kombinirebuli oraluri da saineqcio...

kombinirebuli oraluri da saineqcio kontraceptivebi

kombinirebuli oraluri kontraceptivebi (kok)

ganmarteba

kombinirebuli oraluri kontraceptivebi warmoadgens maRalefeqtur,

sinTezur estrogen-progestagenur preparatebs, romlebic icavs qals

arasasurveli orsulobisagan.

kok-i, masSi Semavali estrogenisa da progestagenis kombinaciis

mixedviT iyofa or ZiriTad tipad: monofazuri da mravalfaziani.

• monofazuri _ 21 aqtiuri tabletidan TiToeuli Seicavs estrogenisa

da progestagenis Tanabar raodenobas

• mravalfaziani: orfaziani (bifazuri) da samfaziani (trifazuri).

• orfaziani (bifazuri) _ 21 aqtiuri tabletidan TiToeuli Seicavs

estrogenis ucvlel dozas, xolo progestagenis doza izrdeba

ciklis meore fazaSi

• samfaziani (trifazuri) _ 21 aqtiuri tableti Seicavs estrogenisa

da progestagenis sam sxvadasxva kombinacias: estrogenis

Semcveloba izrdeba mxolod meore fazaSi, progestagenis

Semcveloba izrdeba safexurebrivad sam etapad.

estrogenuli komponentis Semadgenlobis mixedviT kok-i iyofa:

• maRaldoziani _ 1 tableti Seicavs 50 mkg e. e.*

• dabaldoziani _ 1 tableti Seicavs 30-35 mkg e. e.

• mikrodozirebuli _ 1 tableti Seicavs 15-20 mkg e. e.

(3, 6 _ xarisxi `A~)

moqmedebis meqanizmi

kok-is moqmedebis meqanizmi vlindeba reproduqciuli sistemis sxvadasxva

doneze: hipoTalamusi _ hipofizi _ sakvercxeebi _ saSvilosno _

saSvilosnos milebi.

• Trgunavs ovulacias. kok-is moqmedebiT mcirdeba hipoTalamusis

mier rilizing-hormonis da hipofizis mier gonadotropuli

hormonebis sekrecia, ris Sedegadac sakvercxeSi estrogenis

* e.e. _ eTinilestradioli

1

gamomuSaveba orjer mcirdeba da ovulacia iTrguneba. sakvercxeebi

mcirdeba zomebSi da Seicavs mraval atreziul folikuls.

• endometriumi proliferaciul fazaSi ganicdis swraf regress da

naadrev sekreciul transformacias. zogjer aRiniSneba

atrofiuli cvlilebebic, romelsac aqvs antiimplantaciuri

efeqti.

• mcirdeba saSvilosnos milebis peristaltika, rac aqveiTebs maTSi

spermatozoidebis moZraobas.

• icvleba cervikaluri lorwos bioqimiuri Semadgenloba _

qveiTdeba sialis mJava. aseve cikluri cvlilebebis ararsebobis

gamo cervikaluri lorwo sqeldeba da masSi spermatozoidebis

SeRweva Zneldeba.


efeqturoba

kok-is efeqturoba Seadgens:

0,3 orsulobas 100 qalze/weliwadSi, praqtikulad, sworad da

regularulad gamoyenebis SemTxvevaSi;

6-8 orsulobas qalze/weliwadSi usistemod, araregularulad gamoyenebis

SemTxvevaSi.

(2 _ xarisxi `A~)

kontracepciuli upiratesobebi

• maRali da swrafi efeqturoba

• meTodis Seqcevadoba

• qals eZleva SesaZlebloba akontrolos fertiloba

• gverdiTi movlenebis simcire

• gamoyenebis siadvile

• gamoyenebis win ar aris aucilebeli saSos mxrivi gasinjva

• ar ukavSirdeba sqesobriv aqts

• SedarebiT iafia (Tu SevadarebT abortis xarjebs)

• SeiZleba gavrcelebuli iyos kvalificiuri arasamedicino

personalis mier

• menstruaciuli ciklis adeqvaturi kontroli

(3, 5, 6 _ xarisxi `A~)

2

arakontracepciuli upiratesobebi

samedicino praqtikaSi kok gamoiyeneba ara marto kontracepciuli, aramed

arakontracepciuli mizniTac, romelsac aqvs Tavisi upiratesobebi:

• mcirdeba saSvilosnosgare orsulobis sixSire

• mcirdeba mcire menjis Rrus organoebis anTebiTi daavadebebis

sixSire

• mcirdeba menstruaciuli gamonadeni

• mcirdeba sarZeve jirkvlebis keTilTvisebiani daavadebis (fibrozul-

kistozuri mastopaTia) riski

• mcirdeba sakvercxis, endometriumisa da koloreqtaluri kibos

ganviTarebis riski

• qreba an mcirdeba premenstruaciuli daZabuloba da dismenoreis

simptomebi

• mcirdeba rkinadeficituri anemiis riski (menstruaciuli gamonadenis

Semcirebis xarjze)

• dadebiTad moqmedebs endometriozis mimdinareobaze

• mcirdeba saSvilosnos miomis ganviTarebis riski

• mcirdeba sakvercxis retenciuli warmonaqmnebis sixSire

• xasiaTdeba samkurnalo efeqtiT hiperandrogenuli (akne, hirsutizmi,

seborea) mdgomareobebisas

• gamoiyeneba saSvilosnodan disfunqciuri sisxldenebis, uSvilobis

samkurnalod

• izrdeba Zvlis simkvrive

• ixsneba `arasasurveli orsulobis SiSi~

• SesaZlebelia morigi menstruaciis `gadaweva~ gamocdis, Sejibrebis,

dasvenebis dros an samedicino CvenebiT

(3, 5, 6, 7 _ xarisxi `A~)

naklovanebebi

• miRebis wesis darRveva zrdis arasasurveli orsulobis risks

• saWiroebs kvalificiur konsultacias

3

• yoveldRiuri gamoyeneba _ saWiroebs mudmiv motivacias. gulmaviwyoba

zrdis orsulobis risks.

• efeqturoba qveiTdeba zogierT wamalTan erTdrouli miRebisas

(barbituratebi, antituberkulozuri preparatebi)

• ar icavs sqesobrivi gziT gadamdebi daavadebebisagan (maT Soris B

hepatitis virusi da aiv/Sidsi)

• SesaZloa fertilobis aRdgenis Seferxeba (1-2% SemTxvevaSi)

• Zalian iSviaTad SesaZlebelia seriozuli garTulebebi: infarqti

insulti, filtvis an Tavis tvinis Trombozi (Sesabamisad 1, 3 an da

11-mde SemTxveva 100 000 qalze, romlebic iyeneben kok-s)

• aucilebelia uwyveti momarageba

(3, 5, 6, 7 _ xarisxi `A~)

mdgomareobebi, romlebic kok-is gamoyenebis dawyebamde moiTxovs winaswar

samedicino Sefasebas

janmos klasifikacia:

kategoria 1: kok-i SeuzRudavad gamoiyeneba nebismieri

situaciaSi.

kategoria 2: kok-i umetes SemTxvevaSi SeuzRudavad

gamoiyeneba, radganac sargebloba metia, vidre

Teoriuli da/an dadasturebuli riski.

kategoria 3: kok-is gamoyeneba rekomendebuli ar aris,

radganac Teoriuli an dadasturebuli riski metia

vidre sargebloba. kok-i gamoiyeneba mxolod im

SemTxvevaSi, Tu ki sxva meTodi ar aris xelmisawvdomi.

kategoria 4: kok-is gamoyeneba ar SeiZleba.

(2 _ xarisxi `A~)

kok-is gamoyenebis ukuCvenebebia:

• orsuloba

• mSobiarobis Semdeg 6 Tve ZuZuTi kvebis dros

• mSobiarobis Semdeg 3 kvira ara meZuZur dedebSi

4

ki

meTodis

gamoyeneba

SeiZleba

ara

meTodis

gamoyeneba

rekomendebu-

li ar aris

• sasqeso gzebidan daudgineli genezis sisxldena

• gul-sisxlZarRvTa daavadebis mravlobiTi risk-faqtorebis arseboba.

garTulebebiT mimdinare gulis sarqvlebis daavadebebi

• Tromboflebiti, Tromboemboliuri daavadebebi, Tavis tvinis sisxlis

mimoqcevis darRveva, cerebro-vaskuluri insultebi, miokardiumis

infarqti (anamnezSi)

• Trombogenuri mutacia _ sisxlis Sededebis darRvevebi

• Sakiki nevrologiuri simptomebiT

• 35 wlis zeviT sigaretis moweva (dReSi 15 da meti sigareti)

• arteriuli hipertonia

T/A sistoluri ≥ 160 diastoluri ≥ 100 mm vwy sv (me-4 kategoria),

an sistoluri ≥ 140-159 diastoluri ≥ 90-99 mm vwy sv (me-3 kategoria)

• Saqriani diabeti sisxlZarRvovani garTulebebiT, an sxva

sisxlZarRvovan daavadebebTan erTad, an 20 wlis xangrZlivobiT

• ZuZus kibo amJamad

• RviZlis mwvave daavadeba (hepatiti).

• RviZlis keTilTvisebiani an avTvisebiani simsivne, RviZlis cirozi,

dekompensaciis stadiaSi

• qirurgiuli operacia xangrZlivi imobilizaciiT

(2 _ xarisxi `A~)

orsuloba (dadasturebuli an saeWvo)

kategoria 4. kok-i ar gamoiyeneba orsulobis dros. Tu preparatis miRebis

fonze orsuloba dadasturda saSvilosnos RruSi, saWiroa Sewydes kok-is

gamoyeneba. Tanamedrove monacemebiT kok-is miReba ar zrdis

mkvdradSobadobis, TviTnebiTi abortisa da Tandayolili mankis

ganviTarebis risks. miuxedavad amisa, orsulobis adreul vadazec ki

rekomendebuli araa preparatebis gamoyeneba.

Tu menstruaciis dagvianebisas orsulobis gamoricxva ver xerxdeba, kok-is

miReba unda gadavaddes Semdeg menstruaciamde. am SualedSi qalma unda

gamoiyenos kontracepciis sxva meTodi (mag. barieruli).

5

ZuZuTi kveba

kategoria 4. Tu qali ZuZuTi kvebavs bavSvs da ar iyenebs lam-s,

mSobiarobidan 6 Tvis ganmavlobaSi mizanSewonili araa kok-is miReba,

radganac masSi Semavali estrogeni gadis dedis rZeSi da axalSobilze

SesaZlebelia mavne zegavlena iqonios. aseve cnobilia, rom mSobiarobidan

pirveli 6 kviris ganmavlobaSi estrogeni amcirebs laqtaciis process. Tu

qali ar iyenebs lam-s, mSobiarobidan 6 Tvemde sasurvelia gamoiyenos

kontracepciis sxva meTodi (mag: sSs, barieruli, sufTa progestagenuli

abebi da sxva).

kategoria 3. Tu qali mSobiarobis Semdgom periodSi ar kvebavs

ZuZuTi, kok-is dawyeba SeuZlia mSobiarobidan mxolod 3 kviris Semdeg,

radganac, pirveli 3 kviris ganmavlobaSi estrogenuli komponenti zrdis

Trombis warmoqmnis risks. aseve, mSobiarobidan pirveli 3-6 kviris

ganmavlobaSi ovulaciis naklebi albaTobaa da amdenad qalebi orsulobis

dabali riskis qveS imyofebian.

sasqeso gzebidan daudgeneli genezis sisxldena

kategoria 4. Tu qals aReniSneba sisxldena saSodan, sanam sisxldenis

swori diagnozi ar dadgindeba, rekomendebuli araa kok-is gamoyeneba,

radganac kok-s SeuZlia menstruaciebs Soris periodSi sisxldena SeaCeros

da SeniRbos ZiriTadi problema (mag: saSvilosnos Rrus an saSvilosnos

gare orsuloba, mcire menjis Rrus sxva paTologia da iSviaTad

genitaluri traqtis kibo). saWiroa Catardes srulyofili ginekologiuri

gamokvleva da kategoria ganisazRvros mxolod amis Semdeg.

kategoria 2. diagnozis dadgenis Semdeg Tu dadasturda disfunqciuri

sisxldena saSvilosnodan, kok-is miReba mizanSewonilia samkurnalo

mizniTac.

gul-sisxlZarRvTa daavadebebi

kategoria 4. gul-sisxlZarRvTa daavadebebis dros _ gulis iSemiuri

daavadeba (amJamad da adre), stenokardia, garTulebuli gulis sarqvlebis

daavadeba (filtvismieri hipertenzia, winagulebis fibrilaciis riski,

qvemwvave baqteriuli endokarditi anamnezSi), lipiduri metabolizmis

aTerogenuli darRvevebi, arteriuli an venuri Trombozi, Trombogenuri

6

mutacia (magaliTad: leidenis V faqtori, proTrombinis mutacia, protein

S, protein C da antiTrombinis ukmarisoba) _ rekomendebuli araa kok-is

miReba, radgan man SeiZleba Seqmnas daavadebebis ganviTarebis damatebiTi

riski (estrogenis efeqti).

Tavis tvinis sisxlZarRvebis dazianeba

kategoria 4. Tu qals anamnezSi aReniSneba insulti da Tavis tvinis

sisxlZarRvebis sxva dazianeba, rekomendebuli araa kok-is miReba.

sisxlis Sededebis darRvevebi

kategoria 4. Tu qals aReniSneba Rrma venebis Trombozi an filtvis

embolia amJamad an anamnezSi, an didi qirurgiuli operacia da xangrZlivi

imobilizacia, rekomendebuli araa kok-is miReba.

kategoria 2. Rrma venebis Trombozi / filtvis emboliis ojaxuri anamnezi,

didi operacia araxangrZlivi imobilizaciiT, `mcire~ qirurgia

imobilizaciis gareSe.

Sakiki (Tavis tkivili)

kategoria 4. Tu qals aReniSneba Sakiki kerovani nevrologiuri

simptomebiT (mag: metyvelebis unaris droebiTi dakargva, mxedvelobis

velebis gamovardna da a.S.), nebismier asakSi, rekomendebuli ar aris kok-is

miReba. misma gamoyenebam SeiZleba Seqmnas insultis damatebiTi riski

(estrogenis efeqti).

gamokvlevebiT damtkicda, rom qalebis is jgufi, romelTac aReniSnebaT

aura, imyofebian insultis ganviTarebis ufro maRali riskis qveS vidre

isini, visac aura ara aqvs. auris mqone pacientebSi kok-is gamoyenebisas 2-4-

jer izrdeba insultis riski, vidre im qalebSi, romlebic kontracepciis

am meTods ar iyeneben.

kategoria 3. Sakiki kerovani nevrologiuri simptomebis gareSe ≥ 35 wlis

asakSi.

kategoria 2. Sakiki kerovani nevrologiuri simptomebis gareSe < 35 wlis

asakSi.

7

35 wlis da meti asakis mweveli qalebi

kategoria 4. aRniSnuli asakis qalma ar unda miiRos kok-i, Tu eweva dReSi

≥ 15 sigarets.

35 wlis da ufro meti asakis mweveli (intensiuri an araintensiuri) qalebi

imyofebian infarqtis, insultis da sisxlis Sededebis sxva problemebis

gazrdili riskis qveS. aseT SemTxvevebSi kok-is miReba qmnis Trombis

warmoqmnis damatebiT risks (estrogenis efeqti)

kategoria 3. asaki ≥ 35 _ sigareti <15 dReSi

kategoria 2. asaki < 35

maRali arteriuli wneva

kategoria 4. qalebma, romelTac aReniSnebaT arteriuli wneva ≥160/100

mm.vwy.sv. (sisxlZarRvovani problemebiT an maT gareSe), ar unda miiRon

kok-i.

kategoria 3. Tu eqimTan orjer ganmeorebiTi vizitis dros qals

arteriuli wneva aReniSna 140-159/90-99 mm.vwy.sv., man ar unda miiRos kok.

sasurvelia SeirCes kontracepciis sxva meTodi (spermicidi, kondomi da

a.S.). janmrTel qalebSi kok-is miReba iwvevs arteriuli wnevis mxolod

umniSvnelo cvlilebas. hipertenziis dros ki, is qmnis insultis,

miokardiumis mwvave infarqtis da periferiuli arteriebis dazianebis

damatebiT risks (estrogenis efeqti). wamlis miReba unda Sewydes, Tu

pirveli ramdenime Tvis ganmavlobaSi vlindeba arteriuli wnevis

mniSvnelovani mateba an arteriuli sisxlZarRvebis daavadeba.

kategoria 2. anamnezSi maRali arteriuli wneva orsulobis dros, Tumca

amJamad arteriuli wneva normis farglebSi.

Saqriani diabeti

kategoria 3/4. progresuli da didxans mimdinare (>20 welze) Saqriani

diabeti, sxvadasxva garTulebebiT: sisxlZarRvovani, neiropaTia,

retinopaTia, nefropaTia.

aRniSnuli mdgomareobebis dros qalebma ar unda miiRon kok, radganac

masSi Semavali estrogeni zrdis Trombis warmoqmnis damatebiT risks.

8

kategoria 2. qalebs, insulin damokidebuli an insulin damoukidebeli

Saqriani diabetiT seriozuli garTulebebis gareSe, ZiriTadad SeuZliaT

kok-is miReba.

kategoria 1. anamnezSi diabeti orsulobis dros.

ZuZus kibo

kategoria 4. Tu qals aReniSneba ZuZus kibo amJamad an anamnezSi, ar unda

miiRos kok-i. cnobilia, rom sarZeve jirkvelis kibo hormondamokidebuli

simsivnea da kok-is miRebam SeiZleba gazardos simsivnis progresirebis

riski.

kategoria 1. sarZeve jirkvlebis keTilTvisebiani daavadeba.

kategoria 1. sarZeve jirkvlebis kibos ojaxuri anamnezi. kok-is gamoyeneba

aRniSnuli kategoriis qalebSi ar iwvevs sarZeve jirkvlebis kibos

gazrdil risks imaTTan SedarebiT, visac analogiuri anamnezi hqonda da

kok-s ar iyenebda. Tu aRiniSneba sarZeve jirkvlis kibos ganmapirobebuli

genis BRCA1 tipis mutacia, kok-is gamoyenebam SeiZleba umniSvnelod

gazardos zemoT aRniSnuli kibos riski.

RviZlis daavadebebi

kategoria 4. simptomuri siyviTle, virusuli hepatiti, dubin-jonsonis

sindromi, rotoris sindromi warmoadgens kok-is miRebis ukuCvenebas,

radganac aRniSnuli mdgomareobis dros kok-Si Semavali steroidebi

mTlianad ver metabolizdeba RviZlSi, ramac SeiZleba damatebiTi ziani

moutanos qalis janmrTelobas.

qalebma hepatitis dros ar unda miiRon kok manam, sanam ar moxdeba RviZlis

funqciuri maCveneblebis normalizeba (uxSiresad siyviTlis gaqrobidan 3-5

Tvis Semdeg).

RviZlis simsivneebi, cirozi

kategoria 4. RviZlis keTilTvisebiani (adenoma) da avTvisebiani (hepatoma)

simsivne, mZime (dekomepensirebuli) cirozi warmoadgenen kok-is miRebis

ukuCvenebas, radganac preparatis miRebam SeiZleba gaauaresos zemoT

aRniSnuli mdgomareobebi.

9

naRvlis buStis daavadebebi

kategoria 3. Tu qals, amJamad aReniSneba naRvlis buStis daavadeba da

imyofeba medikamenturi mkurnalobis qveS, sasurvelia kok-i ar miiRos,

garda im SemTxvevebisa, roca kontracepciis sxva ufro Sesaferisi

meTodebi xelmisawvdomi ar aris.

kok-ma SeiZleba gamoiwvios naRvlis buStis daavadebis riskis mcire

gazrda. arsebobs agreTve mosazreba, rom kok-s SeuZlia gamoiwvios

naRvlis buStis arsebuli daavadebebis gauareseba.

kategoria 2. qolecisteqtomiis Semdeg kok-is gamoyeneba SeiZleba.

kategoria 2. asimptomuri mdgomareobis dros, kok-is gamoiyeneba SeiZleba.

qirurgiuli operacia xangrZlivi woliTi reJimiT.

kategoria 4. xangrZlivi imobilizacia zrdis venuri sisxlis Sededebis

momatebis risks. Tu SesaZlebelia, kok-is miReba unda Sewydes qirurgiuli

Carevidan (roca saWiroa xangrZlivi imobilizacia) 4 kviriT adre da mis

Semdeg 2 kviris ganmavlobaSi.

kategoria 3. antikonvulsantebis (fenitoini, barbituratebi, karbamezepini,

primidoni) valprois mJavas garda da antituberkulozuri (rifampicini)

preparatebis miReba.

aRniSnuli preparatebis miRebis fonze dabaldoziani kok-is

efeqturoba mcirdeba, radgan maTi didxans miReba iwvevs RviZlis

fermentebis aqtiurobis momatebas, rac iwvevs estrogenisa da

progestagenis metabolizmis daCqarebas da preparatebis efeqturobis

Semcirebas.

menstruaciebs Soris periodSi sisxliani gamonadeni SeiZleba

miuTiTebdes estrogenis da progestagenis daqveiTebul doneze. am

SemTxvevaSi saWiroa maRaldoziani (estrogenis maRali done) kok-is

gamoyeneba, an unda SeirCes kontracepciis sxva meTodi.

antimikozuri preparatis (grizeofulvini) miReba

kategoria 2. ramdenadac grizeofulvini, romelic iwvevs estrogenis

da progestagenis metabolizmis gazrdas, Cveulebriv mxolod xanmokle

10

periodis ganmavlobaSi (2-4 kvira) gamoiyeneba, qalebs, romlebic mas

sokovani infeqciis samkurnalod iyeneben, SeuZliaT kok-is miRebis

gagrZeleba da paralelurad damatebiTi meTodis (mag: kondomi) gamoyeneba

momdevno menstruaciis dawyebamde.

(2 _ xarisxi `A~)

kok-is miRebis dawyeba da gamoyenebis reJimi

kok-is miRebis dawyeba SesaZlebelia regularuli menstruaciuli ciklis

dros:

• menstruaciuli ciklis dawyebidan 5 dRis ganmavlobaSi

• menstruaciuli ciklis nebismier dros, Tu sakmarisi safuZveli

arsebobs imisi, rom qali orsulad ar aris

• Tu kok-is miReba iwyeba menstruaciuli ciklis dawyebidan 5 dRis

Semdeg, qals rekomendacia eZleva Tavi Seikavos sqesobrivi

kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi 7 dRis

ganmavlobaSi (kondomi / spermicidi)

(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)

amenoreis dros:

• kok-is miRebis dawyeba SeiZleba nebismier dros, Tu sakmarisi

safuZveli arsebobs imisi, rom qali orsulad ar aris. aseT

SemTxvevaSi qalma sasurvelia Tavi Seikavos sqesobrivi kavSirisagan

an gamoiyenos kontracepciis damatebiTi meTodi 7 dRis ganmavlobaSi

(kondomi / spermicidi)


mSobiarobisa da abortis Semdeg:

• mSobiarobidan 6 Tvis Semdeg, Tu qali ZuZuTi kvebavs bavSvs

• mSobiarobidan 3 kviris Semdeg, Tu qali ZuZuTi ar kvebavs bavSvs

• abortis Semdeg kok-is gamoyeneba SeiZleba maSinve. amasTan

kontracepciis damatebiTi meTodis gamoyeneba saWiro ar aris


11

gamoyenebis reJimi:

• qali Rebulobs TiTo tablets yoveldRe 21 dRis ganmavlobaSi

(erTsa da imave dros). isvenebs 7 dRe da me-8-e dRidan iwyebs axal

firfitas.

• Tu firfita Seicavs 28 tablets (bolo 7 tableti arahormonulia da

SeiZleba Seicavdes rkinas an vitamins), qali kok-s Rebulobs uwyveti

reJimiT, anu 28 tabletis damTavrebis Semdeg qali Sesvenebis gareSe

tabletebis miRebas iwyebs axali firfitidan.


• prof. a. xomasuruZis mier SemuSavebuli modifikaciis mixedviT

monofazuri tabletebis raodenoba unda gaizardos an Semcirdes

menstruaciuli ciklis xangrZlivobis mixedviT. mag: 30 dRiani

menstruaciuli ciklis SemTxvevaSi qali Rebulobs TiTo tablets

yovel dRe 23 dRis ganmavlobaSi; 26 dRiani menstruaciuli ciklis

SemTxvevaSi – TiTo tableti erTxel dReSi 19 dRis ganmavlobaSi da

a.S. 7 dRiani Sesvenebis wesi SenarCunebulia.

sxva hormonuli meTodidan kok-ze gadasvla

• SeiZleba Sualedis gakeTebis gareSe, mxolod im pirobiT, rom wina

meTodi gamoyenebuli iyo rekomendaciis mixedviT. aseT SemTxvevaSi

Semdgom menstruaciamde mocda aucilebeli ar aris.

• Tu wina meTodi warmoadgenda ineqcias, kok-is dawyeba SeiZleba

Semdgomi ineqciis savaraudo dRes. aseT SemTxvevaSi kontracepciis

damatebiTi meTodis gamoyeneba saWiro ar aris.


arahormonuli kontracepciidan (sSs-s garda) kok-ze gadasvla

• kok-is miRebis dawyeba SeiZleba menstruaciuli ciklis dawyebidan

5 dRis ganmavlobaSi. kontracepciis damatebiTi meTodis gamoyeneba

saWiro ar aris.

• aseve, kok-is miRebis dawyeba SeiZleba wina meTodis Sewyvetidan

maSinve, an nebismier dros, Tu sakmarisi safuZveli aris imisi, rom

qali orsulad ar aris. Tu kok-is miRebis dawyeba xdeba

12

menstruaciuli ciklis dawyebidan 5 dRis Semdeg, qals rekomendacia

eZleva Semdgomi 7 dRis ganmavlobaSi Tavi Seikavos sqesobrivi

kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi.


sSs-dan (levonorgestreliani sSs-s CaTvliT) kok-ze gadasvla

• kok-is miRebis dawyeba SeiZleba menstruaciuli ciklis dawyebidan 5

dRis ganmavlobaSi. kontracepciis damatebiTi meTodebis gamoyeneba

saWiro ar aris, sSs amoRebuli unda iyos am periodSi.

• aseve kok-is miRebis dawyeba SeiZleba nebismier dros, Tu sakmarisi

safuZveli aris imisa, rom qali orsulad ar aris.

_ Tu aRniSnuli menstruaciuli ciklis ganmavlobaSi qali aqtiuri

sqesobrivi cxovrebiT cxovrobda da menstruaciis dawyebidan

gasulia 5 dReze meti, aseT SemTxvevaSi amoReba rekomendebulia

Semdgomi menstruaciuli ciklis dros

_ Tu aRniSnuli menstruaciuli ciklis ganmavlobaSi qali

sqesobrivi cxovrebiT ar cxovrobda da menstruaciis dawyebidan

gavida 5 dReze meti, qals rekomendacia eZleva Semdgomi 7 dRis

ganmavlobaSi Tavi Seikavos sqesobrivi kavSirisagan an gamoiyenos

kontracepciis damatebiTi meTodi. Tu zemoT xsenebul kontracepciis

damatebiT meTodad sSs iTvleba, maSin misi amoReba unda moxdes

Semdgomi menstruaciuli ciklis dros.

• Tu qals aqvs araregularuli menstruaciuli gamonadeni an

amenorea, kok-is miRebis dawyeba SeiZleba im rekomendaciiT, romelic

miTiTebulia: `kok-is miRebis dawyebaSi amenoreis dros~.


kok-is miRebis Semdeg fertilobis aRdgena

kok-is did upiratesobas warmoadgens misi miRebis Semdeg

fertilobis swrafi aRdgena. hipoTalamus – hipofiz – sakvercxeebis

funqcionireba 90%-Si aRdgeba 2-6 Tvis ganmavlobaSi. SemTxvevaTa 2%-Si

SeiZleba adgili hqondes hipofizis gonadotropuli funqciis

hiperdamuxruWebis sindroms da Sesabamisad amenoreas. aRniSnuli

mdgomareoba ZiriTadad gvxvdeba maRaldoziani preparatebis gamoyenebisas

13

6 da meti Tvis ganmavlobaSi. amenorea SeiZleba ganviTardes endometriumis

atrofiuli cvlilebebis Sedegad, romelic Seqcevadi procesia.

endometriumis funqciuri Sris aRdgenis Semdeg menstruacia TavisTavad

aRdgeba an SesaZlebelia saWiro gaxdes estrogenebiT mkurnaloba.


preparatebiT momarageba

• eqimma qals unda misces kok-is wliuri maragi (damokidebulia

qalis survilze, ramden xans gegmavs igi kok-is miRebas) Tu eqims

gaaCnia kontraceptivebiT (kok-iT) programuli uzrunvelyofa. an

urCios, qalma TviTon izrunos maragis Seqmnaze.

• maragis Sevsebis sistema moqnili unda iyos, romelic qals

saSualebas miscems Tavisuflad miiRos kontracepciis saWiro

raodenoba misTvis mosaxerxebel dros

• janmo-s eqspertebis monacemebiT eqimis mier qalisTvis kok-is

gacema raodenobis TvalsazrisiT SezRuduli ar unda iyos,

radganac hormonuli kontracepciis gamoyenebis dros

arasasurveli (an iZulebiTi) Sesveneba zrdis daugegmavi

orsulobis risks

(1 _ xarisxi `A~)

meTvalyureoba _ ganmeorebiTi viziti

• kok-is gamoyenebisas qali eqimTan unda mivides yovelwliurad

• kok-is miRebis dawyebidan 3 Tvis Semdeg aucilebelia eqimTan

ganmeorebiTi viziti

• qalma eqims unda mimarTos nebismier dros kontracepciasTan

dakavSirebuli romelime gverdiTi movlenis an sxva raime

problemis warmoqmnis SemTxvevaSi an Tu qals surs kontracepciis

aRniSnuli meTodis Secvla

(1 _ xarisxi `A~)

konsultireba

kontracepciis meTodis SerCeva xdeba: reproduqtologis, mean-ginekologis

da ojaxis eqimis mier.

14

qals unda mieces zusti instruqcia kok-is:

• moqmedebis meqanizmze

• gverdiT movlenebze (ix. gverdiTi movlenebi)

• sayuradRebo niSnebze (ix. sayuradRebo niSnebi)

• kok-is miRebis dawyebaze (ix. kok-is miRebis dawyeba)

• reJimze (ix. gamoyenebis reJimi)

• gamotovebul abebze (ix. protokoli gverdiTi movlenebi, Sefaseba,

marTva)

• ganmeorebiT vizitze (ix. meTvalyureoba _ ganmeorebiTi viziti)

• fertilobis aRdgenaze

kok-is gverdiTi movlenebis klasifikacia

estrogendamokidebuli efeqti progestagendamokidebuli efeqti

• Tavis tkivili

• T/A-is momateba (arteriuli wnevis

momateba)

• gaRizianeba

• gulisreva, Rebineba

• Tavbrusxveva

• mastodinia (sisavsis SegrZneba

sarZeve jirkvlebSi)

• qloazma (orsulobis msgavsi

laqebi saxeze)

• varikozuli venebis mdgomareobis

gauareseba

• kontaqturi linzebis autanloba

• sxeulis wonaSi momateba

• Tavis tkivili

• depresia

• advilad daRla

• akne

• libidos daqveiTeba

• saSos lorwovani garsis

simSrale

• varikozuli venebis mdgomareobis

gauareseba

• sxeulis wonaSi momateba

15

estrogenuli efeqtis ukmarisoba

(estrogenis SefardebiT mcire doza)

progestagenuli efeqtis ukmarisoba

(progestagenis SefardebiT

mcire doza)

• Tavis tkivili

• depresia

• gaRizianeba

• sarZeve jirkvlebis zomaSi Semci-

reba

• libidos daqveiTeba

• saSos lorwovani garsis simSra-

le

• menstruaciaTa Soris sisxliani

CamonaSali ciklis dasawyisSi

da/an SuaSi

• mcire menstruaciuli gamonadeni

• Warbi menstruacia

• menstruaciaTa Soris sisxliani

CamonaSali ciklis meore fazaSi

• menstruaciis Seferxeba

16

sayuradRebo niSnebi kok-is miRebisas

qalma unda mimarTos samedicino dawesebulebas maSinve, Tu

SeamCnia qvemoT aRwerili romelime niSani:

• Zlieri tkivili gulmkerdSi an qoSini

• Zlieri Tavis tkivili an mxedvelobis darRveva, metyvelebis

moSla

• Zlieri tkivili qvemo kidurebSi

• Zlieri tkivili muclis areSi

• siyviTle

sisxliani gamonadenis ararseboba: 21 tabletiani firfitis

damTavrebis SemTxvevaSi an 7 araaqtiuri tabletis miRebis

periodSi, romelic SeiZleba iyos orsulobis niSani.


kok-is miRebis dawyebamde rekomendebuli gamokvlevebi da analizebi,

pacientis saWiroebebisa da moTxovnilebebis mixedviT:

klasi

• sarZeve jirkvlebis gamokvleva _ C

• mcire menjis Rrus/sasqeso organoebis gamokvleva _ C

• saSvilosnos yelis kiboze skriningi _ C

• standartuli laboratoriuli analizebi _ C

• hemoglobinis gansazRvra sisxlSi _ C

• sggi-iT daavadebis riski

anamnezis Sekreba da saerTo gasinjva _ C

• sggi/Sids-is gamovlenis skrininguli

laboratoriuli analizebi _ C

• arteriuli wnevis gazomva _ *

klasi _ `C~ _ aRniSnuli gamokvlevisa da analizis Catareba ar

uzrunvelyofs kontracepciis am konkretuli meTodis uSiSrad

gamoyenebas da efeqturobas.

* _ gamokvlevis Catareba rekomendebulia.

17

kombinirebuli saineqcio kontraceptivebi (ksk)

ganmarteba

kombinirebuli saineqcio kontraceptivebi Seicavs xanmokle

moqmedebis (bunebriv) estrogens da xangrZlivi moqmedebis progestagens.

saineqcio preparatebi TandaTanobiT Seiwoveba ineqciis Semdeg 28 dRis

ganmavlobaSi. erTi ineqcia keTdeba TveSi erTxel.

ksk-s tipebi

• 25 mg depo-medroqsiprogesteron acetati da 5 mg estradiol

cipionati (ciklofemi, cikloprovera, lunela da novafemi)

• 50 mg noreTisteron enantati da 5 mg estradiol valerati

(mesijina da noriginoni)

radganac ksk-Si Semavali estrogeni ufro fiziologiuria da

naklebad Zlieri, vidre kok-Si Semavali sinTezuri estrogeni, ksk-s

gamoyenebisas gamovlenili estrogendamokidebuli gverdiTi movlenebi

SeiZleba gansxvavdebodes kok-is gverdiTi movlenebisagan. ksk-s

moklevadianma gamokvlevebma aCvena, rom kok-Tan SedarebiT igi umniSvnelod

moqmedebs arteriul wnevaze, hemostazze, sisxlis Sededebaze, lipidebis

metabolizmze da RviZlis funqciaze.

ksk-i warmoadgens kontracepiis SedarebiT axal meTods, amdenad maTi

xangrZlivi gamoyenebis epidemiologiuri monacemebi am etapze mcirea.

amasTan, kok-is miRebisas hormonuli datvirTvis moxsna SeiZleba

preparatis miRebis SewyvetiT, xolo ksk-s gamoyenebisas hormonis

zemoqmedeba grZeldeba xangrZlivad.

janmo-s samuSao jgufis dakvniTi masala, romelic kok-is

gamoyenebaze arsebobs, umetes SemTxvevaSi misaRebia ksk-ze, magram ara

yvela SemTxvevaSi. amitom ksk-s gamoyenebisas pacientebis mdgomareobis

kvalifikaciis dros janmo-s samuSao jgufi orinetirebuli iyo kok-is da

pk-s (progestagenuli kontraceptivebi) kategoriebze da SearCia saSualo

maT Soris. Tumca mZime formis paTologiebis dros (mag: gulis iSemiuri

daavadeba) klasifikacia aris igive, rac kok-is dros. amitom aRniSnuli

kategoriebi aris winaswari da axali monacemebis mixedviT gadasinjvas

eqvemdebareba.

18

(2 _ xarisxi À~)

ksk-s moqmedebis meqanizmi (ix. kok-i)

efeqturoba

ksk-s efeqturoba Seadgens 0,05 orsuloba 100 qalze/weliwadSi,

sworad da regularulad gamoyenebis SemTxvevaSi. 3 orsuloba 100

qalze/weliwadSi araregularulad gamoyenebis SemTxvevaSi.

(2 _ xarisxi À~)

kontracepciuli upiratesobebi

• maRali efeqturoba

• meTodis Seqcevadoba

• SeiZleba daculi iyos kontracepciis meTodis gamoyenebasTan

dakavSirebuli konfedencialoba

• gamoyenebis siadvile

• gamoyenebis win ar aris aucilebeli saSosmxrivi gasinjva

• ar moiTxovs maragis gakeTebas

(3 _ xarisxi À~)

naklovanebebi

• zogierT SemTxvevaSi iwvevs menstruaciuli ciklis xasiaTis

Secvlas (adreul stadiaze araregularuli _ mcire raodenobiT

sisxliani gamonadeni)

• damokidebulia gamomyenebelze (pacienti klinikaSi unda movides

30 dReSi erTxel)

• ar icavs sqesobrivi gziT gadamdebi daavadebebisagan (maT Soris B

hepatitis virusi da aiv/Sidsi)

(3 _ xarisxi À~)

ksk-is gamoyenebis Cvenebebi

ksk SeiZleba gamoiyenon im qalebma, romlebsac:

• aviwydebaT tabletebis yoveldRe miReba

• progestagenuli saineqcio kontraceptivebis fonze aReniSnebodaT

araregularuli sisxliani CamonaSali

(7 _ xarisxi À~)

19

ksk-s gverdiTi movlenebi

• menstruaciuli ciklis cvlilebebi. ufro naklebad gvxvdeba,

vidre progestagenuli saineqcio kontraceptivebis gamoyenebis

dros. pirveli cikli aris mokle (10-20 dRe), romlis Semdeg

aRiniSneba yovelTviuri sisxldena. araregularuli sisxldena

aRiniSneba SemTxvevaTa 30%-Si pirveli 3 Tvis ganmavlobaSi. ksk-s

gamomyeneblebis umravlesobas pirveli wlis bolos aReniSnebaT

regularuli menstruaciuli cikli

• amenorea ar aRiniSneba

• sxva mcire gverdiTi movlenebia: wonaSi momateba, Tavis tkivili

(3 _ xarisxi `A~)

ukuCvenebebi, kategoriebi, urTierTqmedeba sxva medikamentebTan da

gegmiuri gamokvlevebi ix. kok-is Sesabamis nawilSi

ksk-s gamoyenebis dros gansxvavebuli kategoriebi mocemulia qvemoT:

sigaretis moweva

kategoria 2. asaki < 35 w.

kategoria 2. asaki ≥ 35 w. sigareti < 15 dReSi

kategoria 3. asaki ≥ 35 w. sigareti ≥ 15 dReSi

naRvlis buStis daavadeba

kategoria 2. qolecisteqtomiis Semdeg

kategoria 2. medikamenturi mkurnalobis Semdeg

kategoria 2. daavadeba amJamad

kategoria 2. usimptomod mimdinare

RviZlis cirozi

kategoria 2. msubuqi forma (kompensirebuli)

kategoria 3. mZime forma (dekompensirebuli)

(2 _ xarisxi `A~)

20

ksk-s ineqciis gakeTebis vadebi

regularuli menstruaciuli ciklis dros:

• menstruaciuli ciklis dawyebidan 7 dRis ganmavlobaSi.


• menstruaciuli ciklis nebismier dros, Tu sakmarisi safuZveli

arsebobs imisa, rom qali orsulad ar aris

• Tu ineqcia keTdeba menstruaciuli ciklis dawyebidan 7 dRis

Semdeg, qals eZleva rekomendacia Tavi Seikavos sqesobrivi

kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi 7

dRis ganmavlobaSi

amenoreis dros:

• ksk-s ineqcia SeiZleba nebismier dros, Tu sakmarisi safuZveli

arsebobs imisi, rom qali orsulad ar aris. aseT SemTxvevaSi,

qalma sasurvelia Tavi Seikavos sqesobrivi kavSirisagan an

gamoiyenos kontracepciis damatebiTi meTodi ineqciidan 7 dRis

ganmavlobaSi

mSobiarobisa da abortis Semdeg:

• Tu mSobiarobidan gavida 6 Tveze meti, qali agrZelebs ZuZuTi

kvebas da aqvs amenorea, ksk-s ineqcia keTdeba `amenoreis~

Sesabamisi rekomendaciis mixedviT

• Tu mSobiarobidan gavida 6 Tveze meti, qali ZuZuTi kvebavs da

aqvs regularuli menstruaciuli cikli, ksk-s ineqcia keTdeba

`regularuli menstruaciuli ciklis~ rekomendaciis mixedviT

• Tu mSobiarobidan gavida 3 da meti kvira, qali ZuZuTi ar kvebavs

da aqvs amenorea, ksk-s ineqciis gakeTeba SeiZleba nebismier dros,

Tu sakmarisi safuZveli arsebobs imisa, rom qali orsulad ar

aris. amasTan qals eZleva rekomendacia Tavi Seikavos sqesobrivi

kavSirisagan, an gamoiyenos kontracepciis damatebiTi meTodi

ineqciidan 7 dRis ganmavlobaSi

21

• Tu mSobiarobidan gavida 3 da meti kvira, qali ZuZuTi ar kvebavs

da menstruaciuli cikli aRdga, ksk-s ineqcia keTdeba

`regularuli menstruaciuli cikli~-s rekomendaciis mixedviT

• abortis Semdeg maSinve SeiZleba ksk-s ineqciis gakeTeba. amasTan


ksk-s gamoyenebis reJimi:

• ksk-s ganmeorebiT ineqciebs Soris Sualedi Seadgens 4 kviras

• Tu rekomendebuli intervalis dacva ver xerxdeba, ineqciis

gakeTeba SeiZleba vadaze 1-7 dRiT adre. Tumca aseT SemTxvevaSi

SesaZlebelia dairRves menstruaciuli cikli

• Tu rekomendebuli intervalis dacva ver xerxdeba, ineqciis

gakeTeba SeiZleba 1-7 dRiT gvian. 7 dReze meti gadacilebis

SemTxvevaSi SeiZleba mxolod im pirobiT, Tu sakmarisi safuZveli

arsebobs imisi, rom qali orsulad ar aris. aseT SemTxvevaSi qals

eZleva rekomendacia Tavi Seikavos sqesobrivi kavSirisagan an

gamoiyenos kontracepciis damatebiTi meTodi 7 dRis ganmavlobaSi


sxva hormonuli meTodidan ksk-ze gadasvla

(ix. kok-is Sesabamis nawilSi)

arahormonuli kontracepciidan (sSs-s garda) ksk-ze gadasvla

• ksk-s ineqciis gakeTeba SeiZleba ukve gamoyenebuli meTodis

SewyvetisTanave, Tu sakmarisi safuZveli aris imisi, rom qali

orsulad ar aris. aseT SemTxvevaSi kontracepciis damatebiTi

meTodis gamoyeneba saWiro ar aris

• Tu menstruaciis dawyebidan ar gasula 7 dReze meti, aseT

SemTxvevaSi kontracepciis damatebiTi meTodis gamoyeneba saWiro

ar aris

• Tu ksk-s ineqcia keTdeba menstruaciuli ciklis pirveli 7 dRis

Semdeg, qals eZleva rekomendacia Tavi Seikavos sqesobrivi

kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi 7

dRis ganmavlobaSi

22

sSs-dan (levonorgestrel-sSs-s CaTvliT) ksk-ze gadasvla

• ksk-s ineqciis gakeTeba SeiZleba menstruaciuli ciklis

dawyebidan pirveli 7 dRis ganmavlobaSi. sSs amoRebuli unda

iyos am periodSi. kontracepciis damatebiTi meTodis gamoyeneba

saWiro ar aris

• nebismier dros, Tu safuZveli arsebobs imisa, rom qali orsulad

ar aris

• Tu qals aqvs araregularuli menstruaciuli gamonadeni an

amenorea, ksk-s ineqcia keTdeba `amenoreis~ rekomendaciiT


fertilobis aRdgena

• ksk-s ineqciis Semdeg fertilobis aRdgenis Sesaxeb gamokveTili

monacemebi amJamad ar aris


konsultireba

ksk-s ineqciis gakeTebamde qalTan unda Catardes konsultireba,

romelic moicavs:

• meTodis upiratesobebs da naklovanebebs, efeqturobas, risks da

sargebels, gverdiT movlenebs da Rirebulebas

• ojaxis dagegmvis alternatiul meTodebs

• sigaretis mowevas da masTan dakavSirebul sisxlZarRvovan

garTulebebs

• ineqciebis vadebs

23

24

sayuradRebo niSnebi ksk-s gamoyenebis dros

• Zlieri tkivili muclis areSi

• Zlieri tkivili gulmkerdis areSi, xvela, sunTqvis

ukmarisoba

• Zlieri Tavis tkivili

• mxedvelobis dakargva an dabindva

• mZafri tkivili barZayis an wvivis areSi

• kanis da Tvalebis siyviTle

• Zlieri sisxliani gamonadeni

• diskomforti an sxva problemebi ineqciis adgilze


ksk-s ineqciis dawyebamde skrininguli kiTxvari

anamnezis Sekrebis mizania sxvadasxva risk faqtorebis aRmoCena da maTi

gaTvaliswineba ksk-s ineqciis dawyebamde

qals dausviT Semdegi kiTxvebi:

ara ki1. menstruacia dagvianebulia an fiqrobT, rom orsulad

xarT?2. ZuZuTi kvebavT 6 Tvemde asakis axalSobils?3. eweviT sigarets (dReSi ramdens) da xarT >35 welze? 4. gaqvT Tavis tkivili, xSirad erT mxareze, pulsirebadi,

Tavbrusxveva, diskomforti sinaTlesa da xmaurze?5. gaqvT xolme maRali arteriuli wneva?6. Tu gqoniaT rodisme mwvave sisxlZarRvovani moSla

(insulti, stenokardiuli Seteva, barZayis an filtvis

arteriis Trombozi)?7. gaqvT Tu ara Saqriani diabeti?8. gqoniaT (an amJamad gaqvT) sarZeve jirkvlis kibo?9. gqoniaT (an amJamad gaqvT) RviZlis raime seriozuli

daavadeba an siyviTle?10. amJamad xom ar iRebT antituberkulozur an

antiepilefsiur wamlebs?11. gaqvT sisxldena sqesobrivi kavSiris Semdeg an

menstruaciebs Soris periodSi, rac TqvenTvis uCveuloa?

25

Tu qali Tundac erT kiTxvaze pasuxobs "diax", CautareT gamokvleva. mieciT kondomi kontracepciis sxva meTodis SerCevamde.

Tu qali yvela aRniSnul kiTxvaze pasuxobs - "ara"-mas SeuZlia ksk-is gamoyeneba

literatura: 1. Фонд народонаселения Организции Объединенных Нации в области;

Репродуктивное здоровье и исследования Всемирная Организация

Здравоохранения //«Свод Практических Рекомендаций по применению

средств контрацепции»//, Женева, Издание второе, 2005г. `xarisxi A.~

2. Фонд Организции Объединенных Нации в области народонаселения;

Репродуктивное здоровье и исследования Всемирная Организация

Здравоохранения //«Медицинские критерии приемлемости для

использования методов контрацепции»//, Женева, Третье издание, 2004г.

`xarisxi A.~

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4. Elomaa K., Ranta S., Tuominen J., Lahteenmaki P. Charcoal treatment and risk

of escape ovulation in oral contraceptive users. Human Reproduction, 2001.

`xarisxi A.~

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Eighteenth Revised Edition. N Y, Ardent Media, 2004. `xarisxi A.~.

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`xarisxi A.~.

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репродуктивному здоровью и контрацепции. Второе издание, 1996, стр. 404.

`xarisxi A.~.

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contraceptive containing 25 mg of medroxyprogesterone acetate and 5 mg E (2)

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estradiol-cypionate: effects on cervical mucus. Contraception, 2001. `xarisxi

B.~.

10. Wilcox AJ, Dunson D, Baird DD. The timing of the “fertile window” in the

menstrual cycle: day specific estimates from a prospective study. British Medical

journal, 2000. `xarisxi B.~.

26

11. Wilcox AJ, Dunson DB, Weinberg CR, Trussell J, Baird DD. Likelihood of

conception with a single act of intercourse: providing benchmark rates for

assessment of post-coital contraceptives. Contraception, 2001. `xarisxi B.~.

12. Westhoff C et al. Quick start: novel oral contraceptive initiation method.

Contraception 2002. `xarisxi B.~.

13. Westhoff C et al. Bleeding patterns after immediates vs. conventional oral

contraceptive initiation: a randomized, controlled trial. Fertility and Sterility,

2003. `xarisxi B.~.

avtorebi: prof. a. xomasuriZe, med. doqt. n. marsagiSvili,

med. doqt. g. cercvaZe, med. doqt. T. maRularia.

Eeqspertebi: prof. j. qristesaSvili. Mmed. Ddoqt. Z. boxua, med. Ddoqt.

N n. parunaSvili

27

kok-is klinikuri protokoli

(gaTvaliswinebulia reproduqtologebisaTvis,

mean-ginekologebisaTvis da ojaxis eqimebisaTvis)

kok-is miRebis dawyebamde skrininguli kiTxvari

anamnezis Sekrebis mizania sxvadasxva risk faqtorebis aRmoCena da maTi

gaTvaliswineba kok-is miRebis dawyebamde

dausviT qals Semdegi kiTxvebi:

ara ki1. menstruacia dagvianebulia an fiqrobT, rom orsulad

xarT?2. ZuZuTi kvebavT 6 Tvemde asakis axalSobils?3. eweviT sigarets (dReSi ramdens) da xarT >35 welze? 4. gaqvT Tavis tkivili, xSirad erT mxareze, pulsirebadi,

Tavbrusxveva, diskomforti sinaTlesa da xmaurze?5. gaqvT xolme maRali arteriuli wneva?6. Tu gqoniaT rodisme mwvave sisxlZarRvovani moSla

(insulti, stenokardiuli Seteva, barZayis an filtvis

arteriis Trombozi)?7. gaqvT Tu ara Saqriani diabeti?8. gqoniaT (an amJamad gaqvT) sarZeve jirkvlis kibo?9. gqoniaT (an amJamad gaqvT) RviZlis raime seriozuli

daavadeba an siyviTle?10. amJamad xom ar iRebT antituberkulozur an

antiepilefsiur wamlebs?11. gaqvT sisxldena sqesobrivi kavSiris Semdeg an

menstruaciebs Soris periodSi, rac TqvenTvis uCveuloa?

12. ramdeni dRis win dagewyoT ukanaskneli menstruacia?

28

Tu qali Tundac erT kiTxvaze pasuxobs "diax", CautareT gamokvleva. mieciT kondomi kontracepciis sxva meTodis SerCevamde.

Tu qali yvela aRniSnul kiTxvaze pasuxobs - "ara"-mas SeuZlia kok-is gamoyeneba da gadadiT me-12-e kiTxvaze

• Tu qals ukanaskneli menstruacia daewyo bolo 5 dRis ganmavlobaSi,

SeuZlia exlave daiwyos kok-is miReba.

• Tu qals ukanaskneli menstruacia daewyo 5 dReze meti xnis win da am

periodSi iyenebda kontracepciis romelime meTods (TavSekavebis

CaTvliT), mieciT kok da uTxariT - axlave daiwyos misi miReba da

auxseniT, rom uaxloesi 7 dRis ganmavlobaSi kondomi da/an

spermicidi gamoiyenos.

• Tu qals ukanaskneli menstruacia daewyo 5 dReze meti xnis win da am

periodSi ar iyenebda kontracepciis romelime meTods (TavSekavebis

CaTvliT), mieciT kok da uTxariT, rom misi miReba daiwyos momdevno

menstruaciis pirveli 5 dRis ganmavlobaSi.

29

gverdiTi movlenebi, maTi Sefaseba, marTva

gverdiTi

movlena

Sefaseba marTva

gulisreva,

Rebineba,

Tavbrusxveva

• daadgineT, tabletebs xom

ar Rebulobs diliT an

uzmoze

• SeamowmeT orsulobaze

(testi orsulobaze)

• urCieT qals tabletebi

miiRos Zilis win

vaxSmis Semdeg an

vaxSmis dros

• orsulobis dadgenis

SemTxvevaSi qalma

tabletebis miReba

unda Sewyvitos. da

gagzavnili unda iyos

specialistTan

(ginekologi,

reproduqto-logi). Tu

orsuloba ar

dadasturda, auxseniT

qals, rom es movlenebi

gaivlis 1-2 Tvis

ganmavlobaSi, kok-is

miRebis fonze an

mieciT Zalian mcire

doziani kok-i

(20mkg.e.e.).

• Tu problema

autanelia, Sewyvitos

kok-is miReba.

daexmareT mas

kontracepciis sxva

30

meTodis SerCevaSi.

• amenorea • hkiTxeT qals, rogor

iRebda tabletebs, xom ar

daaviwyda erTi an

ramodenime tabletis

miReba?

• SeamowmeT orsulobaze

(saSvilosnos RruSi,

saSvilosnosgare):

anamnezi, testi

orsulobaze, gasinjva.

• tabletebis gamotoveba

zrdis orsulobis

risks. Tu qalma

gamotova an daagviana

tabletis (erTi an

ramodenime) miReba, is

gamokvleuli unda iyos

orsulobaze.

• orsulobis dadgenis

SemTxvevaSi qali

gaagzavneT

ginekologTan an

reproduqtologTan.

Tu qali gadawyvitavs

orsulobis

SenarCunebas, man

tabletebis miReba

unda Sewyvitos. qals

unda aexsnas, rom kok-

Si Semavali estrogeni

da progestageni

xanmokle miRebisas

orsulobis adreul

stadiaze nayofze

uaryofiT gavlenas ar

axdens.

• Tu pacienti iRebda 21

tabletian firfitas,

daaviwyda erT kviriani

Sesvenebis gakeTeba

menstruaciisaTvis da

uwyveti reJimiT miiRo

tabletebi,

31

ganuviTardeba amenorea.

mieciT axsna-

ganmarteba, rom es

saSiSi araa. Tu qali

ukmayofiloa,

dauniSneT mas

maRaldoziani kok-i (50

mkg e.e.).

• Tu qali swori reJimiT

iRebda tabletebs da

aReniSneba amenorea,

daamSvideT da

auxseniT, rom

amenoreis SemTxvevaSi

mis sxeulSi an

saSvilosnoSi sisxli

ar grovdeba.

progestagenis mcire

dozis mudmivi

moqmedebiT

endometriumis sisqe

mcirdeba, rac iwvevs

sisxldenis Semcirebas

an mTlianad Sewyvetas.

Tu is ganagrZobs

dabaldoziani kok-is

(30-35 mkg e.e.) miRebas,

amenorea Cveulebriv

SenarCundeba. urCieT

qals, ganmeorebiT

momarTos klinikas, Tu

amenorea kvlav

Semawuxebeli iqneba.

• vaginaluri

sisxldena/

• hkiTxeT qals rogor

iRebda tabletebs, xom ar

• Tu qals aviwydeba

tabletebis miReba,

32

CamonaSali daaviwyda erTi an

ramodenime tabletis

miReba?

• kok-s miReba axali

dawyebulia

• SeamowmeT ginekologiur

daavadebebze (menjis Rrus

anTebiTi daavadeba),

orsulobaze

(saSvilosnos RruSi,

eqtopiuri), arasrul

abortze (teqsti

orsulobaze)

• ginekologiur

SeaxseneT wamlis

miRebis wesebi da

auxseniT, rom

tabletebis gamotoveba

zrdis orsulobis

risks. Tu SemdgomSi

mas kvlav aviwydeba

tabletebis miReba,

SeurCieT

kontracepciis sxva

meTodi.

• daamSvideT, uTxariT,

rom

sisxldena/CamonaSali

SesaZlebelia kok-is

gamoyenebis pirveli

sami Tvis ganmavlobaSi

da umravles

SemTxvevaSi mcirdeba

gamoyenebis meoTxe

Tvidan. Tu

sisxldena/CamonaSali

Semawuxebelia,

gadaiyvaneT SedarebiT

maRaldozian kok-ze, an

daexmareT qals

kontracepciis sxva

meTodis SerCevaSi.

33

daavadebebze eWvis

SemTxvevaSi ojaxis eqimi

qals agzavnis Sesabamis

specialistTan

(ginekologTan,

reproduqtologTan)

• kok-is fonze qalma

daiwyo axali

medikamentebis miReba (mag.

rifampicini)

• Tu saxezea

ginekologiuri

problemebi, CaatareT

Sesabamisi mkurnalobis

kursi.

• mieciT maRaldoziani

kok-i (50 mkg.e.e.), an

daexmareT qals

kontracepciis sxva

meTodis SerCevaSi.

• maRali

arteriuli

wneva ≥160/100

_ me-4

kategoria

≥140-159/90-99 _

me-3 kategoria

• Tu arteriuli wnevis

momateba

ganpirobebulia kok-is

gamoyenebiT, qalma

unda Sewyvitos

preparatebis miReba.

daexmareT qals

kontracepciis sxva

meTodebis SerCevaSi.

• kok-is miRebis

Sewyvetis Semdeg 3

Tvis ganmavlobaSi Tu

ar moxda arteriuli

wnevis normalizeba,

qali gaagzavneT

Sesabamis

specialistTan

gamokvlevaze.

34

• tkivili

gulmkerdis

areSi

(gansakuTreb

iT Tu is

dakavSirebu

lia fizikur

datvirTvasT

an)

• SeamowmeT gul-

sisxlZarRvTa

daavadebebze, arteriuli

wneva, guliscemis sixSire

• Tu gamoikveTa gsd-is

niSnebi, gaagzavneT

gamokvlevaze. qals

mieciT rekomendacia

Sewyvitos kok-is

gamoyeneba, daexmareT

kontracepciis sxva

meTodis SerCevaSi

• Tavis

tkivili

(mxedvelobis

darRveviT)

• daadgineT, Seicvala Tu

ara Tavis tkivilis

xasiaTi da intensivoba

kok-is miRebis dawyebis

Semdeg.

• CaatareT fizikuri

gasinjva, SeamowmeT

arteriuli wneva.

aucileblobis

SemTxvevaSi gamoikvlieT:

Tvalis fskeri da

nevrologiuri statusi

• Tu Tavis tkivili

susti xasiaTisaa da

iSviaTia, qali

daamSvideT da mieciT

tkivilgamayuCebeli

wamali. 1 Tvis Semdeg

mdgomareoba SeafaseT

ganmeorebiT.

• Tu kok-is miRebis

dawyebis Semdeg

Seicvala Tavis

tkivilis intensivoba

(tkivilis gaZliereba,

mxedvelobis cvlileba,

metyvelebis unaris

darRveva an dakargva),

SewyviteT kok-is

gamoyeneba da

daexmareT qals

kontracepciis sxva

(arahormonuli)

meTodis SerCevaSi.

• sarZeve

jirkvlebis

daWimuloba

• SeamowmeT orsulobaze • orsulobis SemTxvevaSi

imoqmedeT ise, rogorc

es zemoTaa aRniSnuli

35

an

mtkivneulob

a (mastalgia)

(ix. amenorea).

• gasinjeT s/jirkvali: _

kvanZi an kista -gamonadeni

an galaqtorea (Tu ar

kvebavs ZuZuTi)

• Tu qali orsulad ar

aris, sarZeve

jirkvlebis

mtkivneuloba gaivlis

3 Tvis Semdeg.

• Tu fizikuri gasinjviT

gamovlinda kvanZi an

gamonadeni, romelic

saeWvoa kiboze (mag:

mkvrivi, palpaciis

dros umtkivneulo an

moZraobaSi SezRuduli

kvanZi, romelic ar

icvleba mensturaciis

dros), qali gaagzavneT

Sesabamis gamokvlevaze.

• hkiTxeT qals, Tu amCnevs

s/jirkvlebis

daWimulobas Tvis

mxolod garkveul dros

(mag. menstruaciis

dawyebamde)

• urCieT qals, moeridos

kofeins, Sokolads da

a.S. da auxseniT, rom

s/jirkvlebSi mimdinare

cikluri cvlilebebi

(daWimuloba,

mtkivneuloba)

damokidebulia

estrogen/progestagenis

dozis cvlilebaze.

qali gadaiyvaneT ufro

dabaldozian kok-ze. magram Tu ukve imyofeba

yvelaze dabaldozian kok-

ze da preparatis miRebis

dawyebidan gavida 3 Tveze

36

meti, daexmareT mas

kontracepciis sxva

meTodis SerCevaSi.

• depresia • ganixileT xasiaTis

cvlilebebi

• Tu qals depresia

gauRrmavda kok-is

miRebis Semdeg,

daexmareT

kontracepciis sxva,

arahormonuli meTodis

SerCevaSi, an kok-i

SearCieT progestagenis

dabali doziT.

• Tu xasiaTis cvlileba

kok-s ar gamouwvevia,

SeiZleba maTi miRebis

gagrZeleba.

• SesaZlebelia

piridoqsinis (B6)-s

miReba 50 mg dReSi 2

Tve.

• libidos

daqveiTeba

• ganixileT libidos

cvlilebebi

• Tu kok-s ar

gamouwvevia libidos

daqveiTeba, SeiZleba

maTi miRebis

gagrZeleba. Tu qali

fiqrobs, rom libidos

daqveiTebis mizezi

preparatebia, daexmareT

mas kontracepciis sxva

meTodis SerCevaSi.

• akne • hkiTxeT, rogor da ra

sixSiriT iwmends saxes?

• Cveulebriv kok-is

miRebis dros akne

umjobesdeba da qreba.

37

• xom ar imyofeba amJamad

didi stresis qveS?

Tumca, zogierT

SemTxvevaSi, man

SeiZleba ar imoqmedos

da misi gauaresebac ki

gamoiwvios. qali

gadaiyvaneT naklebi

androgenuli efeqtis

mqone progestagenis

Semcvel kok-ze.

rekomendebulia saxis

gawmenda dReSi orjer

da saxis cximiani

kremebis

gamoyenebisagan Tavis

Sekaveba. Tu

mdgomareoba ar

Seicvala, daexmareT

qals sxva meTodis

SerCevaSi (ara

hormonuli).

• siyviTle • Tu siyviTle gamovlinda

kok-is miRebis dawyebis

Semdeg, SeamowmeT qali

hepatitze, RviZlis

keTilTvisebian an

avTvisebian simsivneze,

cirozze, naRvlis buStis

daavadebaze.

• kok-Si Semavali

hormonebi,

praqtikulad ar

moqmedebs RviZlis

funqciaze. Tu

siyviTle

ganpirobebulia

virusuli hepatitiT,

SewyviteT hormonuli

preparatebis miReba da

daexmareT qals sxva

arahormonuli meTodis

SerCevaSi srul

gamojanmrTelebamde

(anu simptomebis

38

gaqrobidan an RviZlis

funqciis

normalizaciidan 3

Tve).

• Tu siyviTle

ganpirobebulia

RviZlis simsivniT an

ciroziT, SewyviteT

kok-is gamoyeneba,

gagzavneT qali

Sesabamis gamokvlevaze,

daexmareT mas

kontracepciis sxva

meTodis SerCevaSi.

• Tu siyviTle

ganpirobebulia

naRvlis buStis

daavadebiT, SewyviteT

kok-is gamoyeneba da

daexmareT qals sxva

Sesaferisi meTodis

SerCevaSi.

• Rebineba kok-

is miRebidan

2 saaTis

ganmavlobaSi

• aseT SemTxvevaSi qalma

unda miiRos kidev erTi

aqtiuri tableti

• mwvave

Rebineba an

faRaraTi (24

sT-ze meti

xangrZlivob

iT)

• hkiTxeT qals, gagrZelda

Tu ara es 24 saaTze met

xans (am SemTxvevaSi

gamotovebuli iqneba 2

tableti)

• mwvave Rebinebam an

faRaraTma SeiZleba

tabletebis

efeqturobaze

imoqmedos. am

SemTxvevaSi, qalma unda

39

gaagrZelos

tabletebis miReba (Tu

es SesaZlebelia) da

gamoiyenos

kontracepciis

saTadarigo meTodi

manam, sanam faRaraTis

da Rebinebis Sewyvetis

Semdeg 7 aqtiur

tablets miiRebs.

• aqtiuri

tabletis

gamotoveba

(30-35 mkg.

eTinilestra

dioli)

• qals daaviwyda 1 an 2

aqtiuri (hormonuli)

tableti

• qals daaviwyda 3 da meti

aqtiuri (hormonuli)

tableti

• rac SeiZleba adre

miiRos gamotovebuli

aqtiuri (hormonuli)

tableti da

Cveulebrivi sqemiT

gaagrZelos preparatis

miReba ciklis

bolomde, anu 1

tableti erTxel

dReSi. kontracepciis

damatebiTi meTodis

gamoyeneba saWiro ar

aris.

• rac SeiZleba adre

miiRos gamotovebuli

aqtiuri (hormonuli)

tabletebi anu dReSi 2

tableti (erTi

diliT/erTi saRamos, an

2 tableti

erTdroulad) da

Semdegi tabletebis

miReba gaagrelos

Cveulebrivi sqemiT:

1Atableti erTxel

40

dReSi, Semdgomi 7 dRis

ganmavlobaSi saWiroa

Tavi Seikavos

sqesobrivi

kavSirisagan, an

gamoiyenos

kontracepciis

damatebiTi meTodi

(kondomi)

_ Tu tabletebi

gamotovebuli iyo mesame

kviraze unda miiRos

firfitaze darCenili

aqtiuri (hormonuli)

tableti da axali

firfita daiwyos Semdegi

dRidan. amasTan saWiro

aRar aris 7 araaqtiuri

tabletis miReba.

_ Tu tableti

gamotovebuli iyo pirvel

kviras da adgili hqonda

daucvel sqesobriv

kavSirs, aseT SemTxvevaSi

qalma unda mimarTos

gadaudebel kontracepcias.

• Tu tabletis

gamotovebis Semdeg

qals daewyo

menstruaciis msgavsi

sisxldena, urCieT mas

tabletebis miReba

Sewyvitos da axali

firfita daiwyos 7

dRis Semdeg.

41

• araaqtiuri

(`Semaxsenebe

li~)

tabletis

gamotoveba

• qals daaviwyda

`Semaxsenebeli~

tabletebis miReba meoTxe

kviraSi

• 28 tabletiani

firfitis miRebis

SemTxvevaSi, Tu qals

daaviwyda "Semaxsene-

beli" -araaqtiuri

tabletebis miReba,

saWiro ar aris

damatebiT saTadarigo

meTodis gamoyeneba.

urCieT qals gadaagdos

gamotovebuli

araqtiuri tabletebi

da preparatis miReba

gaagrZelos

Cveulebrivi sqemiT, anu

erTi tableti erTxel

dReSi.

(1, 4 _ xarisxi `A~, 10, 11 _ xarisxi `B~)

42

rodis SeiZleba kok-is miRebis dawyeba

regularuli menstrua-ciuli ciklis dros

amenoreis dros

abortis Semdeg

mSobiarobis Semdeg

_ menstruaciuli ciklis

dawyebidan 5 dRis

ganmavlobaSi

_ menstruaciuli ciklis

nebismier dros, Tu sakmarisi

safuZveli arsebobs imisi,

rom qali orsulad ar aris

_ Tu kok-is miReba iwyeba

menstruaciuli ciklis daw-

yebidan 5 dRis Semdeg, qals

rekomendacia eZleva Tavi

Seikavos sqesobrivi

kavSirisagan, an gamoiyenos

kontracepciis damatebiTi

meTodi 7 dRis ganmavlobaSi

(kondomi /sper-micidi)

_ kok-is miRebis dawyeba

SeiZleba nebismier

dros, Tu sakmarisi

safuZveli arsebobs

imisi, rom qali

orsulad ar aris. aseT

SemTxvevaSi qalma

sasurvelia Tavi

Seikavos sqesobrivi kav-

Sirisagan an gamoiyenos

kontracepciis

damatebiTi meTodi 7

dRis ganmavlobaSi

(kondo-mi/spermicidi)

_ abortis Semdeg

kok-is gamoyeneba

SeiZleba maSinve.

amasTan

kontracepciis

damatebiTi

meTodis

gamoyeneba saWiro

ar aris.

qali ZuZu-

Ti kvebavs

bavSvs

qali ZuZu-

Ti ar

kvebavs

bavSvs

_

mSobiarobi

dan 6 Tvis

Semdeg

_

mSobiarobi

dan 3 kvi-

ris Semdeg


43

kok-is gamoyenebis reJimi

21 tabletiani

firfita

28 tabletiani

firfita

_ erTi tableti erTxel

dReSi 21 dRis ganmavlobaSi

(erTsa da imave dros).

Sesveneba 7 dRe, me-8 dRidan

saWiroa axali firfitis

dawyeba.

_ erTi tableti erTxel

dReSi (erTsa da imave dros)

28 dRis ganmavlobaSi (bolo

7 tableti arahormonulia da

SeiZleba Seicavdes rkinas an

vitamins). anu erTi firfitis

damTavrebis Semdeg Sesvenebis

gareSe saWiroa axali fir-

fitis dawyeba.


44

kok-is urTierTqmedeba sxva medikamentebTan

xSirad gamoyenebuli an

daniSnuli wamlebi

gverdiTi efeqtebi komentarebi da

rekomendaciebitkivilgamayuCeblebi _

acetaminofeni

(tailenoli,

paracetamoli da sxv.)

tkivilgamayuCebeli

efeqtis SesaZlo

daqveiTeba (wamlebis

eqskreciis gaZliereba)

Tvalyuri adevneT

tkivilgamayuCebel

efeqts

antibiotikebi * -

grizeofulvini da

rifampicini.

ar arsebobs kliniku-

rad dadasturebuli

efeqti penicilinebisTvis,

tetraciklinebisTvis,

cefalosporinebisTvis

da sxva xSirad

gamoyenebuli

antibiotikebisaTvis.

aRniSnuli

antibiotikebis miRebisas

SeiZleba kontracepciis

hormonuli meTodis

miReba da Cveulebriv

saWiro aRar aris

kontracepciis

damatebiTi meTodis

gamoyeneba

kok-is kontracepciuli

efeqtis daqveiTeba,

gansakuTrebiT

dabaldoziani kok-is

SemTxvevaSi 30-35 mkg

eTinil estradioli (ee)

daexmareT qals,

aarCios

kontracepciis sxva

meTodi an

gamoiyeneT abebi

estrogenis ufro

maRali

SemcvelobiT (50 mkg

ee) an kontracepciis

damatebiTi meTodi

(mag. kondomi)

antidepresantebi

(elavili, norpramini,

tofranili da sxv.)

SesaZloa

antidepresantuli

efeqtis gaZliereba

gamoiyeneT

sifrTxiliT.

antidepresantebis

dabali dozebi

praqtikulad

usafrTxoa

45

hipotenziuri preparatebi

meTildopa (dopegiti),

aldometi da sxv.

SesaZloa hipotenziuri

efeqtis Sesusteba

gamoiyeneT kok da

ksk sifrTxiliT,

gaakontroleT

arteriuli wnevakrunCxvis sawinaaRmdego

barbituratebi

(fenobarbitali da sxv.)

karbamezapini

(tegretoli) fenitoini

(dilantini) primidoni

(misolini)

kok da ksk

kontracepciuli efeqtis

Semcireba,

gansakuTrebiT

dabaldoziani kok-is

miRebis SemTxvevaSi.

SesaZloa fenitoinis

efeqtis gazrda

daexmareT qals

aarCios

kontracepciis sxva

meTodi an

gamoiyeneT

maRaldoziani kok

(50 mkg ee) an

kontracepciis

damatebiTi meTodi

(mag. kondomi)beta blokatori

(korgardi, inderali,

lopresori, tenormini)

SesaZloa beta

blokatoruli efeqtis

gazrda

akontroleT gul-

sisxlZarRvTa

mdgomareobabronqodilatatorebi

Teofilini (bronkotabsi,

maraqsi, primateni,

quibron tedrali, Teo-

duri da sxv.)

Teofilinis efeqtis

gaZliereba

akontroleT

Teofilinis dozis

gadaWarbebis

simptomebi

hipoglikemiuri

(diabineze, orinaze,

tolbutamidi, tolinaze)

SesaZloa

hipoglikemiuri efeqtis

daqveiTeba

akontroleT Saqari

sisxlSi iseve,

rogorc nebismier

diabetian qalSitrankvilizatorebi

benzodiazepini (ativani,

libriumi, seraqsi,

tranqseni, valiumi,

qsanaqsi da sxva)

SesaZloa

trankvilizatorebis

efeqtis gaZliereba an

Sesusteba, maT Soris

fsiqomotoruli

darRvevebi

gamoiyeneT

sifrTxiliT.

Cveulebrivi dozebi,

rogorc wesi,

mniSvnelovan

efeqtebs ar iwvevs.

* ramdenadac grizeofulvini, romelic iwvevs estrogenisa da

progestagenis metabolizmis gazrdas, Cveulebriv mxolod xanmokle

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periodis ganmavlobaSi (2-4 kvira) gamoiyeneba, qalebs, romlebic iReben mas

mikozuri infeqciis samkurnalod, SeuZliaT gaagrZelon kok-is miReba. maT

unda gamoiyenon kontracepciis damatebiTi meTodi grizeofulvinis miRebis

periodSi da misi Sewyvetis Semdeg momdevno menstruaciis dawyebamde.

(7 _ xarisxi `A~)

47

kombinirebuli oraluri da saineqcio...

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