mini-pili”)medportal.ge/linkedfiles/miscdata/6_21.pdf · 2015-01-23 · kiboTi ar SeiZleba...

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9. progestagenuli abebi

(“mini-pili”)

ganmarteba

progestagenuli abebi (pa) Seicavs hormonis mxolod erT saxeobas –

progestagens. aRniSnuli abebi kombinirebuli oraluri

kontraceptivebisagan gansxvavebiT ar Secavs estrogens, ris gamoc

SesaZlebelia maTi gamoyeneba meZuZuri qalebisaTvis, radgan ar aferxeben

rZis gamomuSavebas da dedis rZeSi mxolod umniSvnelo raodenobiT

gadadian.

progestagenuli abebis (“mini-pili”) tipebi

• SefuTva: 30 an 35 abiT. TiToeuli tableti Seicavs 300 mkg

levonorgestrels an 350 mkg noreTindrons;

• SefuTva 28 abiT: Seicavs 75 mkg norgestrels an 500 mkg linestrenols

(1–A, 3–A, 8–B, 9– B).

moqmedebis meqanizmi

• iwvevs saSvilosnos yelis lorwos Sesqelebas, rac xels uSlis

spermatozoidebis SeRwevas cervikalur arxSi;

• endometriumis histomorfologiuri cvlilebebis gamo gaZnelebulia

ganayofierebuli kvercxujredis implantacia saSvilonos RruSi;

• “mini-pilis” hipoTalamusze zegavlenis gamo hipofizis mier

gamomuSavebuli maluTeinizirebeli hormonis koncentraciis

daqveiTebis SemTxvevaSi 50-60%-Si aRiniSneba ovulaciis daTrgunva;

• falopis milebis peristaltikis daqveiTebis gamo ferxdeba

spermatozoidebis gadaadgileba (3_A, 8_B, 12–B).

efeqturoba

sufTa progestagenuli abebi gamoirCeva maRali kontracepciuri

efeqturobiT – 0,5-8 orsuloba 100 qalze weliwadSi Tu maTi miReba xdeba

sworad da mudmivad.

progestagenuli abebi Cveulebriv aseve Zalian efeqturia meZuZuri

qalebisaTvisac: 1 orsuloba yovel 100 qalze weliwadSi (2–A, 3–A, 4–A).

progestagenuli abebis usafrTxoeba

progestagenuli abebi kontracepciis usafrTxo meTodia. maTi gamoyenebis

gamo sikvdilianoba an raime seriozuli samedicino garTuleba ar

dafiqsirebula, TumcaRa 30 welze metia rac am abebs msoflioSi

gamoiyeneben kontracepciis mizniT (2–A, 10–B).

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• “mini-pilis” SemadgenlobaSi estrogeni ar Sedis, masSi mcire doziTaa

warmodgenili mxolod progestageni, ris gamoc maT ar gaaCniT

estrogendamokidebuli gverdiTi movlenebi da garTulebebi.

progestagenuli abebis kontracepciuli upiratesobani

• maRali efeqturoba (yoveldRiuri miRebisasa 0,5 – 8 orsuloba 100

qalze meTodis gamoyenebis pirvel weliwads);

• efeqturia gamoyenebisTanave;

• meTodi Seqcevadia;

• misaRebad mosaxerxebeli da iolia;

• abebis Sewyvetis Semdeg fertilobis aRdgena xdeba 12-24 sT-is

ganmavlobaSi;

• meTodis gamoyeneba ar aris dakavSirebuli sqesobriv aqtTan;

• ar Seicavs estrogens;

• naklebi gverdiTi movlenebi;

• pacients SeuZlia Sewyvitos abebis miReba sakuTari nebasurviliT;

• SeiZleba SeTavazebul iqnas specialurad momzadebuli medpersonalis

mier (1–A, 2–A).

meTodis arakontracepciuli upiratesobebi

• amcirebs saSvilosnosgare orsulobis risks;

• amcirebs mcire menjis Rrus organoTa anTebiTi daavadebebis

ganviTarebis risks;

• iwvevs dismenoreis simptomebis Sesustebasa da gaqrobas;

• amcirebs anemiis risks;

• amcirebs menstrualur sisxldenas;

• aqveiTebs endometriumisa da sakvercxis kibos ganviTarebis risks;

• amcirebs sarZeve jirkvlebis keTilTvisebiani daavadebebis

ganiTarebis risks;

• ar moqmedebs ZuZuTi kvebaze (3–A, 4–A).

“mini-pilis” naklovanebebi

• moiTxovs yoveldRiur gamoyenebas;

• abis regularulad ar miRebis SemTxvevaSi izrdeba maTi

araefeqturoba;

• efeqturoba SeiZleba Semcirdes antikonvulsantebis (barbituratebi

da sxva) da antituberkulozuri (rifampicini da sxva) preparatebis

miRebis fonze;

• iwvevs menstrualuri ciklis xasiaTis Secvlas:

- araregularuli (menstruaciaTaSorisi) sisxliani CamonaSali;

- amenorea;

• iSviaTad SesaZlebelia wonaSi momateba an dakleba;

• ar icavs sqesobribi gziT gadamdebi infeqciebis, aiv/Sidsis, B da C hepatitebisagan;

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• warmateba damokidebulia momxmarebelze (aucilebelia Tavdacvis

mudmivi survili da abebis yoveldRiuri miReba);

• aucilebelia preparatis maragis Sevseba (3–A, 4–A).

vin SeiZleba gamoiyenos progestagenuli abebi

• qalebma reproduqciuli asakis yvela periodSi mSobiarobaTa

nebismieri raodenobiT anamnezSi, aranamSobiarebi qalebis CaTvliT;

• meZuZurma dedebma, romlebsac esaWiroeba kontracepcia (mSobiarobidan

6 an ufro meti kviris Semdeg);

• qalebma, romlebisTvisac ar aris rekomendebuli estrogenis Semcveli

kontraceptivebis miReba;

• mSobiarobis Semdeg arameZuZurma dedebma;

• abortis Semdeg;

• romlebsac aqvT sisxlis Sededebis problemebi an

namglisebrujredovani anemia;

• romlebic ewevian sigarets (asakisa da dReSi moweuli sigaretis

raodenobis miuxedavad);

• romlebsac awuxebT saSualo an seriozuli simZimis menstrualuri

tkivilebi;

• gamoiyeneba aseve hipertonuli daavadebis dros;

• romlebic upiratesobas aniWeben sufTa progestagenuli

kontraceptivebs, magram ar arian Tanaxma mimarTon ineqcias an

implantebs;

• visac ar surT gamoiyenon sufTa progestagenuli sSs (3–A, 4–A).

mdgomareobebi, romlebsac progestagenuli abebis gamoyenebis dawyebamde

moiTxovs winaswar samedicino Sefasebas

janmos klasifikacia

kategoria 1. progestagenuli abebi SeuzRudavad gamoiyeneba nebismier

situaciaSi

kategoria 2. progestagenuli abebi umetes SemTxvevaSi SeuzRudavad

gamoiyeneba, radganac sargebloba metia, vidre

Teoriuli da/an damtkicebul riski.

kategoria 3. progestagenuli abebis gamoyeneba rekomindirebuli ar

aris, radganac Teoriuli an damtkicebuli riski metia

vidre sargebloba, progestagenuli abebi gamoiyeneba

mxolod im SemTxvevaSi, Tu ki sxva meTodi ar aris

xelmisawvdomi.

kategoria 4. progestagenuli abebis gamoyeneba ar SeiZleba (1–A).

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progestagenuli abebis gamoyenebis ukuCvenebebia

• saeWvo an dadasturebuli orsuloba;

• sarZeve jirkvlis kibo;

• mSobiarobidan 6 kviris ganmavlobaSi ZuZuTi kvebis dros;

• sasqeso gzebidan daudgeneli genezis sisxldena;

• virusuli pepatiti;

• RviZlis cirozi an simsivne;

• insulti, gulis iSemiuri daavadeba (amJamad an anamnezSi);

• Rrma venebis Trombozi / filtvis embolia;

• antikonvulsantebis an antituberkulozuri preparatebis miReba

(1-A, 3–A).

orsuloba (dadasturebuli an saeWvo)

kategoria 4. progestagenuli abebis gamoyeneba ar SeiZleba

dadasturebuli an saeWvo orsulobis dros. im

SemTxvevaSi, rodesac preparatis miRebis fonze saSvilosnos

RruSi orsuloba dasturdeba aucilebelia Sewydes misi

miReba. literaturaSi ar aris raime miTiTeba orsulobisas

progestagenuli abebis SemTxveviTi gamoyenebisas maTi

uaryofiTi gavlenis Sesaxeb qalisa da nayofis

janmrTelobaze, Tumca es monacemebi saboloo ar aris. im

SemTxvevaSi, rodesac orsulobis dadgena ver xerxdeba pa-s

miRebis dawyeba unda gadaidos Semdeg menstruaciamde. am

SualedSi pacientma mizanSewonilia gamoiyenos

kontracepciis sxva meTodi (mag. kondomi, spermicidi da sxv.)

(1–A, 3–A).

ZuZus kibo

kategoria 4. qalebi, romlebic amJamad daavadebulebi arian ZuZus

kiboTi ar SeiZleba gamoiyenon progestagenuli abebi.

radganac ZuZus kibo hormondamokidebul simsivnes

warmoadgens, mcire doziT miRebuli progestagenis fonze

daavadebis progresirebis riski izrdeba.

kategoria 3. anamnezSi aRniSnuli ZuZus kibo recidivis gareSe

ukanaskneli 5 wlis ganmavlobaSi (1–A, 3–A).

ZuZuTi kveba

kategoria 3. Tu qali ZuZuTi kvebavs bavSvs mSobiarobidan 6 an 6 kviraze

naklebi drois ganmavlobaSi progestagenuli abebis

gamoyeneba ar aris mizanSewonili (garda im SemTxvevisa,

rodesac sxva meTodi xelmisawvdomi ar aris). “mini-pilis”

gamoyeneba mSobiarobis Semdeg pirveli 6 kviris

ganmavlobaSi gavlenas ar axdens ZuZuTi kvebis xarisxze da

axalSobilis zrda-ganviTarebaze, Tumca ZuZuTi kvebis

periodSi progestagenuli abebis gavlena bavSvis tvinze da

RviZlze bolomde Seswavlili ar aris.

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kategoria 1.

mSobiarobidan 6 Tvis Semdeg.

kategoria 1. mSobiarobidan 6 kviris gavlis Semdeg, rodesac bavSvi

imyofeba ZiriTadad ZuZuTi kvebaze (1–A, 3–A).

sasqeso gzebidan daudgeneli genezis sisxldena

(gamokvlevamde)

kategoria 3. Tu ar aris eWvi orsulobaze an romelime seriozul

paTolobiaze (mag. mcire menjis Rrus organoebis

simsivne) saWiroa Catardes Sesabamisi gamokvleva da

Semdgom gansazRvros kategoria.

kategoria 2. diagnozis dadgenis Semdeg, Tu eWvi orsulobasa an

avTvisebiani simsivnis arsebobaze ar dadasturdeba, pa-s

gamoyeneba SesaZlebelia (1-A, 2-A, 3-A, 4-A).

virusuli hepatiti (aqtiuri forma)

kategoria 3. RviZlis funqciis darRvevis dros, romelic aqtiuri

virusuli hepatitiTaa ganpirobebuli Zneldeba progestage-

nebis metabolizmi, ris gamoc “mini-pilis” gamoyeneba ar

SeiZleba, Tumca aqtiuri hepatitis SemTxvevaSi maTi miReba

ufro naklebad saSiSia, vidre kok-is gamoyeneba analogiur

situaciaSi (1-A).

RviZlis simsivne da cirozi

kategoria 3. RviZlis keTilTvisebiani simsivne (adenoma);

kategoria 3. RviZlis avTvisebiani simsivne (hepatoma);

kategoria 3. RviZlis cirozis dekompensirebuli forma;

kategoria 2. RviZlis cirozis msubuqi forma (kompensirebuli).

imdenad, ramdenadac progestagenuli abebis metabolizmi RviZlSi mimdina-

reobs, “mini-pilis” gamoyenebam RviZlis funqciis darRvevis SemTxvevaSi

SeiZleba uaryofiTi gavlena iqonios qalis janmrTelobaze da garda amisa

aRniSnulma preparatebma SeiZleba xeli Seuwyos simsivnis zrdas. Tumca

progestagenuli abebis miRebisas aRniSnuli riski ufro mcirea, vidre kok-

is gamoyenebisas analogiur situaciaSi (1-A, 3-A).

naRvlis buStis daavadebebi

kategoria 2. qoleqcisteqtomiis Semdeg, pa-s gamoyeneba SeiZleba;

kategoria 2. medikamenturi mkurnalobis Semdeg, pa-s gamoyeneba SeiZleba;

kategoria 2. daavadeba amJamad, pa-s gamoyeneba SeiZleba;

kategoria 2. usimptomod mimdinare daavadeba, pa-s gamoyeneba SeiZleba;

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kategoria 1. anamnezSi qolestazi orsulobis dros, pa-s gamoyeneba

SeiZleba (1-A, 3-A).

insulti, gulis iSemiuri daavadeba

(anamnezSi an amJamad)

kategoria 3.

progestagenuli abebis gamoyenebis dros SesaZlebelia

gaizardos Trombozis riski, rac warmoadgens damatebiT

risk-faqtors aRniSnuli daavadebis ganviTarebisaTvis

(1-A, 5-B, 8–B).

Rrma venebis Trombozi / filtvis embolia

kategoria 3.

pacientebs, romlebsac amJamad aqvT Rrma venebis Trombozi /

filtvebis embolia, Tavi unda Seikavon „mini-pilis“

miRebisagan, garda im SemTxvevisa Tu sxva meTodi

xelmisawvdomi ar aris;

kategoria 2.

Rrma venebis Trombozi / filtvis embolia anamnezSi;

kategoria 2.

qirurgiuli Careva, romelic moiTxovs xangrZliv

imobilizacias (1-A, 5-B, 6-B, 8-B).

antikonvulsantebis (feniToini da barbituratebi) an

antituberkulozuri (rifampicini) preparatebis miReba

kategoria 3.

pacientebi, romlebsac esaWiroebaT aRniSnuli preparatebiT

mkurnaloba mizanSewonilia ar miiRon „mini-pili“, maTi

kontraceptiuli efeqturobis Semcirebis gamo.

antikonvulsantebisa (valprois mJavas garda) da

rifampicinis miRebis fonze RviZlis fermentebis aqtivobis

momatebis gamo Zlierdeba progestagenebis metabolizmi

RviZlSi, rac amcirebs hormonuli preparatebis efeqturobas

(1-A, 2-A, 3-A).

progresuli da didxans mimdinare (20 welze meti) Saqriani diabeti

sisxlZarRvovani garTulebebiT, neiropaTiiT, retinopaTiiT da nefropaTiiT

kategoria 2.

aRniSnuli mdgomareobis dros progestagenuli abebis

gamoyeneba SeiZleba, radganac sisxlSi cirkulirebs

hormonis mcire koncentracia;

kategoria 2.

pacientebs, insulindamokidebuli an insulindamoukidebeli

Saqriani diabetiT sisxlZarRvovani garTulebebis gareSe

ZiriTadad SeuZliaT „mini-pilis“ gamoyeneba. Tumca maTi

miRebis fonze SesaZloa saWiro gaxdes antidiabeturi

preparatebis dozis gazrda (1-A, 12-B).

maRali arteriuli wneva

kategoria 2. hipertenzia anamnezSi abebis miRebamde, maT Soris

orsulobis dros;

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kategoria 1. rodesac sistoluri wneva 140-159 da diastoluri 90-99

mm/Hg;

kategoria 2. rodesac sistoluri wneva ≥ 160 da diastoluri ≥ 100;

kategoria 2. rodesac aRiniSneba sisxlZarRvovani daavadebebi (1-A, 3-A).

Sakiki

kategoria 1. Tavis tkivili kerovani nevrologiuri simptomebis gareSe

nebismier asakSi;

kategoria 2. Tavis tkivili kerovani nevrologiuri simptomebiT nebismier

asakSi (1-A, 3-A).

progestagenuli abebis miRebis wesi

regularuli menstrualuri ciklis dros

• menstrualuri ciklis pirveli dRidan yovel dRe TiTo abi uwyvet

reJimSi 5 dRis ganmavlobaSi;

• menstrualuri ciklis nebismier dRes, Tu sakmarisi safuZveli

arsebobs imisa, rom qali orsulad ar aris;

• im SemTxvevaSi Tu menstruaciis dawyebidan gasulia 5 dReze meti,

pacientebma preparatis miRebidan 2 dRis ganmavlobaSi Tavi unda

Seikavos sqesobrivi kavSirisgan an gamoiyenos kontracepciis sxva

meTodi (spermicidi, kondomi) (2-A, 7-B).

amenoreis dros

• amenoreis dros „mini-pilis“ dawyeba SeiZleba nebismier dRes Tu

arsebobs sakmarisi safuZveli imisa, rom pacienti ar aris orsulad,

aseT SemTxvevaSi mizanSewonilia 2 dRis ganmavlobaSi sqesobrivi

urTierTobisagan Tavis Sekaveba an damatebiT Casaxvis sawinaaRmdego

saSualebebis gamoyeneba (spermicidi, kondomi) (2-A, 7-B).

mSobiarobisa da abortis Semdeg

• mSobiarobidan 6 Tvis Semdeg, Tu qali iyenebs laqtaciuri amenoreis

meTods (lam.);

• mSobiarobidan 6 kviris Semdeg, Tu qali ZuZuTi kvebavs, magram ar

iyenebs lam-s;

• mSobiarobidan maSinve an 6 kviris ganmavlobaSi Tu qali ZuZuTi ar

kvebavs bavSvs;

• abortis Semdeg maSinve kontracepciis damatebiTi meTodis gamoyenebis

gareSe (2-A, 7-B).

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sxva hormonuli meTodidan „mini-pilze“ gadasvla

„mini-pilis“ miReba SesaZlebelia daiwyos qalma maSinve intervalis

gareSe wina meTodis SewyvetisTanave, Tu igi sworad Rebulobda sxva

hormonul preparats an arsebobs sakmarisi safuZveli imisa, rom

pacienti orsulad ar aris. aseT SemTxvevaSi ar aris aucilebeli

mocda Semdegi menstruaciis dawyebamde;

Tu wina meTodi warmoadgenda ineqcias, progestagenuli abebis

gamoyeneba SeiZleba Semdgomi ineqciis savaraudo dRes. am SemTxvevaSi

ar aris saWiro kontracepciis damatebiTi meTodis gamoyeneba (2-A, 7-B).

arahormonuli kontracepciidan (sSs-s garda) progestagenul abebze

gadasvla

progestagenuli abebis miReba SeiZleba menstruaciis dawyebidan 5

dRis ganmavlobaSi, kontracepciis damatebiTi meTodis gamoyenebis

gareSe;

„mini-pilis“ miReba SeiZleba ukve gamoyenebuli meTodis

SewyvetisTanave, Tu sakmarisi safuZveli arsebobs imisa, rom qali ar

aris orsulad. am SemTxvevaSi ar aris saWiro kontracepciis

damatebiTi meTodis gamoyeneba;

Tu abebis miReba iwyeba menstrualuri ciklis pirveli 5 dRis Semdeg

aucilebelia Tavis Sekaveba sqesobrivi kavSirisgan an kontracepciis

sxva meTodis (barieruli, spermicidi) gamoyeneba 2 dRis ganmavlobaSi

(2-A, 7-B)

sSs-dan (levonorgestrel _ sSs-s CaTvliT) progestagenul abebze gadasvla

progestagenuri abebis miRebis dawyeba SeiZleba menstrualuri

ciklis pirveli 5 dRis ganmavlobaSi. sSs amoRebuli unda iqnes am

periodSi. am SemTxvevaSi damatebiTi meTodis gamoyeneba saWiro ar

aris;

nebismier dros Tu arsebobs sakmarisi safuZveli imisa, rom qali

orsulad ar aris.

Tu qals aqvs amenorea an araregularuli menstrualuri gamonadeni

“mini-pili” gamoiyeneba “amenoreis” rekomendaciiT (2-A, 7-B).

rogor unda moiqces qali morigi progestagenuli abis miRebis gamotovebis

SemTxvevaSi

a) regularuli menstrualuri ciklis dros

• rac SeiZleba adre unda iqnes miRebuli gamotovebuli

progestagenuli 1 abi da gagrZeldes danarCeni abebis miReba sqemis

mixedviT anu TiTo abi dReSi erTxel. am SemTxvevaSi qalma ori

momdevno dRis ganmavlobaSi Tavi unda Seikavos sqesobrivi

kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi (kondomi

/ spermicidi);

• saWiroebis SemTxvevaSi SeiZleba qalma mimarTos gadaudebeli

kontracepciis meTodsac.

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b) mSobiarobis Semdeg

• ZuZuTi kvebis dros menstrualuri ciklis ararsebobisas pacientma

rac SeiZleba swrafad unda miiRos „mini-pilis“ erTi abi da

gaagrZelos darCenili abebis miReba Cveulebrivi sqemiT anu erTi abi

dReSi erTxel;

• mSobiarobis Semdeg 6 Tvemde aseve miRebuli unda iqnes „mini-pilis“

erTi abi da gagrZeldes danarCeni abebis miReba Cveulebrivi sqemiT. am

SemTxvevavaSi kontracepciis damatebiTi meTodis gamoyeneba ar aris

saWiro (2-A, 10-B).

Rebineba da Zlieri diarea ganviTarebuli progestagenuri abebis miRebis

dros

Rebinebis dros, romelic abis miRebidan 2 saaTis ganmavlobaSi

ganviTarda, qalma unda miiRos „mini-pilis“ damatebiTi erTi abi;

Zlieri deareisa da Rebinebis SemTxvevaSi, romelic 24 saaTi da meti

xnis ganmavlobaSi grZeldeba pacientma SeZlebisdagvarad unda

gaagrZelos abebis miReba;

Zlieri Rebinebisa da diareis SemTxvevaSi, romelic grZeldeba 2

dReze met xans pacientma „mini-pili“ unda miiRos iseTi sqemiT,

romelic rekomendirebulia gamotovebuli abis miRebisas (2-A, 11-B).

instruqcia pacientebisTvis

• auxseniT pacients “mini-pilis” miRebis wesi, aCveneT abebis Sekvra

da miuTiTeT SekvraSi pirvel abze;

• auxseniT, rom abebis miReba yovelTvis unda daiwyos pirveli

abidan menstrualuri ciklis pirvel 5 dRis ganmavlobaSi

TanmimdevrobiT. yovel dRe erTsa da imave dros, miuxedavad imisa

pacients aqvs Tu ara sqesobrivi kavSiri. Sekvris dasrulebis

Semdeg imis miuxedavad qals aqvs Tu ara menstruacia, man unda

diwyos axali Sekvris gamoyeneba;

• “mini-pilis” miRebis dawyebisas menstrualuri ciklis pirveli 5

dRis gasvlis Semdeg unda iqnes gamoiyenebuli kontracepciis sxva

meTodi rogoricaa kondomi an spermicidi ori dRis ganmavlobaSi;

• auxseniT Tu rogor unda moiqces erTi an meti abis gamotovebis an

dagvianebis (3 sT-ze meti xniT) SemTxvevaSi. aseve isic, TuErogor

unda moiqces Rebinebis da faRaraTis SemTxvevaSi (mouwevs sxva

meTodis, kondomis an spermicidis gamoyeneba);

• gaafrTxileT SesaZlo gverdiTi movlenebis Sesaxeb;

• gaafrTxileT, rom aucileblad mimarTos klinikas iseT

SemTxvevebSi, rogoricaa:

- Zlieri an gaxangrZlivebuli sisxldena (> 8 dRis ganmavlobaSi);

- Sakiki, ganmeorebiTi an dabinduli mxdvelobiT;

- gadacilebuli menstruacia regularuli ciklebis SemTxvevaSi,

rac SeiZleba iyos orsulobis niSani;

- muclis mwvave tkivili;

- rifampicinis an antikonvulsantebis miRebis dawyebamde;

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• auxseniT pacients, rom romelime gverdiTi movlenis dros

mimarTos klinikas (1-A, 2-A).

„mini-pilis“ miRebis Semdeg fertilobis aRdgena

progestagenuli abebis miRebis Sewyvetis Semdeg fertilobis aRdgena xdeba

12-24 saaTis ganmavlobaSi (1-A, 2-A, 3-A).

konsultireba

meTodis SerCeva xdeba reproduqtologis, mean-ginekologis, ojaxis eqimis,

pirveladi jandacvis rgolis eqimis mier.

pacients unda mieces dawvrilebiTi informacia progestagenuri abebis

moqmedebis meqanizmis, efeqturobis, gverdiTi movlenebis sargebelisa da

riskis, garTulebebis da fertilobis aRdgenis Sesaxeb.

sayuradRebo niSnebi

pacientma unda mimarTis samedicino dawesebulebas maSinve, Tu aReniSneba

qvemoT CamoTvlili romelime garTuleba:

- menstrualuri sisxldenis Sewyveta ramodenime Tvis regularuli

menstrualuri ciklis Semdeg;

- Zlieri tkivili muclis areSi da mcire menjis RruSi;

- Warbi da xangrZlivi vaginaluri sisxldena;

- Zlieri Tavis tkivili (Sakiki) ganmeorebiTi an axal warmoqmnili;

- qoSini da Zlieri tkivili gulmkerdis areSi;

- Tvalebis lorwovanisa da kanis siyviTle (1-A, 2-A, 3-A, 8-B).

progestagenuli abebis gamoyenebamde rekomendebuli gegmiuri gamokvlevebi

da analizebi:

klasi

• sarZeve jirkvlebis gamokvleva . . . . . . . . . . . . . . . . . . . C • mcire menjis Rrus sasqeso organoebis

gamokvleva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C • saSvilosnos yelis skriningi . . . . . . . . . . . . . . . . . . . C • standartuli lab. gamokvlevebi . . . . . . . . . . . . . . . . . C • sggi-riskis Sefaseba anamnezisa da

lab. gamokvlevebis safuZvelze . . . . . . . . . . . . . . . . . . C • sggi/aiv skrininguli

laboratoriuli gamokvleva . . . . . . . . . . . . . . . . . . . . C • arteriuli wnevis gazomva . . . . . . . . . . . . . . . . . . . . . . * * *

kategoria _ „C“- aRniSnuli gamokvlevis Catareba ar uzrunvelyofs

kontracepciis konkretuli meTodis SeuzRudavad gamoyenebasa da

efeqturobas.

*** _ rekomendebulia gamokvlevis Catareba (1-A).

153

gamoyenebuli literatura

1. Medical eligibility criteria for contraceptive use, WHO, 3rd edition, 2004.

2. Selected practice recommendations for contraceptive use, WHO, 2nd edition, 2006

3. Руководство по контрацепции (под редакцией Прилепской В.Н., Москва, МЕДпресс, 2006, 399 стр.

4. Hatcher, R., Rinehart, W., Blackburn P., Geller, J. The Essentials of Contraceptive Technology, Handbook for clinical staff, The John Hopkins school of Public Health, 2001.

5. World Health Organization, Collaborative study of cardiovascular disease and steroid hormone contraception. Venous thromboembolic disease and combined oral contraceptives: results of intranational multicenter case –controlled study. Lancet, 1995, 346: 1575-82.

6. Klemens J., Agra, A., Groble D. Third generation oral contraceptives and risk of venous thromboembolism: a meta analysis. Br. Med. Journal, 2001. 323, 131-4.

7. Wilox A., Dunson D., Baird D. The timing of the fertile window in the menstrual cycle: day-specific estimates from a prospective study. BMJ, 2000, 321: 1259 – 1262

8. Benagiano G., Primiero F., Farris M. Clinical profile of contraceptive progestins. The Europian Journal of Contraception and Reproducrtive Health Care. 2004, v.9; #3: p.182-193

9. Staneryk F., Herzl M. The use of the name “progestin”. Contraception, 2001, 64; p.1-2

10. Mccann, M., Potter L., Progestin only contraception: a comprehensive review. Contraception, 1994, 50 (Suppl 6): S1-195

11. Elomaa et all. Charcoal treatment and risk of escape ovulation in oral contraceptive users. Human Repruduction, 2001, 16:76-81.

12. Niegratz I., Kuhl H. Metabolic and Clinical Effects of progestagens; The Eourepean Journal of Contraception and Reproductive Health Care, 2006, 11, #3: 153-161.

154

avtorTa jgufi

saqarTvelos reproduqtologTa asociacia

⇒ a. xomasuriZe _ profesori, medicinis mecnierebaTa doqtori;

i.Jordanias sax. adamianis reproduqciuli janmrTelobis s/k

institutis direqtori;

⇒ T. maRularia _ medicinis doqtori;

⇒ g. cercvaZe _ medicinis doqtori. i.Jordanias sax. adamianis

reproduqciis s/k instituti. Sobadobis regulaciis ganyofilebis

ufrosi;

⇒ j. qristesiaSvili _ iv. javaxiSvilis saxelobis Tbilisis

saxelmwifo universitetis, reproduqtologia-meanoba-gienkologiis

departamentis asocirebuli profesori; i.Jordanias sax. adamianis

reproduqciis samecniero kvleviTi instituti, med. mecn. doqtori,

profesori.

eqspertebi:

⇒ n. marsagiSvili _ medicinis doqtori. i.Jordanias sax. adamianis

reproduqciis s/k institutis Sobadobis regulaciis ganyofileba;

⇒ n. parunaSvili – medicinisAdoqtori;

⇒ saojaxo medicinis profesionalTa kavSiri _ i. qarosaniZe.

155

protokoli

progestagenuli abebi (“mini-pili”)

(reproduqtologebisaTvis, mean-ginekologebisa da ojaxis eqimebisaTvis)

skrininguli kiTxvari progestagenuli abebis (pa) gamoyenebis dawyebamde

dausviT pa-s potenciur momxmarebels Semdegi kiTxvebi:

1. menstruacia dagvianebulia an SesaZlebelia orsulad iyoT?

Tu pacienti pasuxobs “diax” CautareT gamokvleva an gaagzavneT is

klinikaSi/eqimTan diagnozis dasazusteblad da mieciT kondomi an spermicidi rom

am drois ganmavlobaSi gamoiyenos. Tu pacienti pasuxobs “ara” gadadiT me-2

kiTxvarze.

2. kvebavT Tu ara bavSvs ZuZuTi, romelic 6 kviraze naklebi asakisaa?

Tu pacienti pasuxobs „diax“ pa miRebis vada gadadeT, mieciT pa da uTxariT, rom

maTi gamoyeneba unda daiwyos, rodesac bavSvi 6 kviris gaxdeba.

3. gaqvT / gqoniaT ZuZus kibo?

Tu pacienti pasuxobs „diax“ ar misceT progestagenuli abebi, daexmareT mas iseTi

meTodis SerCevaSi, romelic hormonebs ar Seicavs.

4. gaqvT Tu ara siyviTle, cirozi mwvave fazaSi, hepatiti an RviZlis

simsivne? (pacientis Tvalebi da kani uCveulod yviTeli xom ar aris?

Tu pacienti pasuxobs „diax“ ar misceT mas pa. gaagzavneT Sesabamis specialistTan

gamokvlevebze. daexmareT mas kontracepciis sxva arahormonuli meTodis SerCevaSi.

5. RebulobT Tu ara antikonvulsantebs Setevis dros? RebulobT

rifampicins an grizeofulvins?

Tu pacienti Rebulobs feniToins, karbamazepins, barbituratebs, primidons Setevis

dros, rifampicins an grizeofulvins mieciT mas kondomebi an spermicidi pa-sTan

erTad gamosayeneblad. Tu igi mkurnalobis xangrZliv kurss gadis, daexmareT mas

kontracepciis sxva efeqturi meTodis SesarCevad.

6. gaqvT Tu ara sisxliani gamonadeni sasqeso gzebidan, rac uCveuloa

TqvenTvis?

Tu pacienti pasuxobs „diax“ gamoikvlieT SesaZlo orsulobaze an sxva raime

ginekologiur paTologiaze. pa-is Semdgomi gamoyenebis SesaZlebloba SeafaseT

gamokvlevis Sedegebze dayrdnobiT.

156

gverdiTi movlenebi, maTi Sefaseba da marTva

(reproduqtologebis da mean-ginekologebisaTvis)

gverdiTi

movlena Sefaseba marTva

amenorea • regularuli menstrualuri

ciklis Semdeg amenorea

SeiZleba Sefasdes rogorc

orsulobis niSani

(saSvilosnos Rrus an mis

gareT).

• CautareT pacients testi

orsulobaze. Tu testi

uaryofiTia saWiroa

pacients Cautardes

konsultieba. auxseniT mas,

rom amenoreis SemTxvevaSi

sisxli ar grovdeba

saSvilosnoSi an sadme

sxvagan qalis organizmSi.

progestagenis mcire doziT

mudmivi zemoqmedebis gamo

mcirdeba endometriumis

sisqe, rac iwvevs

menstrualuri sisxldenis

TandaTanobiT Semcirebas,

zogierT SemTxvevaSi

Sewyvetasac ki. urCieT

pacients kvlav mimarTos

eqims Tu SemdgomSi

Seawuxebs amenorea da

SeurCieT mas kontracepciis

sxva meTodi.

• Tu testi dadebiTia

daadgineT orsulobis

lokalizacia (saSvilosnos

Rrus an mis gareT).

• saSvilosnos Rrus

orsulobisas pacients

gauwieT konsultacia

arCevanTan dakavSirebiT.

_ Tu pacienti apirebs

orsulobis SenarCunebas

SewyviteT pa-is miReba da

auxseniT mas, rom

progestagenis mcire dozas,

romelsac Seicavs «mini-

pili» nayofze

damazianebeli gavlena ara

aqvs.

saSvilosnosgare orsulobis

SemTxvevaSi CautareT

saTanado mkurnaloba.

157

menstruaciaTa

Sorisi

vaginaluri

sisxliani

gamonadeni (mcire

an saSualo

raodenobiT)

vaginaluri sisxliani

gamonadenis mizezi SeiZleba

iyos iseTi ginekologiuri

daavadebebi, rogorebicaa:

vaginiti, cerviciti, sggd,

saSvilosnos yelis polipi an

saSvilosnos simsivne.

• aRniSnul daavadebaTa

dasadgenad an gamosaricxad

CautareT pacients

damatebiTi gamokvlevebi.

_ Tu ginekologiur

daavadebas adgili ara aqvs,

auxseniT pacients, rom

menstruaciebs Soris

periodSi mcire / saSualo

sisxliani gamonadeni pa-is

momxmarebel bevr qalSi

aRiniSneba (gamoyenebis

pirveli wlis ganmavlobaSi

SemTxvevaTa 15-20%-Si). igi

seriozul problemas ar

warmoadgens da Cveulebriv

ar saWiroebs mkurnalobas.

_ Tu konsultirebis Semdeg

pacienti diskomforts mainc

ganicdis da nerviulobs –

daexmareT mas kontracepciis

sxva meTodis SerCevaSi.

• Tu dadginda romelime

ginekologiuri daavadeba

CautareT pacients

Sesabamisi mkurnaloba.

menstruaciaTa

Soris periodSi

Warbi da /an

xangrZlivi

sisxliani

gamonadeni

(normalurTan

SedarebiTi

orjer meti

raodenobiT da 8

dReze meti

xangrZlivobiT).

• CautareT pacients

damatebiTi gamokvlevebi

raTa daadasturoT an

gamoricxoT iseTi

daavadebebi, rogoricaa

cerviciti, saSvilosnos

yelis polipi an

saSvilosnos simsivne,

TviTnebiTi aborti,

saSvilosnos Rrus an

saSvilosnosgare

orsuloba.

im SemTxvevaSi, rodesac

adgili ara aqvs genitaluri

traqtis paTologias da

pacients surs gaagrZelos

pa-s miReba rekomendebulia

mkurnalobis 2 varianti:

a) kok (30-35 mkg eTinil

estradiolis Semcveli) 21

dRe, romlis damTavrebidan

1 kviris ganmavlobaSi

pacients unda hqondes

menstrualuri gamonadeni.

b) ibuprofeni (800 mg. 3 -

jer dReSi) an sxva romelime

arasteroiduli

anTebissawinaaRmdego

preparati 5 dRe.

• mkurnalobis Sedegad

sisxldena unda Semcirdes

3 dRis ganmavlobaSi.

• SeamowmeT pacienti anemiis

arsebobaze.

• anemiis SemTxvevaSi

uzrunvelyaviT pacienti

rkinis preparatiT (romelic

158

Seicavs 100 mg. rkinas) 1-3

Tve.

• Tu Catarebuli

mkurnalobis Sedegad

sisxldenis kupireba ar iqna

miRweuli SewyviteT pa-is

miReba da daexmareT

pacients kontracepciis sxva

meTodis SerCevaSi.

• orsulobis (saSvilosnos

Rrus an saSvilosnos

gare) an TviTnebiTi

abortis diagnozis

dasadgenad CautareT

pacients damatebiTi

gamokvlevebi.

• orsulobis SemTxvevaSi

imoqmedeT ise, rogorc es

zemoTaa aRniSnuli

(ix. amenorea).

tkivili muclis

qveda areSi

• SeamowmeT:

– pulsi;

– arteriuli wneva;

– temperatura.

• CautareT abdominuri da

vaginaluri bimanualuri

gasinjva raTa

gamoiricxos:

– apendiciti; – saSviloosnosgare

orsuloba;

– mcire menjis Rrus

organoTa anTebiTi

daavadebebi;

– sakvercxeebis cista.

• iSviaT SemTxvevaSi pa-is

miRebis fonze sakvercxeSi

mwifdeba folikuli da ar

xdeba misi drouli

ukuganviTareba (atrezia). Tu

folikulis zrda gagrZelda

misma zomam SeiZleba

gadaaWarbos normaluri

folikulis sidides.

rTulia, amgvarad

gadidebuli folikulis

sakvercxis cistisagan

garCeva, radganac es procesi

ZiriTadad usiptomo

mimdinareobiT xasiaTdeba,

Tumca SesaZlebelia misi

vaginalurad gasinjva.

umravles SemTxvevaSi

gadidebuli folikuli

TavisiT qreba da ar

saWiroebs mkurnalobas an

pa-s miRebis Sewyvetas.

Zalian iSviaTad igi

SeiZleba Semoigrixos an

gaskdes, rac iwvevs tkivils

muclis areSi da SesaZloa

qirurgiuli Carevac gaxdes

saWiro.

wonaSi dakleba

an momateba

• SeadareT pacientis

amJamindeli wona pa-s

gamoyenebamde arsebul

wonasTan.

• SeamowmeT aris Tu ara

• pa-is gamoyenebis dros

wonaSi matebis mizezi

SeiZleba iyos

gaZlierebuli mada da ara

siTxis dagroveba

organizmSi. aseT

159

pacienti orsulad.

• gaarkvieT pacientis kvebis

reJimi da fizikuri

datvirTva (varjiSi)

SemTxvevaSi rekomendebulia

samkurnalo dieta cximebisa

da naxSirwylebis

SezRudviT, romelic

pacients aZlevs saSualebas

Tavidan aicilos wonis

mateba da masTan

dakavSirebuli

garTulebebi.

• Tu wonaSi mateba (an kleba)

awuxebs pacients

konsultaciis Catarebis

Semdegac, SewyviteT pa-is

gamoyeneba da daexmareT mas

kontracepciis sxva

meTodis SerCevaSi.

a k n e • hkiTxeT pacients rogor

da riTi uvlis saxis kans.

• kok-sgan gansxvavebiT

progestagenis gavleniT

mcirdeba seqshormon-

SemakavSirebeli

globulinis done, ris

Sedegadac izrdeba

Tavisufali

testosteronis

koncentracia sisxlSi,

rac aknes gaCenis mizezs

warmoadgens.

• rekomendebulia saxis kanis

gawmenda sapnis an gamwmendi

xsnarebis gamoyenebiT (mag.

adgilobrivad SeiZleba

gamoyenebul iqnes 1%

klindamicinis xsnari an

geli).

Tu mdgomareobis

gamosworeba ar moxerxda

pacients SeurCieT

kontracepciis sxva meTodi

(arahormonuli an kok,

romelic antiandrogenuli

moqmedebis mqone

progestagens Seicavs Tu

pacients ara aqvs

estrogenis gamoyenebis

ukuCveneba.

sarZeve

jirkvlebis

daWimuloba da

mtkivneuloba

(mastodinia)


pacienti orsulad

(CautareT testi

orsulobaze).



zemoTaa aRniSnuli (ix.

amenorea).

• Tu qali orsulad ar aris,

sarZeve jirkvlebis

daWimuloba gaivlis pa-is

miRebis dawyebidan 2-3 Tvis

ganmavlobaSi. ar

SeawyvetinoT pacients

„mini-pilis“ gamoyeneba Tu

konsultaciis Semdeg is

amas ar gTxovT.

• gasinjeT sarZeve jirkvali,

xom ar SeiniSneba:

• Tu sarZeve jirkvlebis

gasinjviT gamovlinda

gamonadeni an kvanZi (mkvrivi

160

– gamagrebuli adgilebi an

cista

– gamonadeni an galaqtoria

(Tu ar kvebavs ZuZuTi)

konsistenciis, umtkivneulo

palpaciis dros,

SezRuduli moZraobaSi,

romelic ar icvleba

menstrualuri ciklis

ganmavlobaSi es SeiZleba

muTiTebdes simsivnis

arsebobaze. pacienti

gaagzavneT mamologTan

diagnozis dasazusteblad.

tkivili

gulmkerdis

areSi

(gansakuTrebiT

fizikuri

datvirTvis

dros)

• SeamowmeT:

_ arteriuli wneva;

_ pulsi.

• gul-sisxlZarRvTa

daavadebis simptomebis

gamovlenisas SewyviteT pa-s

miReba da pacienti

gaagzavneT specialistTan

Semdgomi

gamokvlevebisaTvis.

• Tu gul-sisxlZarRvTa

daavadebisaTvis

damaxasiaTebeli simptomebi

ar aRiniSneba saWiro ar

aris pa-is gamoyenebis

Sewyveta, radganac “mini-

pilis” SemadgenlobaSi

arsebuli progestagenis

mcire doza ar zrdis gul-

sisxlZarRvTa daavadebis

ganviTarebis risks.

• depresia

• libidos

daqveiTeba

• ganixileT xasiaTisa da

libidos cvlileba pa-s

miRebis dawyebamde da mis

Semdeg.

• Tu qals depresia

gauRrmavda an libido

dauqveiTda pa-s miRebis

fonze, daexmareT mas

kontracepciis sxva

arahormonuli meTodis

SerCevaSi.

• SesaZlebelia aRniSnuli

simptomebis kupirebisaTvis

B6 vitaminis (piridoqsinis miReba 50 mg. – dReSi 2 Tvis

ganmavlobaSi).

WarbTmianoba

(hirsutizmi) an

Tmis cvena

• SeafaseT pacientis

mdgomareoba pa-is

miRebamde da mis Semdeg.

• “mini-pilis” gamoyenebis

fonze pacients SeiZleba

gauRrmavdes pa-is miRebamde

arsebuli WarbTmianoba.

aRniSnuli cvlilebebi,

Cveulebriv, mniSvnelovani

ar aris da droTa

ganmavlobaSi gaivlis.

• saWiro ar aris pa-is

miRebis Sewyveta, garda im

161

SemTxvevisa, roca amas

pacienti daJinebiT

moiTxovs.

Tavis tkivili

(mxedvelobis

dabindva)

• daadgineT, Seicvala Tu

ara Tavis tkivilis

simZafre an intensivoba

pa-is miRebis fonze

• gauzomeT arteriuli

wneva

• nevrologiuri statusis

gamosakvlevad gaagzavneT

specialistTan.

• Tu Tavis tkivili susti an

zomieri siZlierisaa da

iSviaTia, pacienti

daamSvideT, mieciT

tkivilgamayuCebeli

preparati. 1 Tvis Semdeg

kvlav SeafaseT

mdgomareoba.

• Tu pa-is miRebis fonze

gaZlierda Tavis tkivilis

intensivoba, rasac Tan

daerTo yurSi xmauris

SegrZneba, mxedvelobis

daqveiTeba an metyvelebis

unaris darRveva. SewyviteT

abebis gamoyeneba da

daexmareT pacients

kontracepciis sxva

meTodis (arahormonuli)

SerCevaSi.

maRali

arteriuli wneva

(160/100 mm vwy. sv).

daadgineT xom ar hqonda

pacients maRali arteriuli

wneva pa-s miRebamde.

• Tu arteriuli wnevis

momateba aRiniSneba pa-s

dawyebis Semdeg, auxseniT

pa-cients rom misi

cvlileba Cveulebriv 1-dan

3-TveSi daregulirdeba da

abebis miRebis Sewyveta

saWiro ar aris.

• Tu 3 Tvis gavlis Semdeg

arteriuli wneva normas ar

daubrunda, daexmareT

pacients kontracepciis


Tu arteriuli wnevis

momateba ganpirobebulia

sisxlZarRvovani

problemebiT (stenokardia,

cirkulatoruli

darRvevebi) da aRiniSneba

pa-s miRebis drosac

pacientma unda Sewyvitos

preparatis miReba.

daexmareT mas

kontracepciis sxva


SerCevaSi.

162

s i y v i T l e Tu siyviTle ar aris

dakavSirebuli pa-s

gamoyenebis dawyebasTan,

SeamowmeT pacienti:

– mwvave virusul hepatitze;

– naRvlis buStis

daavadebaze;

– RviZlis keTilTvisebian an

avTvisebian simsivneze;

– cirozze.

• progestagenis mcire doza,


pili» Zalian mcired

moqmedebs RviZlis

funqciaze, ar zrdis

naRvlis buStis an RviZlis

simsivneebis ganviTarebis

risks.

• Tu pacients daudginda

mwvave virusuli hepatiti

da ar surs kontracepciis

meTodis Sewyveta, auxseniT

mas, rom riski imisa, rom pa

gaauaresebs daavadebis

mimdinareobas mcirea da pa-

s gamoyeneba naklebad

saSiSia, vidre aseT dros

orsuloba.

gulisreva /

Rebineba /

Tavbrusxveva.

daadgineT aris Tu ara

pacienti orsulad. (CautareT

testi orsulobaze).

• urCieT pacients abebi

miiRos Zilis win an

vaxSmis Semdeg. auxseniT

pacients, rom es movlenebi

Cveulebriv 1-3 Tvis



imoqmedeT, ise rogorc es


amenorea).

Tromboemboli

uri

mdgomareoba

CautareT pacients

laboratoriuli gamokvleva

sisxlis Sededebaze.

• progastagenis dabali doza

ar zrdis sisxlis Sededebis

risks.

• Tu sisxlis Sededebis

problemebi gamovlinda

SewyviteT abebis gamoyeneba

da gaagzavneT pacienti

specialistTan damatebiTi

gamokvlevebis Casatareblad.

Rebineba pa-s

miRebidan 2 sT-is

ganmavlobaSi.

• aseT SemTxvevaSi qalma unda

miiRos pa-is damatebiTi

erTi abi da gaagrZelos

danarCeni abebis miReba

Cveulebrivi sqemiT anu erTi

abi dReSi erTxel.

mwvave faRaraTi

an Rebineba (24

sT-ze meti

xangrZlivobiT).

• hkiTxeT qals, gaugrZelda

Tu ara Rebinaba an mwvave

faRaraTi 24 sT-ze met xans.

am SemTxvevaSi qalma

SeZlebisdagvarad unda

gaagrZelos abebis miReba da

gamoiyenos kontracepciis

damatebiTi meTodi (kondomi,

spermicidi) an Tavi Seikavos

163

sqesobrivi kavSirisagan

momdevno 2dRis

ganmavlobaSi.

gamotovebuli

abebi

– Tu qals daaviwyda 1 abis

miReba.

• erTi abis gamotovebis

SemTxvevaSi me-2 dRes rac

SeiZleba adre unda iqnes

miRebuli gamotovebuli

tabletebi da danarCni

abebis miReba gagrZeldes

sqemis mixedviT anu TiTo

abi dReSi erTxel ciklis

bolomde. am SemTxvevaSi

qalma ori momdevno dRis

ganmavlobaSi Tavi unda

Seikavos sqesobrivi

kavSirisagan an gamoiyenos

kontracepciis damatebiTi

meTodi

(barieruli/spermicidi).

• saWiroebis SemTxvevaSi

SeiZleba qalma mimarTos

gadaudebel kontracepcias.

Tu qals daaviwyda zedized 2

an meti tabletis miReba.

(1–A, 2–A, 4-A, 6-B, 11-B, 12-B).

• Tu qalma gamotova 2 an

orze meti abi man unda

miiRos 2 tableti (diliT

eTi da saRamos erTi an

saRamos 2 tableti

erdroulad) vidre ar

miiRebs yvela gamotovebul

abs da 2 dRis ganmavlobaSi

Tavi unda Seikavos

sqesobrivi kavSirisagan an


damatebiTi meTodi

(kondomi/spermicidi).

164

gverdiTi movlenebi, maTi Sefaseba da marTva

(ojaxis eqimebisTvis)

gverdiTi

movlena Sefaseba marTva

amenorea • regularuli menstrualuri

ciklis Semdeg amenorea

SeiZleba Sefasdes rogorc

orsulobis niSani


gareT).

• CautareT pacients testi

orsulobaze. Tu testi

uaryofiTia saWiroa

pacients Cautardes

konsultieba. auxseniT mas,

rom amenoreis SemTxvevaSi

sisxli ar grovdeba

saSvilosnoSi an sadme

sxvagan qalis organizmSi.

progestagenis mcire doziT

mudmivi zemoqmedebis gamo

mcirdeba endometriumis

sisqe, rac iwvevs

menstrualuri sisxldenis

TandaTanobiT Semcirebas,

zogierT SemTxvevaSi

Sewyvetasac ki. urCieT

pacients kvlav mimarTos

eqims Tu SemdgomSi

Seawuxebs amenorea da

SeurCieT mas kontracepciis

sxva meTodi.

• Tu testi dadebiTia

gaagzavneT pacienti

reproduqtologTan an mean-

ginekologTan orsulobis

lokalizaciis dasadgenad


gareT).

• saSvilosnos Rrus

orsulobisas pacients

gauwieT konsultacia

arCevanTan dakavSirebiT.

_ Tu pacienti apirebs

orsulobis SenarCunebas

SewyviteT pa-is miReba da

auxseniT mas, rom

progestagenis mcire dozas,


pili» nayofze

damazianebeli gavlena ara

aqvs.

• saSvilosnosgare

165

orsulobis diagnozis

dadgenis SemTxvevaSi

mkurnalobas Caatarebs mean-

ginekologi an

reproduqtologi.

menstruaciaTa

Sorisi

vaginaluri

sisxliani

gamonadeni (mcire

an saSualo

raodenobiT)

vaginaluri sisxliani

gamonadenis mizezi SeiZleba

iyos iseTi ginekologiuri

daavadebebi, rogorebicaa:

vaginiti, cerviciti, sggd,

saSvilosnos yelis polipi an

saSvilosnos simsivne.

• aRniSnul daavadebaTa

dasadgenad an gamosaricxad

gaagzavneT pacienti


ginekologTan.

_ Tu ginekologiur

daavadebas adgili ara aqvs,

auxseniT pacients, rom

menstruaciebs Soris

periodSi mcire / saSualo

sisxliani gamonadeni pa-is

momxmarebel bevr qalSi

aRiniSneba (gamo-yenebis

pirveli wlis ganmavlobaSi

SemTxvevaTa 15-20%-Si). igi

seriozul problemas ar

warmoadgens da Cveulebriv

ar saWiroebs mkurnalobas.

_ Tu konsultirebis Semdeg

pacienti diskomforts mainc

ganicdis da nerviulobs –

daexmareT mas kontracepciis


• Tu dadginda romelime

ginekologiuri daavadeba

urCieT pacients Caitaros

Sesabamisi mkurnaloba


ginekologTan.

menstruaciaTa

Soris periodSi

Warbi da /an

xangrZlivi

sisxliani

gamonadeni

(normalurTan

SedarebiTi orjer

meti raodenobiT

da 8 dReze meti

xangrZlivobiT).

• gaagzavneT pacienti

reproduqtologTan an

mean-ginekilogTan, raTa

daadasturos an

gamoricxos iseTi

daavadebebi, rogoricaa

cerviciti, saSvilosnos

yelis polipi an

saSvilosnos simsivne,

TviTnebiTi aborti,

saSvilosnos Rrus an

saSvilosnosgare

orsuloba.

im SemTxvevaSi, rodesac

adgili ara aqvs genitaluri

traqtis paTologias da

pacients surs gaagrZelos

pa-s miReba rekomendebulia

mkurnalobis 2 varianti:

a) kok (30-35 mkg eTinil

estradiolis Semcveli) 21

dRe, romlis damTavrebidan

1 kviris ganmavlobaSi

pacients unda hqondes

menstrualuri gamonadeni.

b) ibuprofeni (800 mg. 3 -

jer dReSi) an sxva romelime

arasteroiduli

anTebissawinaaRmdego

166

preparati 5 dRe.

• mkurnalobis Sedegad

sisxldena unda Semcirdes

3 dRis ganmavlobaSi.

• SeamowmeT pacienti anemiis

arsebobaze.

• anemiis SemTxvevaSi

uzrunvelyaviT pacienti

rkinis preparatiT (romelic

Seicavs 100 mg. rkinas) 1-3

Tve.

• Tu Catarebuli

mkurnalobis Sedegad

sisxldenis kupireba ar iqna

miRweuli SewyviteT pa-is

miReba da daexmareT

pacients kontracepciis sxva

meTodis SerCevaSi.

• orsulobis (saSvilosnos

Rrus an saSvilosnos

gare) an TviTnebiTi

abortis diagnozis

dasadgenad gaagzavneT

pacienti

reprodiqtologTan an

mean-ginekologTan




amenorea).

tkivili muclis

qveda areSi

• SeamowmeT:

– pulsi;

– arteriuli wneva;

– temperatura.

• gaagzavneT pacienti

reproduqtologTan an

mean-ginekologTan, raTa

gamoiricxos:

– saSviloosnosgare

orsuloba;

– mcire menjis Rrus

organoTa anTebiTi

daavadebebi;

– sakvercxeebis cista.

• iSviaT SemTxvevaSi pa-is

miRebis fonze sakvercxeSi

mwifdeba folikuli da ar

xdeba misi drouli

ukuganviTareba (atrezia). Tu

folikulis zrda

gagrZelda, misma zomam

SeiZleba gadaaWarbos

normaluri folikulis

sidides. rTulia, amgvarad

gadidebuli folikulis

sakvercxis cistisagan

garCeva, radganac es procesi

ZiriTadad usiptomo

mimdinareobiT xasiaTdeba,

Tumca SesaZlebelia misi

vaginalurad gasinjva.

umravles SemTxvevaSi

gadidebuli folikuli

TavisiT qreba da ar

saWiroebs mkurnalobas an

pa-s miRebis Sewyvetas.

Zalian iSviaTad igi

SeiZleba Semoigrixos an

167

gaskdes, rac iwvevs tkivils

muclis areSi da SesaZloa

qirurgiuli Carevac gaxdes

saWiro.

wonaSi dakleba

an momateba

• SeadareT pacientis

amJamindeli wona pa-s

gamoyenebamde arsebul

wonasTan.


pacienti orsulad.

• gaarkvieT pacientis kvebis

reJimi da fizikuri

datvirTva (varjiSi)

• pa-is gamoyenebis dros

wonaSi matebis mizezi

SeiZleba iyos

gaZlierebuli mada da ara

siTxis dagroveba

organizmSi. aseT

SemTxvevaSi rekomendebulia

samkurnalo dieta cximebisa

da naxSirwylebis

SezRudviT, romelic

pacients aZlevs saSualebas

Tavidan aicilos wonis

mateba da masTan

dakavSirebuli

garTulebebi.

• Tu wonaSi mateba (an kleba)

awuxebs pacients

konsultaciis Catarebis

Semdegac, SewyviteT pa-is

gamoyeneba da daexmareT mas

kontracepciis sxva

meTodis SerCevaSi.

a k n e • hkiTxeT pacients rogor

da riTi uvlis saxis kans.

• kok-sgan gansxvavebiT

progestagenis gavleniT

mcirdeba seqshormon-

SemakavSirebeli

globulinis done, ris

Sedegadac izrdeba

Tavisufali

testosteronis

koncentracia sisxlSi,

rac aknes gaCenis mizezs

warmoadgens.

• rekomendebulia saxis kanis

gawmenda sapnis an gamwmendi

xsnarebis gamoyenebiT (mag.

adgilobrivad SeiZleba

gamoyenebul iqnes 1%

klindamicinis xsnari an

geli).

• Tu mdgomareobis

gamosworeba ar moxerxda,

pacients SeurCieT

kontracepciis sxva meTodi

(arahormonuli an kok,

romelic antiandrogenuli

moqmedebis mqone

progestagens Seicavs, Tu

pacients ara aqvs

estrogenis gamoyenebis

ukuCveneba.

sarZeve

jirkvlebis

daWimuloba da

mtkivneuloba

(mastodinia)


pacienti orsulad

(CautareT testi

orsulobaze).




amenorea).

• Tu qali orsulad ar aris,

sarZeve jirkvlebis

168

daWimuloba gaivlis pa-is

miRebis dawyebidan 2-3 Tvis

ganmavlobaSi. ar

SeawyvetinoT pacients

„mini-pilis“ gamoyeneba Tu

konsultaciis Semdeg is

amas ar gTxovT.

• gasinjeT sarZeve jirkvali,

xom ar SeiniSneba:

– gamagrebuli adgilebi an

cista

– gamonadeni an galaqtoria

(Tu ar kvebavs ZuZuTi)

• Tu sarZeve jirkvlebis

gasinjviT gamovlinda

gamonadeni an kvanZi (mkvrivi

konsistenciis, umtkivneulo

palpaciis dros,

SezRuduli moZraobaSi,

romelic ar icvleba

menstrualuri ciklis

ganmavlobaSi es SeiZleba

muTiTebdes simsivnis

arsebobaze. pacienti

gaagzavneT mamologTan

diagnozis dasazusteblad.

tkivili

gulmkerdis

areSi

(gansakuTrebiT

fizikuri

datvirTvis

dros)

• SeamowmeT:

_ arteriuli wneva;

_ pulsi.

• gul-sisxlZarRvTa

daavadebis simptomebis

gamovlenisas SewyviteT pa-s

miReba da pacienti

gaagzavneT specialistTan

Semdgomi

gamokvlevebisaTvis.

• Tu gul-sisxlZarRvTa

daavadebisaTvis

damaxasiaTebeli simptomebi

ar aRiniSneba saWiro ar

aris pa-is gamoyenebis

Sewyveta, radganac “mini-

pilis” SemadgenlobaSi

arsebuli progestagenis

mcire doza ar zrdis gul-

sisxlZarRvTa daavadebis

ganviTarebis risks.

• depresia

• libidos

daqveiTeba

• ganixileT xasiaTisa da

libidos cvlileba pa-s

miRebis dawyebamde da mis

Semdeg.

• Tu qals depresia

gauRrmavda an libido

dauqveiTda pa-s miRebis

fonze, daexmareT mas

kontracepciis sxva

arahormonuli meTodis

SerCevaSi.

• SesaZlebelia aRniSnuli

simptomebis kupirebisaTvis

B6 vitaminis (piridoqsinis miReba 50 mg. – dReSi 2 Tvis

ganmavlobaSi).

169

WarbTmianoba

(hirsutizmi) an

Tmis cvena

• SeafaseT pacientis

mdgomareoba pa-is

miRebamde da mis Semdeg.

• “mini-pilis” gamoyenebis

fonze pacients SeiZleba

gauRrmavdes pa-is miRebamde

arsebuli WarbTmianoba.

aRniSnuli cvlilebebi,

Cveulebriv, mniSvnelovani

ar aris da droTa


• saWiro ar aris pa-is

miRebis Sewyveta, garda im

SemTxvevisa, roca amas

pacienti daJinebiT

moiTxovs.

Tavis tkivili

(mxedvelobis

dabindva)

• daadgineT, Seicvala Tu ara

Tavis tkivilis simZafre an

intensivoba pa-is miRebis

fonze

• gauzomeT arteriuli wneva

• nevrologiuri statusis

gamosakvlevad gaagzavneT

specialistTan.

• Tu Tavis tkivili susti an

zomieri siZlierisaa da

iSviaTia, pacienti

daamSvideT, mieciT

tkivilgamayuCebeli

preparati. 1 Tvis Semdeg

kvlav SeafaseT

mdgomareoba.

• Tu pa-is miRebis fonze

gaZlierda Tavis tkivilis

intensivoba, rasac Tan

daerTo yurSi xmauris

SegrZneba, mxedvelobis

daqveiTeba an metyvelebis

unaris darRveva, SewyviteT

abebis gamoyeneba da

daexmareT pacients

kontracepciis sxva


SerCevaSi.

maRali

arteriuli wneva

(160/100 mm vwy. sv).

daadgineT xom ar hqonda

pacients maRali arteriuli

wneva pa-s miRebamde.

• Tu arteriuli wnevis

momateba aRiniSneba pa-s

dawyebis Semdeg, auxseniT

pacients rom misi

cvlileba Cveulebriv 1-dan

3-TveSi daregulirdeba da

abebis miRebis Sewyveta

saWiro ar aris.

• Tu 3 Tvis gavlis Semdeg

arteriuli wneva normas ar

daubrunda, daexmareT

pacients kontracepciis

sxva meTodis

(arahormonuli) SerCevaSi.

Tu arteriuli wnevis

momateba ganpirobebulia

sisxlZarRvovani

170

problemebiT (stenokardia,

cirkulatoruli

darRvevebi) da aRiniSneba

pa-s miRebis drosac,

pacientma unda Sewyvitos

preparatis miReba.

daexmareT mas

kontracepciis sxva


SerCevaSi.

s i y v i T l e Tu siyviTle ar aris

dakavSirebuli pa-s

gamoyenebis dawyebasTan,

SeamowmeT pacienti:

– hepatitze (mwvave); – naRvlis buStis

daavadebaze;

– RviZlis keTilTvisebian an

avTvisebian simsivneze;

– cirozze.

• progestagenis mcire doza,


pili» Zalian mcired

moqmedebs RviZlis

funqciaze, ar zrdis

naRvlis buStis an RviZlis

simsivneebis ganviTarebis

risks.

• Tu pacients daudginda

mwvave virusuli hepatiti

da ar surs kontracepciis

meTodis Sewyveta, auxseniT

mas, rom riski imisa, rom pa

gaauaresebs daavadebis

mimdinareobas mcirea da pa-

s gamoyeneba naklebad

saSiSia, vidre aseT dros

orsuloba.

gulisreva /

Rebineba /

Tavbrusxveva.

daadgineT aris Tu ara

pacienti orsulad. (CautareT

testi orsulobaze an

gaagzavneT

reproduqtologTan / men-

ginekologTan)

• urCieT pacients abebi

miiRos Zilis win an

vaxSmis Semdeg. auxseniT

pacients, rom es movlenebi

Cveulebriv 1-3 Tvis



imoqmedeT, ise rogorc es


amenorea).

Tromboemboli

uri

mdgomareoba

CautareT pacients

laboratoriuli gamokvleva

sisxlis Sededebaze.

• progastagenis dabali doza

ar zrdis sisxlis Sededebis

risks.

• Tu sisxlis Sededebis

problemebi gamovlinda,

SewyviteT abebis gamoyeneba

da gaagzavneT pacienti

specialistTan damatebiTi

gamokvlevebis Casatareblad.

Rebineba pa-s

miRebidan 2 sT-is

• aseT SemTxvevaSi qalma unda

miiRos pa-is damatebiTi

171

ganmavlobaSi.

erTi abi da gaagrZelos

danarCeni abebis miReba

Cveulebrivi sqemiT anu erTi

abi dReSi erTxel.

mwvave faRaraTi

an Rebineba (24

sT-ze meti

xangrZlivobiT).

• hkiTxeT qals, gaugrZelda

Tu ara Rebinaba an mwvave

faRaraTi 24 sT-ze met xans.

• am SemTxvevaSi qalma

SeZlebisdagvarad unda

gaagrZelos abebis miReba da


damatebiTi meTodi (kondomi,

spermicidi) an Tavi Seikavos

sqesobrivi kavSirisagan

momdevno 2dRis

ganmavlobaSi.

gamotovebuli

abebi

– Tu qals daaviwyda 1 abis

miReba.

• erTi abis gamotovebis

SemTxvevaSi me-2 dRes rac

SeiZleba adre unda iqnes

miRebuli gamotovebuli

tabletebi da danarCni

abebis miReba gagrZeldes

sqemis mixedviT, anu TiTo

abi dReSi erTxel ciklis

bolomde. am SemTxvevaSi

qalma ori momdevno dRis

ganmavlobaSi Tavi unda

Seikavos sqesobrivi

kavSirisagan an gamoiyenos

kontracepciis damatebiTi

meTodi

(barieruli/spermicidi).

• saWiroebis SemTxvevaSi

SeiZleba qalma mimarTos

gadaudebel kontracepcias.

– Tu qals daaviwyda zedized

2 an meti tabletis miReba.

(1–A, 2–A, 4-A, 6-B, 11-B, 12-B).

• Tu qalma gamotova 2 an

orze meti abi man unda

miiRos 2 tableti (diliT

eTi da saRamos erTi an

saRamos 2 tableti

erdroulad) vidre ar

miiRebs yvela gamotovebul

abs da 2 dRis ganmavlobaSi

Tavi unda Seikavos

sqesobrivi kavSirisagan an


damatebiTi meTodi

(kondomi/spermicidi).

mini-pili”)medportal.ge/linkedfiles/miscdata/6_21.pdf · 2015-01-23 · kiboTi ar SeiZleba...

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Transcript of mini-pili”)medportal.ge/linkedfiles/miscdata/6_21.pdf · 2015-01-23 · kiboTi ar SeiZleba...