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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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Combined oral contraceptive pills cocs

Combined OralContraceptive Pills(COCs)

Advanced Slide Set


Combined oral contraceptives effectiveness

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.


Protective effect of coc use on ovarian and endometrial cancer

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.


Understanding relative risk definition

Understanding Relative Risk Definition

Probability of developing condition X in exposed population

Relative Risk =

Probability of developing condition X in unexposed population


Understanding relative risk risk versus protection

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


Understanding relative risk confidence interval

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


Relative risk for breast cancer among coc users and non users

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 .


Coc users and risk of blood clots

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.


Coc users and risk of heart attack

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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