No, this is not just a hypothetical problem that only the most anxious of us would come up with as we prepare for a trip. Timing is everything with daily birth control pills, and the last thing you want to deal with on a trip is an after-hours period, or worse, an unexpected and unwanted pregnancy. But with a little advance planning, OB/GYNs say you can figure out how to keep taking your birth control when you change time zones for optimal effectiveness.
Why timing is key for birth control pills
There are two main types of hormonal birth control pills, says Mary Rosser, MD, PhD, an OB/GYN and director of integrated women’s health at New York-Presbyterian/Columbia University Irving Medical Center. First, you have combined oral contraceptives (COCs), which use a combination of estrogen and progesterone to prevent pregnancy to prevent ovulation and fertilization of the egg. While perfect use of these pills involves taking them around the same time each day, COCs can be taken “at any time on any given day,” he says, as long as you take them within 24 hours of your last dose.
Meanwhile, progestin-only pills (POPs), also called mini-pills, work by making the cervical mucus thicker and the lining of the uterus thinner to prevent a fertilized egg from implanting. These pills only contain progestin (a synthetic version of progesterone), and often in lower doses than you’ll find in a COC. As such, the hormone stays in your system for only about 24 hours.
Taking your pill at around the same time every day ensures that your body is constantly getting the right amount of hormones to prevent pregnancy. “When the concentration or amount of hormonal contraceptives in a person’s bloodstream decreases, control over communication between the brain and the ovaries is lost. This loss of control translates into a loss of contraception,” says Rachel B. Danis, MD, a board-certified OB/GYN and REI at RMA New York.
The more you change your daily pill schedule, the greater the risk that the medicine will not work as intended. “The worst case scenario is decreased efficacy and an unplanned pregnancy, but the most common would be irregular bleeding or spotting,” says Christie Cobb, MD, a gynecologist and sexual medicine specialist.
How strict you need to be over time depends on the type of pill you take. Dr. Rosser says that missing your usual dose by a couple of hours on a COC is usually not a big problem, as long as you take it as soon as you can. With the Minipill, you has to take it within the same three-hour window each day. If you miss that window, you should take it as soon as possible, and then use a backup form of birth control, such as condoms, for the next two days.
How to keep taking your birth control pills when you change time zones
Traveling can already be chaotic, so remembering to bring your medications, let alone take them at the right time, can be a challenge when you’re crossing time zones. To stay on track, you need to find out what your home time is at your new destination, and then make sure you take a pill every 24 hours, regardless of time zone.
Let’s say you travel from New York to San Francisco, regressing three hours from your normal time. That means if you normally take your pill at 3 p.m. in New York, you’ll just take it at noon in the Bay, says Dr. Danis. If you’re traveling from New York to London, which is five hours down the road, I’d take it at 8:00pm while you’re in the UK.
Does a tip that Dr. Danis recommends work in any time zone? Set an alarm on your phone to remind you that he needs to take his pills. These alarms should automatically update to the time zone you’re in, so just set it to your regular pill-taking time and your phone will do the rest. (You can label the alarms so you know exactly what they’re for, even if you’re seriously jet lag.)
Where this gets trickier is if you’re doing a big time zone change. Suppose you are traveling from New York to Tokyo, which is 13 hours ahead. Sticking to your 3pm schedule would mean taking your pill at 4am while in Japan. (Not exactly ideal!)
If you’re going somewhere that requires crossing the International Date Line, which adds or subtracts a date from the calendar, making things more confusing, Dr. Cobb recommends consulting a time zone conversion app or chart, such as this one, to see what time your dosing time correlates to your destination. He also recommends raising any concerns with your doctor or pharmacist about taking your birth control pills when you change time zones. before you go.
If you’re taking a COC, you have more leeway to adjust your pill timing to something more reasonable and should aim to take one pill every 24 hours, says Dr. Rosser. In the Tokyo example, this could mean taking your dose before bed, or first thing in the morning, to avoid having to wake up at 4 a.m.
To maintain coverage with a POP, you need to stay close to your normal dosing time. If matching your regular schedule means waking up in the middle of the night, you can gradually change your doses two to four hours earlier, says Dr. Rosser.
To do this with the Tokyo example above, Dr. Danis says you could take your pill before bed at 11pm or midnight in Japan, which would mean your dose is about 18 hours instead of 24 hours, so you’d still be covered. Then he would keep this adjusted time on his trip and then readjust it when he landed back on the East Coast.
If you are determined to stick to the evening schedule of your pill, you could double the dose. “I would say take two tablets at a time the day you land in Tokyo, but also wear a condom for the first seven days or abstain in case there’s a break in hormones,” says Dr. Danis.
In general, all doctors recommend being cautious and taking the pill as soon as possible. If you forget to take your pills completely or mistime the timing, there is a greater chance that sex will result in an unwanted pregnancy. To stay covered, use backup birth control if you’re sexually active while traveling, says Dr. Cobb. “For the rest of that cycle, you want to use a barrier method, such as male or female condoms to decrease the risk of pregnancy,” she says. It’s not a bad idea to pack your own condoms so you’re not frantically searching on the spot or dependent on someone else having them.
5 Other Tips for Keeping Up with Your Birth Control While Traveling
1. Discuss your travel plans with your doctor beforehand
Before embarking on your adventure, Dr. Cobb advises talking with your doctor and making a plan for how to handle the time zone change. Ask questions and tell them how many hours in advance you’ll be so they can help you pinpoint the exact time to take your pills, or an ideal strategy for adjusting your dosage to the new time zone. He can also consult his pharmacist, who is equally qualified to answer questions about medication dosing and timing.
2. Take a photo of the pill instructions
Take a picture of your pill instructions so you know exactly what to do if you miss a dose. “Before you go on your journey, look at the package insert for your birth control, which is the folded piece of paper it comes with,” says Dr. Cobb. “Every birth control pill will have a table or paragraph (in that insert) telling you what to do if you forget to take a pill.” You can also use these instructions to plan what time to take your pills. That way, if something happens, you’ll have the relevant information for your specific medication right in your camera roll.
3. Pack enough pills for the entire trip
It sounds obvious, but double check that you didn’t forget your birth control pills and that you have a sufficient supply. Don’t rely on finding your pills far from home, because it’s never a guarantee that you’ll find your exact medication or have reasonable access to a pharmacy. “You’d be surprised by the phone calls I’ve gotten from all over the place,” warns Dr. Cobb. Be sure to fill your prescription well in advance of your trip, too; don’t add a frantic run to the pharmacy to your pre-trip checklist.
4. Pack your pills in your handbag
It sounds obvious, but be sure to pack your pills in your purse or carry-on, says Dr. Cobb. Never put your medications in a checked bag (and if you have to check a carry-on bag at the last minute, remember to take it out); Even the best planning doesn’t matter if your pills are stuck in a lost bag or in the cargo hold of a missed connecting flight.
5. Consider a different method of birth control
Depending on how long you’ve been gone, it may be worth switching birth control methods entirely if you know it will be a challenge to take your birth control pills correctly when you change time zones.
If you’ll be gone for at least a month, Dr. Cobb advises “strongly considering” swapping pills for a birth control patch or birth control ring, both of which require less frequent dosing, to minimize errors caused by time zone changes. Long-acting reversible methods of birth control, such as IUDs and implants, mean you don’t have to worry about this at all. “For my patients who are flight attendants or my doctors and nurses who have crazy hours, having that method is much more foolproof,” she says.