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Combined Oral Contraceptive Pills (COCs)

Combined Oral Contraceptive Pills (COCs). Advanced Slide Set. Combined Oral Contraceptives Effectiveness. Spermicides. Female condom. Standard Days Method. Male condom. Oral contraceptives. DMPA. IUD (TCu-380A). Pregnancy rate when used correctly and consistently.

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Combined Oral Contraceptive Pills (COCs)

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  1. Combined OralContraceptive Pills(COCs) Advanced Slide Set

  2. Combined Oral ContraceptivesEffectiveness Spermicides Female condom Standard Days Method Male condom Oral contraceptives DMPA IUD (TCu-380A) Pregnancy rate when used correctly and consistently Female sterilization Male sterilization Pregnancy rate as commonly used Implants 0 10 20 25 30 5 15 Percentage of women pregnant in first year of use Source: Trussell, 2011.

  3. Reduces risk by more than 50% Protection develops after 12 months of use and is present for at least 15 years Lifetime risk of acquiring ovarian or endometrial cancer after 8+ years of COC use Number per 100 women 100 10 Ovarian Cancer Endometrial Cancer Non COC users Non COC users 8 COC users COC users 6 4 3.1 1.7 2 1.2 0.7 0.7 0.6 0.6 0.4 0.3 0.2 0.2 0.1 0 United States Costa Rica China Protective Effect of COC Use onOvarian and Endometrial Cancer Source: Petitti and Porterfield, 1992; CASH Study 1987.

  4. Understanding Relative Risk Definition Probability of developing condition X in exposed population Relative Risk = Probability of developing condition X in unexposed population

  5. 10 5 1 0.5 0.1 Understanding Relative RiskRisk Versus Protection Relative Risk Log Scale Increased Risk Exposure increases risk of disease No association No Effect Exposure decreases risk of disease Protective Effect

  6. 10 Increased Risk 5 No Effect 1 Protective Effect 0.5 0.1 Understanding Relative RiskConfidence Interval Relative Risk Log Scale B A C D Statistical interpretation: A – Significant risk B – Nonsignificant risk C – Nonsignificant protection D – Significant protection

  7. 10 Increased Risk No Effect 1 Protective Effect 0.1 Relative Risk for Breast Cancer among COC users and Non-users Relative Risk Log Scale 1.0 1.24 [1.15–1.33] 1.16 [1.08–1.23] 1.07 [1.02–1.13] 1.01 [0.96–1.05] [95% Confidence Interval] Current COC users 1–4 yrs after stopping 5–9 yrs after stopping 10+ yrs after stopping Non-users Source: Collaborative Group on Hormonal Factors in Breast Cancer, 1996; Milne, 2005; Silvera, 2005 .

  8. COC Users and Risk of Blood Clots Estimates of venous thromboembolism per 100,000 woman-years Pregnancy presents a higher risk of blood clots than do COCs. Source: WHO, 1998; Speroff, 2005.

  9. Estimated number of heart attacks per million woman-years COC Users and Risk of Heart Attack Screening for existing risk factors is important. Source: Farley, 1998.

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