if an IUD would have worked for me.
PERKS – Long term protection, one time procedure, may reduce blood flow
PEEVES – Expensive if your insurance does not cover costs of the actual device and insertion, may cause long term spotting/bleeding, can fall out, in rare cases some women experience complications such as infections or a ruptured uterus
2. BIRTH CONTROL PILLS – My second plan of action was to try birth control pills. The idea of toting around a year with of pills was not ideal, but I was willing to try this next. For U.S. citizens, Walgreens offers two generic pills (Mononessa and TriNessa) that you can get a 12-month supply for $144 USD (out of pocket) with their Prescription Club Rewards Program. The Rx program costs $20 USD, but brought the out of pocket expense down from $344 to $144, which was well worth the membership cost. I did convince my doctor to write a script for two years, but the problem of expiration occurs. Even if I were able to buy two years of pills right before departure, some of the pills would have expired on the road. That would have forced me to rely on someone to send me pills while traveling.
PERKS – Inexpensive, convenient, may be easy to get and cheaper while traveling (but I was not willing to risk not having a plan in place and didn’t want to worry about trying to locate a similar/the same pill while abroad)
PEEVES – Carrying around packs of pills (I want to travel light!), having to remember to take it at the same time every day to increase effectiveness (encountering time changes, ugh!), weight gain (I gained a lot of weight in the one month I took the pills and I did not like the way they made me feel. Unfortunately, I was running out of time to try different pills for months at a time to see what worked for my body. If you are new to birth control pills, start your search early to ensure that you find a pill that works well with your body).
3. CONDOMS – The only reason I address this one is because it came up too many times; “Why don’t you just use condoms?” Well, this is a personal decision and conversation, but let’s just say that for us, when we think of condoms, we think of Julia Roberts “profession” in Pretty Woman. This would be a last resort option.
PERKS – Cheap, easy to access, no hormone use or side effects for women
PEEVES – Loss of intimacy
4. BIRTH CONTROL CONTROL IMPLANT – I was starting to get desperate and running out of options. So I made an appointment with another OB-GYN who was highly recommended by a friend. After a 45 minute consultation, she had advised me to highly consider Inplanon, a match-stick sized rod that is inserted into the arm. We revisited the Skyla option, but to proceed I would have to get an internal ultra-sound. Many physicians are not trained to insert the implant, so I was referred to my local Planned Parenthood.
I made the appointment and had the procedure done last week. It was fast, however my arm did bruise heavily and it felt very strange in my arm for the first few days. In fact, after my compression bandage came off, I was convinced that it was placed incorrectly as the tip of the rod kept poking inside my arm when I flexed. However, I allowed some time for it to “settle” and each day I noticed it less and less. Another concern was scarring, but I have seen two women that have the implant and the incision point is hardly noticeable. After my procedure, I could not find progression photos online to help see what this thing is supposed to look like each day, so I did my own for your (icky) viewing pleasure.
PERKS – Three years of protection so “set it and forget it”, may stop periods all together
PEEVES – The removal procedure is harder than insertion, it may be difficult to find a trained professional to insert/remove it, there is bruising, pain and recovery time following the procedure, scarring, may cause continuous spotting/bleeding
*If you are moving from one form of birth control to another – START EARLY. I would allow for at least a 6 month+ window to find the option that works best for your body.
*If you are lucky enough to have a Planned Parenthood Facility in your area – SEEK THEM OUT! In hindsight, when beginning my long term birth control plan, I wish I went there first. They are highly trained in all things birth control and had options that my primary physicians did not even know about. Best to always consult with specialists!
*I thought these two websites were good for getting additional information such as side by side comparisons and learning more about advantages and disadvantages for all forms of birth control.
Told you it was TMI.
UPDATE If anyone has made it this far in this post, you are serious about birth control planning! Unfortunately, about 6 months after insertion of my Implanon implant, I started to experience breakthrough, nonstop bleeding and cramping. I decided that this Implanon was a great form of birth control because I could never have sex. So during a layover back in the United States, I had my implant removed. Planned Parenthood in Santa Monica, California quoted me approximately $80.00 USD without insurance.
Considering that NuvaRing worked so well for me and my body, after I had my implant removed, I was on a mad quest to continue to use this form of birth control. Unable to find forums or posts online, I vowed to do ongoing “research” so other women can find countries that will supply NuvaRings (and other birth control options) without the need for a physician’s prescription.
COUNTRIES WHERE YOU CAN PURCHASE NUVARINGS WITHOUT A DOCTORS PRESCRIPTION
Argentina (Mendoza) – The pharmacies in Mendoza sold NuvaRings over the counter for around $15 a piece. They were properly stored in the refrigerator at each pharmacy.
Taipei, Taiwan – 3/2017 – Our recent trip to Asia, we visited Japan, South Korea, Malaysia, the Philippines, Taiwan and Thailand. Southeast Asia always seemed more liberal and more accessible for finding medication. Sadly, this is NO LONGER the case! I asked almost every pharmacy that we came across if they carried the NuvaRing (showing photo to aid against any language barrier). The ONLY pharmacy that I found that carried the NuvaRing and allowed me to purchase them without a prescription was in a swanky neighborhood in Taipei. It was called Honesty Health Insurance Pharmacy. Below is their card that may help you locate it. You may need to ask a local or taxi driver for help. Cost $18 USD per NuvaRing. I purchased six and they were properly stored.
Thailand (Phuket) – The pharmacy in Patong Mall sold them each for 590 baht, or ~$20 USD over the counter. They were stored properly in the refrigerator and the staff was extremely professional.
UPDATE 1/13/17- Pharmacies in Thailand are telling me that they no longer carry NuvaRings due to decreased popularity. This will cause some trouble for us long term travelers wanting to use the NuvaRing! Look under the “What to Get” section here.
The Netherlands (Amsterdam) – After traveling through Europe, I finally found a place to purchase my next 6 month supply of NuvaRings. The Schiphol Airport conveniently has a 24-hour travel clinic that you do not need to make an appointment to visit. If you want to consult with a physician, a consultation was ~27€ Monday through Friday and 45€ on weekends. However, the pharmacy, located in Departure Hall 2 above row 16, told me that they would make an exception for travelers. As long as I could show proof that I was currently on the medication (e.g., empty box, the NuvaRing package) they would allow me to purchase the mediation without a script. Therefore, I bought another 6 month supply at 12,50 € each.
Split, Croatia –
With our extended, 90 day stay in Croatia, I needed to get a prescription to get my next 6 months supply. A friend provided the contact information of two local physicians that agreed to write me a script without an exam. I made an appointment with the doctor who quoted me the cheapest cost, 100 kunas. * The consult was quick and easy, however, during check out, the receptionist said the doctor wanted 200 kunas. I argued and showed the doctor proof of his initial quote of 100 kuna in an email, so I wasn’t happy feeling scammed. Here is the contact information to both physicians who stated they would provide a prescription for a year supply without an exam. Dr. Sparac- info@poliklinika (100-200 kunas*) Dr. Marko Mimica – email@example.com (250 kunas, 33 €)
UPDATE 4/2017 – I contacted both doctors who told me that they would no longer offer me a prescription for NuvaRings without a full exam. Although pharmacies in Croatia do carry them, due to decreased popularity they are getting harder and harder to find. I was able to get NuvaRings, but we went on a wild goose chase around Split trying to locate pharmacies that had them in stock. Many pharmacies in Croatia will order them from Germany, however, it takes about 2-3 weeks and the price is about $26 USD per ring (shipping costs increase the price). A prescription is now required.
Remember that if you store them properly, they can last until the expiration date. I keep them in the fridge during lodging, and while traveling they are inside a thermal folder with three ice packs that the Argentina pharmacy gave me with my purchase. On long flights, I ask the flight attendants for bags of ice to be on the safe side.
If you have found this information helpful, I’d love to hear from you!