High-altitude medicine

ZONE OF KNOWLEDGE

Women acclimatize to altitude in a similar way to men. No significant differences have been found in respiratory acclimatization between the sexes, although progesterone increases ventilation and the respiratory response to hypoxia. The incidence of acute mountain sickness (AMS) in women is also similar to that in men.

The incidence of AMS does not depend on the phase of the menstrual cycle. Some sources indicate that high-altitude pulmonary edema (HAPE) occurs less frequently in women than in men. However, facial or lower limb swelling is more common in women. There are no data indicating a different course of high-altitude cerebral edema (HACE) in women.

HYGIENE AND PRACTICAL TIPS

In difficult mountain conditions, urination can be challenging, especially in a tent. It may be helpful to bring a bottle with a wide opening or a special device like a "she-wee."

To facilitate hygiene during menstruation, some women choose to shorten or shave hair in the intimate areas. It is also advisable to have medications for:

➤ urinary tract infections,

➤ vaginitis,

➤ urinary incontinence issues.

MENSTRUATION AT ALTITUDE

The timing of menstruation at altitude may change. Factors influencing this include:

➤ sudden change in time zones (jet lag),

➤ intense physical exertion,

➤ cold,

➤ weight loss.

Menstruation can be particularly troublesome during expeditions where access to sanitary facilities is very limited.

To avoid bleeding during the expedition, some women use continuous oral contraceptive pills without a break for menstruation, even for several months. However, spotting may occur during the first three months of such use.

Alternatives may include progesterone-based methods such as:

➤ the so-called mini-pill,

➤ medroxyprogesterone injections,

➤ contraceptive implants,

➤ hormonal intrauterine devices.

It is best to begin planning cycle regulation about 6 months before the trip.

If menstruation is heavy, significant amounts of iron can be lost with blood at altitude. In such cases, it is advisable to consult a doctor regarding supplementation. During acclimatization, the body increases the production of iron-rich red blood cells, so iron stores – assessed, among other things, by ferritin levels – should be adequately replenished before the expedition.

CONTRACEPTION IN THE MOUNTAINS

There is no data indicating that altitude reduces the effectiveness of contraceptive methods such as:

➤ hormonal pills,

➤ contraceptive injections,

➤ vaginal diaphragms,

➤ female condoms,

➤ intrauterine devices.

In expedition conditions – with irregular eating, fatigue, or sleep disturbances – the effectiveness of contraception may be somewhat lower.

It is worth noting that the use of broad-spectrum antibiotics (e.g., penicillins or tetracyclines) may reduce the effectiveness of contraceptive pills containing less than 50 µg of estrogen – additional contraceptive methods should be used during treatment and for 7 days after its completion.

It has not been conclusively established whether hormonal contraception affects the acclimatization process.

Contraceptive pills (except for preparations containing only progesterone) combined with dehydration, cold, prolonged immobilization, or increased blood viscosity may increase the risk of deep vein thrombosis and pulmonary embolism. This risk may rise after about a week of staying above 4500 m, especially in women who smoke or have low physical fitness.

Therefore, it is often recommended to use preparations containing only progesterone.It is also advisable to start planning contraception about 6 months before the trip.

PREGNANCY AND ALTITUDE

Pregnant women are not more susceptible to altitude sickness than others, but hypoxia can disrupt circulation between the placenta and the fetus, leading to fetal hypoxia. At altitude, blood flow through the uterus decreases, and intense maternal exertion further reduces the oxygen available for the fetus.

Pregnant women are also more susceptible to dehydration.Both pregnancy and altitude increase the frequency and depth of breathing, and breathing dry mountain air promotes fluid loss.

Prolonged stays at altitudes above 2500 m may increase the risk of complications such as:

➤ bleeding from the birth canal,

➤ premature placental abruption,

➤ hypertension and preeclampsia,

➤ premature birth,

➤ fetal growth restriction,

➤ intrauterine fetal demise.

An additional issue during expeditions is the distance from medical care, limited diagnostic capabilities, and a higher risk of injuries or travel-related infections. Some tropical diseases, such as malaria or hepatitis E, may have more severe courses during pregnancy.

Many medications used for altitude sickness prevention or malaria prophylaxis are contraindicated during pregnancy.This includes acetazolamide, which should not be used in the first trimester or after 36 weeks of pregnancy.

ALTITUDE AT DIFFERENT STAGES OF PREGNANCY

There are suspicions that altitude may increase the risk of spontaneous miscarriages in the first trimester. For this reason, trips to high mountains during this period are generally discouraged, especially for women at increased risk of miscarriage.

After the first trimester, women with low risk of complications can stay temporarily at altitudes of around 2500 m above sea level. After 2–3 days of acclimatization, moderate physical activity is possible. However, intense exertion should be limited.

Traveling to high altitudes is not recommended after 20 weeks of pregnancy if there are factors such as:

➤ hypertension,

➤ preeclampsia,

➤ anemia,

➤ maternal smoking,

➤ fetal growth disturbances,

➤ maternal heart or lung diseases.

If staying at high altitude is necessary, regular medical check-ups are recommended, including ultrasound examinations, blood pressure measurements, and monitoring fetal development.

PHYSICAL ACTIVITY DURING PREGNANCY

In the first trimester, there are no contraindications to moderate activities such as climbing or skiing at low altitudes (close to sea level). During climbing, it is recommended to use a harness that covers the entire body to avoid pressure on the abdomen.

In later stages of pregnancy, climbing or skiing is usually discouraged. Changes in the center of gravity, increased body weight, and greater joint laxity may contribute to falls, injuries, and potential pregnancy complications.

SUMMARY

➤ Women acclimatize to altitude similarly to men.

➤ Menstruation, contraception, and hygiene require prior planning.

➤ It is best to plan contraception and cycle regulation a few months before the trip.

➤ Pregnant women should plan their stay at altitude with particular caution and consult such trips with a doctor.

Proper medical and logistical preparation allows women to safely pursue ambitious mountain plans.

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WANT TO LEARNMORE?

If you want to better prepare yourself health-wise for trekking or high-altitude expeditions, you can find the extended version of the guide in the ebook"High Altitude Medicine in Practice – A Guide for Trekking and Expeditions" >>

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You can also learn practical knowledge about emergency procedures in the mountains in the online training"High Altitude First Aid" >> - designed for those planning trips to high altitudes.

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Detailed contents of the expedition first aid kit and exact instructions for preparing an expedition first aid kit and personal rescue kit can be found in the ebook"Expedition First Aid Kit – A Complete Medical Guide" >>

PLANNINGTREKKINGORHIGH-ALTITUDE EXPEDITION?

If you want to check whether your health condition allows you to safely participate in trekking or a high-altitude expedition, it is advisable to take advantage ofa medical consultation >> ora telemedicine expedition package >>

This way, you can assess health risks in advance, prepare adequately for the trip, and increase safety while at high altitude.

The company was established in 2004. The goal of MedEverest is education in the field of mountain medicine and the dangers of high altitudes. I deal with all medical aspects of staying at high altitude. I organize medical support for trekking and high-altitude expeditions.

Specialist Medical Practice Medeverest Robert Szymczak based in Gdańsk (80-360), at ul. Bolesława Krzywoustego 19F, NIP: 5841943576, REGON: 220148318.

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