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Combined Oral Contraceptive Pills (COCs)

Combined Oral Contraceptive Pills (COCs). Session I: Characteristics of COCs. Combined Oral Contraceptives Objectives. Participants will be able to: Describe the characteristics of COCs in a manner that clients can understand Demonstrate how to screen clients for eligibility for COC use

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Combined Oral Contraceptive Pills (COCs)

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  1. Combined OralContraceptive Pills(COCs) Session I: Characteristics of COCs

  2. Combined Oral ContraceptivesObjectives Participants will be able to: Describe the characteristics of COCs in a manner that clients can understand Demonstrate how to screen clients for eligibility for COC use Describe when to initiate COCs Explain how to use COCs, what to do when pills are missed, and when to return Address common concerns, misconceptions, and myths Explain how to manage side effects Identify conditions that require switching to another method Identify clients in need of referral for COC-related complications

  3. COCs Key Points for Providers and Clients

  4. What Are COCs? Traits and Types

  5. Effectiveness of COCs More effective Less effective In this progression of effectiveness, where would you place combined oral contraceptives (COCs)? COCs

  6. Relative Effectiveness of FP Methods

  7. COCs: Mechanism of Action Suppresses hormones responsible for ovulation Thickens cervical mucus to block sperm COCs have no effect on an existing pregnancy.

  8. COCs: Characteristics • Safe and more than 99% effective if used correctly • Can be stopped at any time • No delay in return to fertility • Are controlled by the woman • Do not interfere with sex • Have health benefits • Less effective when not used correctly (91%) • Require taking a pill every day • Do not provide protection from STIs/HIV • Have side effects • Have some health risks (rare) Source: Hatcher, 2007; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.

  9. COCs: Menstrual-Related Health Benefits Decreased amount of flow and fewer days of bleeding; no bleeding (less common) Regular, predictable menstrual cycles Reduced pain and cramps during menses Reduced pain at time of ovulation Source: Davis, 2005.

  10. COCs: Other Health Benefits Protection from: Risks of pregnancy Ovarian cancer Endometrial cancer Symptomatic PID Reduced risk of: Ovarian cysts Iron-deficiency anemia Decreased symptoms of endometriosis (pelvic pain, irregular bleeding) Decreased symptoms of polycystic ovarian syndrome (irregular bleeding, acne, excess hair on face or body) Source: Petitti and Porterfield, 1992; CASH Study, 1987; CCP and WHO, 2011; Belsey, 1988; Davis, 2007.

  11. No Overall Increase in Breast Cancer Risk for COC Users Analysis of a large number of studies: No overall increase in breast cancer risk among women who had ever used COCs Current use and use within past 10 years: very slight increase in risk May be due to early diagnosis or accelerated growth of pre-existing tumors More recent study: No increase in breast cancer risk regardless of age, estrogen dose, ethnicity, or family history of breast cancer Source: Collaborative Group on Hormonal Factors in Breast Cancer, 1996; Marchbanks, 2002.

  12. COCs and Cervical Cancer Cervical cancer is caused by certain types of human papillomavirus (HPV) Some increase in risk among women with HPV and others who use COCs more than 5 years Risk of cervical cancer goes back to baseline after 10 years of non-use Cervical cancer rates in women of reproductive age are low. Risk of cervical cancer at this age group is low compared to mortality and morbidities associated with pregnancy. COC users should follow the same cervical cancer screening schedule as other women. Source: Smith, 2003; Appleby, 2007; CCP and WHO, 2011.

  13. Risk of Blood Clots is Limited COCs may slightly increase risk of blood clots: Stroke Heart attack Risk is concentrated among women who have additional risk factors, such as: Hypertension Diabetes Smoking • Deep vein thrombosis • Pulmonary embolism Stop COCs immediately if a blood clot develops. Source: World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception ,1995; Jick, 2006; WHO, 1998; Farley, 1998.

  14. Possible Side-Effects If a woman chooses this method, she may have some side-effects. They are not usually signs of illness. • But many women do not have any side-effects. • Side-effects often go away after a few months and are not harmful. Most common: • Nausea (upset stomach) • Changes in bleeding patterns (lighter, irregular, infrequent or no monthly bleeding) • Mood changes or headaches • Tender breasts • Dizziness • Slight weight gain or loss

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