Ask the Flight Surgeon / By MAJ (Dr.) Laura S. Ball: Q: For female aviators, what are the flight approved contraceptive methods and are there any women’s health requirements for flight physicals?
FS: In the US, approximately 45% of pregnancies are unintended. Within the military, the number of unplanned pregnancies is even higher. Having a reliable form of contraception is an important consideration for women in the military since there are some regulatory limitations that go along with pregnancy. For example, women who are pregnant cannot deploy and serve in a combat zone. When it comes to Aviation, initial applicants for flight school are considered disqualified until 6 weeks after delivery assuming they are fully recovered at that time. Rated aircrew members who become pregnant can be on flight status with approval from their OB/GYN physician. However, there are restrictions. For example, the Aeromedical Policy Letter (APL) states that during gestational weeks 12-25, flight is allowed but restricted to “multi-engine, non-ejection seat, fixed wing aircraft with dual-pilot status and a cabin altitude less than or equal to 10,000 feet”. These restrictions limit female helicopter pilots to flight simulator duty only throughout the duration of their pregnancy and until fully recovered after delivery. If the pregnancy is uncomplicated, it is listed as information only on the flight physical (i.e. no waiver is needed).
There are numerous options available for contraception: contraceptive pills and patches; intra-uterine devices (IUD) that are effective for up to 12 years; implantable devices that are effective for up to 5 years, injectable medication that works for approximately 3 months. There are also barrier methods such as condoms, diaphragms and sponges and surgical options such as tubal ligation for yourself and vasectomy for your male partner. There are also practices such as withdrawal, fertility awareness (aka Rhythm Method) and abstinence. All methods have different side effects including effects on fertility and menstrual bleeding as well as different levels of effectiveness in preventing pregnancy.
Some things to consider when deciding on the right method of contraception for you include future-plans for pregnancy, overall health status, effectiveness in preventing pregnancy, whether the method uses hormones and ease of use of the method. For example, women who plan to become pregnant within a year or two probably should not opt for an IUD. However, for women who do not plan to become pregnant and who want an easy to use method that requires little planning, an IUD might be a good option. Women who are deploying or frequently going to the field, may choose an option that stops or reduces menstrual bleeding not only for contraception, but for convenience and personal hygiene reasons as well. It is important to note that contraception can also have a role in the treatment of acne, premenstrual syndrome, menstrual migraines, and pelvic pain due to endometriosis as well as decreasing the risk of endometrial, ovarian and colorectal cancers. The decision regarding which method is best for you can be made with your primary care or OB/GYN provider. For women on flight status the use of contraceptives that contain hormones is acceptable and is documented as information only on the flight physical.
When it comes to well woman exams and pap smears that screen for cervical cancer, the APL does not make any specific recommendations. However, from a primary care perspective, within the Aeromedical community we follow guidelines put forth by the US Preventative Services Task Force (USPSTF). Screening is done by a pathologist through microscopic examination of cells obtained from the cervix during the well woman exam. This is usually reviewed as part of the flight physical. Currently, the USPSTF recommendation is that women ages 21-29 receive cervical cancer screening every 3 years and for women ages 30-65 it is done every 5 years along with co-testing for the Human Papilloma Virus (HPV). Human Papilloma Virus infections are very common. According to the Centers for Disease Control and Prevention, virtually everyone will get infected at least one time in their lives. A cervical infection with HPV is usually without symptoms and resolves without any medical intervention or complications.
However, if the infection persists, it has the potential to cause cervical cancer. Almost all cases of cervical cancer can be attributed to HPV infection. If abnormalities are detected on cervical cancer screening, there may be follow up procedures or testing that is done depending on the type of abnormality. Abnormalities are classified as atypical squamous cells, low grade squamous cell intraepithelial lesion or high-grade squamous cell intraepithelial lesion. If there are abnormalities detected there may be a waiver required for the flight physical. This, like follow up care, depends on the type of abnormality. Remember, women’s health is an important part of medical readiness and safety in flight!
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The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated
MAJ Laura Ball, MD is a flight surgeon at the U.S. Army School of Aviation Medicine at Fort Rucker, Alabama