Endo & Backpacking

Prelude:

It’s 6 AM. I’m crouched on the curb across from a small fishing port in northern Peru, my knees drawn tightly to my chest. I rock slowly, focusing on the motion. I let out a sound somewhere between a sob and a moan. The pain comes in sharp waves, breaking around my lower back, upper thighs, and amdomen. The man running the whale-watching tour I’ve booked asks if I’m okay; he looks genuinely concerned. I’ve been huddled on the curb, rocking gently, for over an hour.

It’s hard to describe the pain. I usually reel off a list of physical symptoms that poorly capture the experience. There’s the obvious stuff like cramping, sharp, shooting pains, and aching. I feel physically heavy, like I have scorching rocks weighing me down. The nausea, which on this occasion was coupled with travel sickness from the 45-minute tuk-tuk ride on small back roads in various states of repair and disrepair, gives way to a panic that wedges itself in my throat and blurs my vision. Eventually, the pain dissipates, melting into a manageable ache. I stay on the curb, resting my head on my knees. I sob in frustration as my boyfriend rubs my back.

Act I - My First Period:

I was officially diagnosed with endometriosis a year before my six-month backpacking trip. I say "officially" because I knew what I had long before a doctor gave name to it. It makes me sad to admit now, but before the diagnosis, I tried to rationalize my experience, discrediting myself and my pain. It was all in my head. I’d had countless teachers tell me as much. It was just an excuse to get out of lessons, one I’d carried embarrassingly far into adulthood. But on a light Monday afternoon, in an anesthetic-induced haze, my pain was transformed, crystallized into something quantifiable, medically recognizable. Real.

In the lead-up to my trip, people asked me how I was feeling, assuming I would be worried about safety or making friends like most 20-something backpackers are. 

Other travelers spend weeks researching which cities are safe for tourists or finding the sturdiest locks to protect their too-expensive running shoes in shared hostel dorms. Unlike theirs, my anxiety was entirely localized. I spent weeks researching transcutaneous electrical nerve stimulation (TENS) machines, BeYou cooling patches, pressure points, breathing techniques and natural remedies, preemptively trying to quell the pain of my first period aborad. I obsessively watched endometriosis YouTube videos—TED Talks, videos by endometriosis influencers, doctors, surgeons, animated explanations. Maybe, somewhere in the hours of carefully edited videos, there would be an answer.

I bought BeYou cooling patches (because they’re cheap) and skipped out on the TENS machine (because they’re expensive). I hadn’t had an exceptionally painful period—the kind that’s coupled with panic, vomiting, and fainting—in years. Cooling patches and enough ibuprofen to make the cashier at Boots worried seemed like a strong enough tonic to get me through six months. After five days in Lima, a week hiking in Huaraz, and one very long bus journey to Máncora, it was time to put my provisions to the test.

Shock. None of it worked.

Act II: (Mis)management:

I’d been managing my symptoms, in my own way, for years: a refined cocktail of ibuprofen, hot water bottles, diet, and exercise (the last two to a lesser extent if I’m being honest). But long-term travel doesn’t lend itself to a stable routine. Traveling for months at a time requires a level of flexibility that's challenging to balance with managing a chronic health condition, a lesson I’ve learned the hard way. 

During my first week teaching English in Shanghai, I miscalculated the date of my period, these were the days when I would guesstimate its arrival, and bled onto my white uniform. Luckily, I noticed in the bathroom before anyone else did. I knotted my fleece tightly around my waist and searched for the nearest Western brand that would have clothes in my size. There was a heavy downpour that lasted as long as it took me to run back from H&M to the school. I was soaking wet, in a blood-stained skirt, with three back-to-back classes ahead of me. I would have quit on the spot if my visa wasn’t tied to my job.

I live in a blissful state of delusion when I’m not on my period. I forget every period that has come before and every period that will come after. I imagine it’s a coping mechanism, a way of denying my reality—I have 30 more years of this. So despite the weeks of frantic research before my trip, worrying about the fated first period abroad, I hadn’t thought to check my due date when I booked a 16-hour night bus to Máncora, a party-come-surf town in the summer and a great spot for whale watching in the fall.

Two hours into the bus ride, and one poorly timed packet of Flaming Hot Cheetos later, I was vomiting in the cramped bus toilet. I’ve always struggled with travel sickness, but this was beyond anything I’d experienced before. I tried desperately not to look into the bowl as I steadied myself, retching forcefully. Fourteen hours later, I was thrown into the early morning of a new day and greeted by a herd of taxi drivers vying for business. I was used to this play; the same animated scene unfolded at every bus terminal. Men jostled each other, undercutting prices in a bid to secure a ride. I was utterly overwhelmed. I stumbled to the nearest man, thrusting my phone into his hand, the address of my Airbnb already loaded.

I spent a day sleeping off the travel sickness, only to be awoken by my alarm (I’d booked a 5 AM whale-watching tour) and cramps (my period had started). I don’t tend to anger, but on this late September morning, I was enraged. After almost a decade, I still wasn’t prepared for the most regular thing in my life.

I went on a whale-watching tour. Nothing runs on time in South America, so the one-hour delay worked in my favor, giving me just enough time to ride out the flare. The tour was easily one of my highlights from my time traveling in South America, despite the awful start to the day. But as our boat pulled into the harbor after three incredible hours, I promised myself I would never go through another morning like that.

Act III: Management

I told anyone who would listen about my endometriosis, earnestly explaining its cause, the symptoms, and how to manage it. Ex-boyfriends told me about ex-girlfriends that had the same thing (!). I joked with strangers in bars about bleeding through XL super-absorbent tampons, wearing it like a badge of honor rather than a source of shame. I met other travelers who had endometriosis. We shared stories, advice, and medication. I dished out BeYou patches and ibuprofen. I cried when a friend had to book an emergency flight home to have multiple cysts removed from her ovaries, another common and painful symptom of endometriosis.

I downloaded a period tracking app and religiously monitored my cycle. My boyfriend downloaded the app as well so he could track my cycle. He reminded me to buy extra tampons, he knew which days my 40L backpack felt extra heavy, and when to surprise me with a hotel stay (or private hostel dorm when money was tight). Endometriosis flares are triggered by stress, and I’ve never known stress like the Mexico-Guatemala land border crossing. I spent the day in bed nursing a severe flare after that 20-hour journey so I took flights instead of buses.

I cut down on processed food and traveled slowly, spending weeks rather than days in each place. My symptoms eased with each precaution. After six months, seven countries, and twenty-six periods, the pain that seemed insurmountable in Peru now seemed manageable

Postlude:

Before I started my backpacking trip, I joked to a friend that I would need extra baggage for all my tampons, pads, and ibuprofen. My endometriosis inspired the title of this newsletter and the stories I want to share here. At its core, travel is a privilege. I’m lucky to be able to do it at all, even with the added challenges. Even so, there have been times when I’ve questioned whether the adventure is worth the pain.

But in the end, I muddled through. I adapted and found my own imperfect ways to cope. And maybe this essay will give you the courage to do the same.

Folly Fowowe

Folly Fowowe is a content creator, travel writer, and podcaster sharing honest and authentic insights into modern travel. Diagnosed with endometriosis in 2022, she also writes about the realities of travelling with a chronic illness; balancing adventure with the unpredictability of pain and fatigue. Having backpacked through South and Central America, lived in Shanghai, and now based in Toronto, she explores the realities of life on the move, career shifts, and navigating new spaces as a woman of colour. Whether through storytelling, digital content, or podcasting, Folly is all about making conversations around travel, work, and health more transparent and accessible.

[This article was originally published by Folly Fowowe in September 2024 as travelling with endometriosis sucks on follyfowowe.substack.com.]