progestagenuli abebi(“mini-pili”)Sesavali

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 –AA, 3 –AA, 8 – B, 9 – B ).

moqmedebis meqanizmi

• iwvevs saSvilosnos yelis lorwos Sesqelebas, rac xels uSlis spermatozoidebis SeRwevas cervikalur arxSi;

• endometriumis histomorfologiuri cvlilebebis gamo gaZnelebulia ganayo- fierebuli 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 spermatozoide-bis 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 dafiqsirebul, TumcaRa 30 welze metia rac am abebs msoflioSi gamoiyeneben kontracepciis mizniT ( 2 – A, 10 – B ).

• “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 neba-surviliT;

• SeiZleba SeTavazebul iqnas specialurad momzadebuli med-personalis 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;

• warmateba damokidebulia momnxmarebelze (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;

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• 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 hopertonuli daavadebis dros;

• romlebic upiratesobas aniWeben sufTa progestagenuli kontraceptivebs, magram ar arian Tanaxma mimarTon ineqcias an implantebs;

• visac ar surT gamoiyenon sufTa progestsgenuli 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 xelmisa-

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

progestagenuli abebis gamoyenebis ukuCvenebebia

• saeWvo an dadasturebuli orsuloba;

• sarZeve jirkvlebis kibo;

• mSobiarobidan 6 kviramde ZuZuTi kvebis dros;

• sasqeso gzebidan daudgeneli genezis sisxlis dena;

• 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 ).

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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 uaryoiTi gavlenis Sesaxeb qalisa da nayofis janmrTelobaze, Tumca es monacemebi sabo-loo ar aris. im SemTxvevaSi, rodesac orsulobis dadgena ver xerxdeba pa-s miRebis dawyeba unda gadaidos Semdeg men-struaciamde. am SualedSi pacientma mizanSewonilia gamoiyenos kontracepciis sxva meTodi (mag. kondomi, spermicidi da)

( 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 mSobia-robis Semdeg pirveli 6 kviris ganmavlobaSi gavlenas

ar axdens ZuZuTi kvebis xarisxze da axalSobilis zrda-ganviTa-

rebaze, Tumca ZuZuTi kvebis periodSi progestagenuli abebis gavlena bavSvis tvinze da RviZlze bolomde Seswavli-

li ar aris.

kategoria 1. mSobiarobidan 6 Tvis Semdeg.

kategoria 1. mSobiarobidan 6 kviris gavlis Semdeg rodesac bavSvi imyofeba ZiriTadad ZuZuTi kvebaze ( 1 – A, 3 – A ).

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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 gansazRvrul iqnas 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 Sei-Zleba uaryofiTi gavlena iqonios qalis janmrTelobaze da garda amisa aRniSnulma preparatebma SeiZleba xeli Seuwyos simsivnis zrdas. Tumca pro-gestagenuli 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.

kategoria 1. anamnezSi qolestazi orsulobis dros, pa-s gamoyeneba SeiZleba ( 1 - A, 3 - A ).

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insulti, gulis iSemiuri daavadeba (anamnezSi an amJamad)

kategoria 3. progestagenuli abebis gamoyenebis dros SesaZlebelia gaizardos Trombozis riski, rac warmoadgens damatebiT risk-faqtors aRninuli 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 xelmisaw-

vdomi 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 miRe bis 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

sisxlZarRvovani garTulebebiT, neiropaTiiT, retinopaTiiT da nefropaTiiT.

kategoria 2. aRniSnuli mdgomareobis dros progestagenuli abebis gamoyeneba

SeiZleba, radganac sisxlSi cirkulirebs hormonis mcire koncentracia.

kategoria 2. pacientebs, insulin damokidebuli an insulin damoukidebeli 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 cistoluri 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 5 dRis ganmavlobaSi dRidan yovel dRe TiTo abi uwyvet reJimSi;

• 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.);

• 6 Tvis Semdeg mSobiarobidan 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. aseTSemTxvevaSi ar aris aucilebeli mocda Semdegi menstruaciis dawye-bamde;

• 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 ganma-vlobaSi, 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 gamoye-neba;

• 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

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• rac SeiZleba adre unda iqnes miRebuli gamotovebuli progestage- nuli 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.

b) mSobiarobis Semdeg

• ZuZuTi kvebis dros menstrualuri ciklis ar arsebobisas 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 deareasa da Rebinebis SemTxvevaSi, romelic 24 saaTi da meti xani 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 rekomendire-bulia 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 meTo-dis, kondomis an spermicidis gamoyeneba);

• gaafrTxileT SesaZlo gverdiTi movlenebis Sesaxeb;

• gaafrTxileT, rom aucileblad mimarTos klinikas iseT SemTxvevebSi, rogoricaa:

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- 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;

• 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

10

• arteriuli wnevis gazomva . . . . . . . . . . . . . . . . . . . . . . * * *kategoria _ „C“- aRniSnuli gamokvlevis Catareba ar uzrunvelyofs

kontracepciis konkretuli meTodis SeuzRudavad gamoyenebasa da

efeqturobas.

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

progestagenuli abebis ( „mini-pilis“) gamoyenebis ukuCvenebebi

1. saeWvo da dadasturebuli orsuloba;

2. sarZeve jirkvlebis kibo;

3. mSobiarobidan 6 kviramde ZuZuTi kvebis dros;

4. sasqeso gzebidan daudgeneli genezis sisxlis dena;

5. virusuli pepatiti;

6. RviZlis cirozi an simsivne;

7. insulti, gulis iSemiuri daavadeba (amJamad an anamnezSi);

8. Rrma venebis Trombozi / filtvis embolia;

9. antikonvulsantebis an antituberkulozuri preparatebis miReba

( 1 - A, 3 -A ).

11

AAAAAAAAAAAgamoyenebuli 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.

Aavtorebi: profesori a. xomasuriZe, medicinis doqtori T.maRularia,

medicinis doqtori g.cercvaZe, profesori j.qristesaSvili.

Eeqspertebi: medicinis doqtori n. marsagiSvili, medicines doqtori

AAAAAAAAAAAAAAAAAz. boxua, medicinis doqtori n. parunaSvili.

12

AAAAAAAAAAAAAAAAAA klinikuri protokoli

(gaTvaliswinebulia reproduqtologebisaTvis, mean-ginekologebisa da ojaxios 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 gaagzavneTis klinikaSi/eqimTan diagnozis dasazusteblad da mieciT kondomi an spermicidi rom am drois ganmavlo-baSi gamoiyenos. Tu pacienti pasuxobs “ara” gadadiT me-2 kiTxvarze.

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

Tu pacientienti pasuxobs „diax“ pa miRebis vada gadadeT, mieciT pa da uTxariT, rom maTi gamoyeneba unda daiwyos, rodesac bavSvi 6 kviris gaxdeba.

3. gaqvT Tu 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, karbamezapins, barbituratebs, primidons Setevis dros, rifampicins an grizeofulvins mieciT mas kondomebi an spermicidi pa-sTan erTad gamosayene-blad. 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“ gamoukvlieT SesaZlo orsulobaze an sxva raime gineko-logiur paTologiaze. pa-is Semdgomi gamoyenebis SesaZlebloba SeafaseT gamokvlevis Sedegebze dayrdnobiT.

13

gverdiTi movlenebi, maTi Sefaseba da marTva (reproduqtologebis da mean-ginekologebisaTvis)

gverdiTi movlena Sefaseba marTva

amenorea • regularuli menstrualuri

ci-klis Semdeg amenorea SeiZleba Sefasdes rogorc orsulobis niSani (saSvilosnos Rrus an mis gareT).

• CautareT pacients testi orsulobaze. Tu testi uaryofi-Tia saWiroa pacie-nts Cautardes kon-sultieba. auxseniT mas, rom amenoreis SemTxvevaSi sisxli ar grovdeba saSvi-losnosSi an sadme sxvagan qalis orga-nizmSi. progestagenis mcire doziT mudmivi zemo-qmedebis gamo mcir-deba endometriumis sisqe, rac iwvevs menstrualuri sisx-ldenis TandaTano-biT Semcirebas, zogierT SemTxvevaSi Sewyvetasac ki. urCi-eT pacients kvlav mimarTos eqims Tu SemdgomSi Seawuxebs amenorea da SeurCi-eT mas kontracepci-is sxva meTodi.

• Tu testi dadebiTia daadgineT rsulobis lokalizacia (saSvi-losnos Rrus an mis gareT).

• saSvilosnos Rrus orsulobisas pacie-nts gauwieT konsu-ltacia arCevanTan dakavSirebiT.

_ Tu pacienti apirebs orsulobis SenarCu- nebas SewyviteT pa-is miReba da auxseniT

14

menstruaciaTa Sorisi vaginaluri sisxlianigamonadeni (mcire an saSualo raodenobiT)

menstruaciaTa Soris periodSi Warbi da /an xangrZlivi sisxliani gamonadeni (normalu-rTan SedarebiTi or-jer meti raodenobiT da 8 dReze meti xan-grZlivobiT).

vaginaluri sisxliani gamonadenis mi-zezi SeiZleba iyos iseTi ginekolo-giuri daavadebebi, rogorebicaa:vaginiti, cerviciti, sggd, saSvilos-nos yelis polipi an saSvilosnos simsivne.

• CautareT pacients damatebiTi ga mokvlevebi raTa daadasturoT an gamoricxoT iseTi daavadebebi, rogoricaa cerviciti, saSvilos-nos yelis polipi an saSvilosnos simsivne, TviT-nebiTi aborti,saSvi-losnos Rrus an aSvilosnosgare orsuloba.

mas, rom progesta-genis mcire dozas, romelsac Seicavs «mini-pili» nayofze damazianebeli gav-lena ara aqvs.

• saSvilosnosgare orsulobis SemTxve-vaSi CautareT saTa-nado mkurnaloba.

• aRniSnul daavadeba-Ta dasadgenad an gamosaricxad Cauta-reT pacients dama-tebiTi gamokvlevebi.

_ Tu ginekologiur daavadebas adgili ara aqvs auxseniT pacients, rom menst-ruaciebs Soris pe-riodSi mcire / sa-Sualo sisxliani gamonadeni pa-is mom-xmarebel bevr qal-Si aRiniSneba (gamo--yenebis pirveli

wlis ganmavlobaSi SemTxvevaTa 15-20%-Si). igi seriozul problemas ar warmo-adgens da Cveuleb-riv ar saWiroebs mkurnalobas.

_ Tu konsultirebis Semdeg pacienti diskomforts mainc ganicdis da nerviu-lobs – daexmareT mas kontracepciis sxva meTodis SerCe-vaSi.

• Tu dadginda rome-lime ginekologiuri daavadeba CautareT pacients Sesabamisi mkurnaloba.

15

tkivili muclis qveda areSi

• SeamowmeT pacienti anemiis ar-sebobaze.

• orsulobis (saSvilosnos Rrus an saSvilosnos gare) an TviT- nebiTi abortis diagnozis da-

sadgenad CautareT pacients da-matebiTi gamokvlevebi.

• SeamowmeT

_ arteriuli wneva ; _ temperatura.

• CautareT abdominaluri da vaginaluri bimanualuri gasinjva raTa gamoiricxos :

_ apendiciti; _ saSviloosnosgare orsuloba; _ mcire menjis Rrus organoTa anTebiTi daavadebebi; _ sakvercxeebis cista.

im SemTxvevaSi, ro-desac adgili ara aqvs genitaluri traqtis paTologias da pacients surs gaagrZelos pa-s mi-Reba rekomendebulia

mkurnalobis 2 varia- nti :a) kok (30-35 mkg eTi-nil estradio-lis Semcveli) 21 dRe, romlis damTavrebi-dan 1 kviris ganmav-lobaSi pacients un-da hqondes menstru-aluri gamonadeni.b) ibuprofeni (800 mg. 3 - jer dReSi) an sxva romelime aras-teroiduli anTebis-sawinaaRmdego prepa-rati 5 dRe.

• mkurnalobis Sede-gad sisxldena un-da Semcirdes 3 dRis ganmavlobaSi.

• anemiis SemTxvevaSi uzrunvelyaviT paci-enti rkinis prepara-tiT (romelic Sei-cavs 100 mg. rkinas) 1-3 Tve.

• Tu Catarebuli mku- rnalobis Sedegad sisxldenis kupire-

ba ar iqna miRweu-li SewyviteT pa-is miReba da daexmareT pacients kontracep-ciis sxva meTodis

SerCevaSi.

• orsulobis SemTx-vevaSi imoqmedeT ise, rogorc es ze-moTaa aRniSnuli

(ix. amenorea).

• iSviaT SemTxvevaSi pa-is miRebis fonze

16

wonaSi dakleba anmomateba

• SeadareT pacientis amJamindeli wo- na pa-s gamoyenebamde arsebul wonas- Tan.

• SeamowmeT aris Tu ara pacienti or- sulad.

• gaarkvieT pacientis kvebis reJimi da fizikuri datvirTva (varjiSi)

sakvercxeSi mwifde-ba folikuli da ar xdeba misi drouli ukuganviTareba (atrezia). Tu folikulis zrda gagrZelda misma zomam SeiZleba gadaaWarbos norma-luri folikulis sidides. rTulia, amgvarad gadidebu-li folikulis sakvercxis cistisa-gan garCeva, radga-nac es procesi ZiriTadad usiptomo mimdinareobiT xasia-Tdeba, Tumca SesaZ-lebelia misi vagina-lurad gasinjva. um-ravles SemTxvevaSi gadidebuli foli-kuli TavisiT qreba da ar saWiroebs

mkurnalobas an pa-s miRebis Sewyvetas.Zalian iSviaTad igi SeiZleba Semoigri-xos an gaskdes, rac iwvevs tkivils muc-lis areSi da SesaZ-loa qirurgiuli Ca-revac gaxdes saWiro.

• pa-is gamoyenebis dros wonaSi mate-bis mizezi SeiZleba iyos gaZlierebuli mada da ara siTxis dagroveba organizm-Si. aseT SemTxvevaSi rekomendebulia sam-kurnalo dieta cxi-mebisa da naxSirwy-lebis SezRudviT, romelic pacientsaZlevs saSualebas Tavidan aicilos wonis mateba da mas-Tan dakavSirebuli garTulebebi.

• Tu wonaSi mateba(an kleba) awuxebs pacients konsulta-ciis Catarebis Sem-degac, SewyviteT

17

a k n e

sarZeve jirkvlebis daWimuloba da mtkiv-neuloba (mastodinia)

• hkiTxeT pacients rogor da riTi uvlis saxis kans.

• kok-sgan gansxvavebiT progestage- nis gavleniT mcirdeba seqshormon- SemakavSirebeli globulinis done, ris Sedegadac izrdeba Tavisufa- li testosteronis koncentracia sisxlSi, rac aknes gaCenis mizezs

warmoadgens.

• SeamowmeT aris Tu ara pacienti or-sulad (CautareT testi orsulo- baze).

• gasinjeT sarZeve jirkvali, xom ar SeiniSneba:_ gamagrebuli adgilebi an cista_ gamonadeni an galaqtoria (Tu ar kvebavs ZuZuTi)

pa-is gamoyeneba da daexmareT mas kontracepciis sxvameTodis SerCevaSi.

• rekomendebulia sa-xis kanis gawmenda sapnis an gamwmendi xsnarebis gamoyene-biT (mag. adgilobri-vad SeiZleba gamoye-nebul iqnes 1% kli-ndamicinis xsna-ri an geli).

• Tu mdgomareobis ga- mosworeba ar moxer-xda pacients SeurCi-

eT kontracepciis sxva meTodi (arahor-monuli an kok, rome-lic antiandrogenu-li moqmedebis mqone

progestagens SeicavsTu pacients araaqvs estrogenis ga-moyenebis ukuCveneba.

• orsulobis SemTxve-vaSi imoqmedeT ise,rogorc es zemoTaa aRniSnuli (ix. ame-norea).

• Tu qali orsulad ar aris, sarZeve ji-rkvlebis daWimu-loba gaivlis pa-is miRebis dawyebidan 2-3 Tvis ganmavlo-baSi. ar Seawyveti-noT pacients „mini-pilis“ gamoyeneba Tu konsultaciis Semdeg is amas ar

18

tkivili gulmkerdis areSi (gansakuTre- biT fizikuri datvi-rTvis dros)

• depresia

• libidos daqvei-Teba

WarbTmianoba (hirsutizmi) an Tmis cvena

• SeamowmeT: _ arteriuli wneva;_ pulsi

• ganixileT xasiaTisa da libidos cvlileba pa-s miRebis dawyebamde da mis Semdeg.

• SeafaseT pacientis mdgomareoba pa-is miRebamde da mis Semdeg.

gTxovT.

• Tu sarZeve jirkv-lebis gasinjviT gamovlinda gamona-deni an kvanZi (mkv-rivi konsistenciis, umtkivneulo palpa-ciis dros, SezRu-duli moZraobaSi, romelic ar icvle-ba menstrualuri ciklis ganmavlo-baSi es SeiZleba muTiTebdes simsiv-nis arsebobaze. pa-cienti gaagzavneT mamologTan diag-nozis dasazusteb-lad.

• gul-sisxlZarRvTadaavadebis simpto-mebis gamovlenisasSewyviteT pa-s miRe-ba da pacienti gaag-zavneT specialist-Tan Semdgomi gamok-vlevebisaTvis.

• Tu gul-sisxlZarR-vTa daavadebisaTvis damaxasiaTebeli si-mptomebi ar aRiniS-neba saWiro ar aris pa-is gamoyene-bis Sewyveta, radga- nac “mini-pilis” Se-madgenlobaSi arse-buli progestagenis mcire doza ar zrdis gul-sisxl-ZarRvTa daavadebis ganviTarebis risks.

• Tu qals depresia gauRrmavda an li-bido dauqveiTda pa-s miRebis fonze, daexmareT mas kont-racepciis sxva ara-hormonuli meTodis SerCevaSi.

19

Tavis tkivili(mxedvelobis dabindva)

maRali arteriuli wneva (160 / 100 mm vwy. sv).

• daadgineT, Seicvala Tu ara Tavis tkivilis simZafre an intensivoba

pa-is miRebis fonze

• gauzomeT arteriuli wneva

• nevrologiuri statusis gamosakv- levad gaagzavneT specialistTan.

daadgineT xom ar hqonda pacients ma-Rali arteriuli wneva pa-s miRebamde.

• SesaZlebelia aRni-Snuli simptomebis kupirebisaTvis B6 vitaminis (piridoq-sinis miReba 50 mg. – dReSi 2 Tvis gan- mavlobaSi).

• “mini-pilis” gamoye-nebis fonze paci-ents SeiZleba gau-Rrmavdes pa-is miRe-bamde arsebuli Wa-rbTmianoba. aRniS-nuli cvlilebebi, Cveulebriv, mniSvne-lovani ar aris da droTa ganmavloba-Si gaivlis.

• saWiro ar aris pa-is miRebis Sewyve-ta, garda im SemT-xvevisa, roca amas pacienti daJinebiT moiTxovs.

• Tu Tavis tkivili susti an zomieri siZlierisaa da iS-viaTia, pacienti daamSvideT, mieciT tkivilgamayuCebe-li preparati. 1 Tvis Semdeg kvlavSeafaseT mdgoma-reoba.

• Tu pa-is miRebis fonze gaZlierda Tavis tkivilis in-tensivoba, rasac Tan daerTo yurSi xmauris SegrZneba, mxedvelobis daqve-iTeba an metyvele-bis unaris darRve-va. SewyviteT abebis gamoyeneba da daex-mareT pacients ko-ntracepciis sxva meTodis (arahormo-nuli) SerCevaSi.

20

s i y v i T l e

gulisreva/Rebineba / Tavbrusxveva.

Tu siyviTle ar aris dakavSirebuli pa-s gamoyenebis dawyebasTan, Seamow-meT pacienti:_ mwvave virusul hepatitze; _ naRvlis buStis daavadebaze;_ RviZlis keTilTvisebian an avTvi- sebian simsivneze;_ cirozze.

daadgineT aris Tu ara pacienti orsu-lad. (CautareT testi orsulobaze).

• Tu arteriuli wne-vis momateba aRini-Sneba pa-s dawyebis Semdeg, auxseniT pa-cients rom misi cvlileba Cveuleb-riv 1-dan 3-TveSidaregulirdeba da abebis miRebis Sew-yveta saWiro ar aris.

• Tu 3 Tvis gavlis Semdeg arteriuli wneva normas ar da-ubrunda, daexmareT pacients kontracep-ciis sxva meTodis SerCevaSi.

• Tu arteriuli wne-vis momateba ganpi-robebulia sisxl-ZarRvovani proble-mebiT (stenokardia, cirkulatoruli darRvevebi) da aRi-niSneba pa-s miRebis drosac pacientma unda Sewyvitos pre-paratis miReba. dae-xmareT mas kontra-cepciis sxva meTo-dis (arahormonuli)SerCevaSi.

• progestagenis mci-re doza, romelsac Seicavs «mini-pili»

• Zalian mcired moq-medebs RviZlis fu-nqciaze, ar zrdis naRvlis buStis an RviZlis simsivnee-bis ganviTarebis risks.

• Tu pacients daud-ginda mwvave viru-suli hepatiti da ar surs kontracep-ciis meTodis Sewy-veta, auxseniT mas, rom riski imisa, rom pa gaauaresebs daavadebis mimdina-reobas mcirea da

21

Tromboemboliuri mdgomareoba

• Rebineba pa-s miRebi- dan 2 sT-is ganmav-lobaSi.

• mwvave faRaraTi anRebineba (24 sT-ze meti xangrZlivobiT).

gamotovebuli abebi

CautareT pacients laboratoriuli gamokvleva sisxlis Sededebaze.

• hkiTxeT qals , gaugrZelda Tu ara Rebinaba an mwvave faRaraTi 24 sT- ze met xans.

_ Tu qals daaviwyda 1 abis miReba.

pa-s gamoyeneba nak-lebad saSiSia, vid- re aseT dros or-suloba.

• urCieT pacients abe-

bi miiRos Zilis win an vaxSmis Semdeg. auxseniT pacients, rom es movlenebi Cveulebriv 1-3 Tvis ganmavlobaSi gaiv-lis.

• orsulobis SemTxve-vaSi imoqmedeT, ise rogorc es zemoTaaaRniSnuli (ix. ame-norea).

• progastagenis daba-li doza ar zrdis sisxlis Sededebis risks.

• Tu sisxlis Sedede-bis problemebi ga-movlinda SewyviteT abebis gamoyeneba da gaagzavneT pacientispecialistTan dama-tebiTi gamokvleve-bis Casatareblad.

• aseT SemTxvevaSi qa-lma unda miiRos pa-is damatebiTi erTi abi da gaagrZelos danarCeni abebis mi-Reba Cveulebrivi sqemiT anu erTi abi dReSi erTxel.

am SemTxvevaSi qalma SeZlebisdagvarad

22

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA_ -Tu qals daaviwyda zedized 2 an me-

ti tabletis miReba. AAAAAAAAAAAAA ( 1 – A, 2 – A, 4 - A, 6 - B, 11 -B,

AAAAAAA 12 - B).

unda gaagrZelos abebis miReba da ga-moiyenos kontracep-ciis damatebiTi me-Todi (kondomi, sper- cidi) an Tavi Seika-vos sqesobrivi kav-Sirisagan momdevno2dRis ganmavlobaSi.

• erTi abis gamotove- bis SemTxvevaSi me-2

dRes rac SeiZleba adre unda iqnes mi-Rebuli gamotovebu-li tabletebi da danarCni abebis miRe-ba gagrZeldes sqe-mis mixedviT anu Ti-

To abi dReSi erT-xel ciklis bolo-mde. am SemTxvevaSi

qalma ori momdevno dRis ganmavlobaSi Tavi unda Seikavos sqesobrivi kavSiri-sagan an gamoiyenos kontracepciis dama-tebiTi meTodi (bar- ieruli/spermicidi).

• saWiroebis SemTxve-vaSi SeiZleba qalma mimarTos gadaude-bel kontracepcias.

• 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 ganma-vlobaSi Tavi undaSeikavos sqesobrivi kavSirisagan an gamo-iyenos kontracepci-is damatebiTi meTo-di (kondomi/spermi-

23

cidi).

gverdiTi movlenebi, maTi Sefaseba da marTva (ojaxis eqimebisTvis)

gverdiTi movlena Sefaseba marTva

amenorea • regularuli menstrualuri

ci-klis Semdeg amenorea SeiZleba Sefasdes rogorc orsulobis niSani (saSvilosnos Rrus an mis gareT).

• CautareT pacients testi orsulobaze. Tu testi uaryofi-Tia saWiroa pacie-nts Cautardes konsultieba. auxseniT mas, rom amenoreis Sem-TxvevaSi sisxli ar grovdeba saSvilos-nosSi an sadme sxva-gan qalis organiz-mSi. progestagenis mcire doziT mudmi-vi zemoqmedebis gamo mcirdeba endometri-umis sisqe, rac iw-vevs menstrualuri sisxldenis TandaTa-nobiT Semcirebas, zogierT SemTxvevaSi Sewyvetasac ki.

24

menstruaciaTa Sorisi vaginaluri sisxlianigamonadeni (mcire an saSualo raodenobiT)

vaginaluri sisxliani gamonadenis mi-zezi SeiZleba iyos iseTi ginekolo-giuri daavadebebi, rogorebicaa:vaginiti, cerviciti, sggd, saSvilos-nos yelis polipi an saSvilosnos simsivne.

urCi-eT pacients kvlav mimarTos eqims Tu SemdgomSi Seawuxebs amenorea da SeurCi-eT mas kontracepci-is sxva meTodi.

• Tu testi dadebiTia gaagzavneT pacienti reproduqtologTan an mean-ginekolog-Tan orsulobis lokalizaciis dasa-dgenad (saSvilos-nos Rrus an mis gareT).

_ saSvilosnos Rrus orsulobisas pacie-nts gauwieT konsu-ltacia arCevanTan dakavSirebiT.

_ Tu pacienti apirebs orsulobis orsu-lobis SenarCunebas SewyviteT pa-is miRe-

ba da auxseniT mas, rom progestagenis mcire dozas, rome-lsac Seicavs «mini-pili» nayofze dama-zianebeli gavlena ara aqvs.

• saSvilosnosgare orsulobis diagno-zis dadgenis SemTx-vevaSi mkurnalobas Caatarebs mean-gine-kologi an reprodu-qtologi.

• aRniSnul daavadeba-Ta dasadgenad an gamosaricxad gaagzavneT pacienti reproduqtologTan an mean-ginekolog-Tan.

_ Tu ginekologiur daavadebas adgili ara aqvs auxseniT pacients, rom menst-

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menstruaciaTa Soris periodSi Warbi da /an xangrZlivi sisxliani gamonadeni (normalu-rTan SedarebiTi or-jer meti raodenobiT da 8 dReze meti xan-grZlivobiT).

• gaagzavneT pacienti reproduqto-logTan an mean-ginekilogTan, ra-Ta daadasturos an gamoricxos iseTi daavadebebi, rogoricaa cer-viciti, saSvilosnos yelis poli-pi an saSvilosnos simsivne, TviT-nebiTi aborti, saSvilosnos Rrus an saSvilosnos gare orsuloba.

• SeamowmeT pacienti anemiis ar-

ruaciebs Soris pe-riodSi mcire / sa-Sualo sisxliani gamonadeni pa-is mom-xmarebel bevr qal-Si aRiniSneba (gamo--yenebis pirveli

wlis ganmavlobaSi SemTxvevaTa 15-20%-Si). igi seriozul problemas ar warmo-adgens da Cveuleb-riv ar saWiroebs mkurnalobas.

_ Tu konsultirebis Semdeg pacienti diskomforts mainc ganicdis da nerviu-lobs – daexmareT mas kontracepciis sxva meTodis SerCe-vaSi.

• Tu dadginda gineko-logiuri romelime daavadeba urCieT pacients Caitaros Sesabamisi mkurna-loba reproduqto-logTan an mean-gine-kologTan.

im SemTxvevaSi, ro-desac adgili ara aqvs genitaluri traqtispaTologias da pacients surs gaagrZelos pa-s mi-Reba rekomendebu-lia mkurnalobis 2 varianti :_ kok (30-35 mkg eTinil estradio-lis Semcveli) 21 dRe, romlis damTa-vrebidan 1 kviris ganmavlobaSi pacie-nts unda hqondes menstrualuri gamo-nadeni._ ibuprofeni (800 mg. 3 - jer dReSi) an

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tkivili muclis qveda areSi

sebobaze.

• orsulobis (saSvilosnos Rrus an saSvilosnosgare) an TviTnebi- Ti abortis diagnozis dasadgenad

gaagzavneT pacienti reprodiqto- logTan an mean-ginekologTan.

• SeamowmeT

_ arteriuli wneva _ temperatura.

• gaagzavneT pacienti reproduqto-logTan an mean-ginekologTan,

raTa gamoiricxos: ginaluri bimanualu _ saSviloosnosgare orsuloba

_ mcire menjis Rrus organoTa anTebiTi daavadebebi; _ sakvercxeebis cista.

sxva romelime aras-teroiduli anTebis-sawinaaRmdego prepa-rati 5 dRe._ mkurnalobis Sede-gad sisxldena unda Semcirdes 3 dRis ganmavlobaSi.

• anemiis SemTxvevaSi uzrunvelyaviT paci-enti rkinis prepara-tiT (romelic Sei-cavs 100 mg. rkinas) 1-3 Tves.

• Tu Catarebuli mku- rnalobis Sedegad sisxldenis kupire-

ba ar iqna miRweu-li SewyviteT pa-is miReba da daexmareT pacients kontracep-ciis sxva meTodis

SerCevaSi.

• orsulobis SemTx-vevaSi imoqmedeT ise, rogorc es ze-moTaa aRniSnuli

(ix. amenorea).

• iSviaT SemTxvevaSi pa-is miRebis fonze sakvercxeSi mwifde-ba folikuli da ar xdeba misi drouli ukuganviTareba (atrezia). Tu folikulis zrda gagrZelda misma zomam SeiZleba gadaaWarbos norma-luri folikulis sidides. rTulia, amgvarad gadidebu- li folikulis sa-kvercxis cistisagan garCeva radganac es procesi ZiriTadad usiptomo

mimdinareobiT xasia-

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wonaSi dakleba anmomateba

a k n e

sarZeve jirkvlebis daWimuloba da mtkiv-neuloba (mastodinia)

• SeadareT pacientis amJamindeli wo- na pa-s gamoyenebamde arsebul wonas- Tan.

• SeamowmeT aris Tu ara pacienti or- sulad.

• gaarkvieT pacientis kvebis reJimi da fizikuri datvirTva (varjiSi)

• hkiTxeT pacients rogor da riTi uvlis saxis kans.

• kok-sgan gansxvavebiT progestage- nis gavleniT mcirdeba seqshormon- SemakavSirebeli globulinis done, ris Sedegadac izrdeba Tavisufa- li testosteronis koncentraciaia

sisxlSi, rac aknes gaCenis mizezs zs warmoadgens.

• SeamowmeT aris Tu ara pacienti

Tdeba, Tumca SesaZ-lebelia misi vagina-lurad gasinjva. um-ravles SemTxvevaSi gadidebuli foli--kuli TavisiT qreba da ar saWiroebs mkurnalobas an pa-s miRebis Sewyvetas.Zalian iSviaTad igi SeiZleba Semoigri-xos an gaskdes, rac iwvevs tkivils muc-lis areSi da SesaZ-loa qirurgiuli Ca-revac gaxdes saWiro.

• pa-is gamoyenebis dros wonaSi mate-bis mizezi SeiZleba iyos gaZlierebuli mada da ara siTxis dagroveba organizm-Si. aseT SemTxvevaSi rekomendebulia sam-kurnalo dieta cxi-mebisa da naxSirwy-lebis SezRudviT, romelic pacientsaZlevs saSualebas Tavidan aicilos wonis mateba da mas-Tan dakavSirebuli garTulebebi.

• Tu wonaSi mateba(an kleba) awuxebs pacients konsulta-ciis Catarebis Sem-degac, SewyviteT pa-is gamoyeneba da daexmareT pacients kontracepciis sxvameTodis SerCevaSi.

• rekomendebulia sa-xis kanis gawmenda sapnis an gamwmendi xsnarebis gamoyene-biT (mag. adgilobri-vad SeiZleba gamoye-nebul iqnes 1% kli-ndamicinis xsna-ri an geli).

• Tu mdgomareobis ga- mosworeba ar

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tkivili gulmkerdis areSi (gansakuTre- biT fizikuri datvi-rTvis dros)

orsulad (CautareT testi orsu- lobaze).

• gasinjeT sarZeve jirkvali, xom ar SeiniSneba:_ gamagrebuli adgilebi an cista_ gamonadeni an galaqtoria (Tu ar kvebavs ZuZuTi)

• SeamowmeT: _ arteriuli wneva;_ pulsi

moxer-xda pacients SeurCi-

eT kontracepciis sxva meTodi (arahor-monuli an kok, rome-lic antiandrogenu-li moqmedebis mqone progestagens Seica-vs, Tu pacients ara aqvs estrogenis ga-moyenebis ukuCveneba.

• orsulobis SemTxve-vaSi imoqmedeT ise,rogorc es semoTaa aRniSnuli (ix. ame-norea).

• Tu qali orsulad ar aris, sarZeve ji-rkvlebis daWimu-loba gaivlis pa-is miRebis dawyebidan 2-3 Tvis ganmavlo-baSi. ar Seawyveti-noT pacients „mini-pilis“ gamoyeneba Tu konsultaciis Semdeg is amas ar gTxovT.

• Tu sarZeve jirkv-lebis gasinjviT gamovlinda gamona-deni an kvanZi (mkv-rivi konsistenciis, umtkivneulo palpa-ciis dros, SezRu-duli moZraobaSi, romelic ar icvle-ba menstrualuri ciklis ganmavlo-baSi es SeiZleba muTiTebdes simsiv-nis arsebobaZe. pa-cienti gaagzavneT mamologTan diag-nozis dasazusteb-lad.

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• depresia

• libidos daqvei-Teba

WarbTmianoba (hirsutizmi) an Tmis cvena

Tavis tkivili(mxedvelobis dabind-viT).

• ganixileT xasiaTisa da libidos cvlileba pa-s miRebis dawyebamde da mis Semdeg.

• SeafaseT pacientis mdgomaeoba pa-is miRebamde da mis Semdeg.

• daadgineT, Seicvala Tu ara Tavis tkivilis simZafre an intensivoba

pa-is miRebis fonze

• gauzomeT arteriuli wneva

• nevrologiuri statusis gamosakv- levad gaagzavneT specialistTan.

• gul-sisxlZarRvTadaavadebis simpto-mebis gamovlenisasSewyviteT pa-s gamoyeneba da gaag-zavneT pacienti Semdgomi gamokvle-vebisaTvis.

• Tu gul-sisxlZarR-vTa daavadebisaTvis damaxasiaTebeli si-mptomebi ar aRiniS-neba saWiro ar aris pa-is gamoyene-bis Sewyveta, radga- nac “mini-pilis” Se-madgenlobaSi arse-buli progestagenis mcire doza ar zrdis gul-sisxl-ZarRvTa daavadebis ganviTarebis risks.

• Tu qals depresia gauRrmavda an li-bido dauqveiTda pa-s miRebis fonze, daexmareT mas kont-racepciis sxva ara-hormonuli meTodis SerCevaSi.

• SesaZlebelia aRni-Snuli simptomebis kupirebisaTvis B6 vitaminis (piridoq-sinis miReba 50 mg. – dReSi 2 Tvis gan- mavlobaSi).

• “mini-pilis” gamoye-nebis fonze paci-ents SeiZleba gau-Rrmavdes pa-is miRe-bamde arsebuli Wa-rbTmianoba. aRniS-nuli cvlilebebi, Cveulebriv, mniSvne-lovani ar aris da droTa ganmavloba-Si gaivlis.

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maRali arteriuli wneva (160 / 100 mm vwy. sv).

s i y v i T l e

daadgineT xom ar hqonda pacients ma-Rali arteriuli wneva pa-s miRebamde.

• saWiro ar aris pa-is miRebis Sewyve-ta, garda im SemT-xvevisa, roca amas pacienti daJinebiT moiTxovs.

• Tu Tavis tkivili susti an zomieri siZlierisaa da iS-viaTia, pacienti daamSvideT, mieciT tkivilgamayuCebe-li preparati. 1 Tvis Semdeg kvlavSeafaseT mdgoma-reoba.

• Tu pa-is miRebis fonze gaZlierda Tavis tkivilis in-tensivoba, rasac Tan daerTo yurSi xmauris SegrZneba, mxedvelobis daqve-iTeba an metyvele-bis unaris darRve-va. SewyviteT abebis gamoyeneba da daex-mareT pacients ko-ntracepciis sxva meTodis (arahormo-nuli) SerCevaSi.

• Tu arteriuli wne-vis momateba aRini-Sneba pa-s dawyebis Semdeg, auxseniT pa-cients rom misi cvlileba Cveuleb-riv 1-dan 3-TveSidaregulirdeba da abebis miRebis Sew-yveta saWiro ar aris.

• Tu 3 Tvis gavlis Semdeg arteriuli wneva normas ar da-ubrunda, daexmareT pacients kontracep-ciis sxva meTodis (arahormonuli)SerCevaSi.

• Tu arteriuli wne-vis momateba ganpi-robebulia sisxl-

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gulisreva/Rebineba / Tavbrusxveva

Tromboemboliuri mdgomareoba

• Rebineba pa-s miRebi- dan 2 sT-is ganmav-lobaSi.

Tu siyviTle ar aris dakavSirebuli pa-s gamoyenebis dawyebasTan, Seamow-meT pacienti:_ hepatitze (mwvave)_ naRvlis buStis daavadebaze_ RviZlis keTilTvisebian an avTvi- sebiani simsivneze_ cirozze

daadgineT aris Tu ara pacienti orsu-lad. (CautareT testi orsulobaze angaagzavneT reproduqtologTan / men-ginekologTan).

CautareT pacients laboratoriuli gamokvleva sisxlis Sededebaze.

ZarRvovani proble-mebiT (stenokardia, cirkulatoruli darRvevebi) da aRi-niSneba pa-s miRebis drosac pacientma unda Sewyvitos pre-paratis miReba. dae-xmareT mas kontra-cepciis sxva meTo-dis (arahormonuli)SerCevaSi.

• progestagenis mci-re doza, romelsac Seicavs «mini-pili»

• Zalian mcired moq-medebs RviZlis fu-nqciaze, ar zrdis naRvlis buStis an RviZlis simsivnee-bis ganviTarebis risks.

• Tu pacients daud-ginda mwvave viru-suli hepatiti da ar surs kontracep-ciis meTodis Sewy-veta, auxseniT mas, rom riski imisa, rom pa gaauaresebs daavadebis mimdina-reobas mcirea. da aseve pa-s gamoyeneba naklebad saSiSia, vidre aseT dros orsuloba.

• urCieT pacients abe-

bi miiRos Zilis win an vaxSmis Semdeg. auxseniT pacients, rom es movlenebi Cveulebriv 1-3 Tvis ganmavlobaSi gaiv-lis.

• orsulobis SemTxve-vaSi imoqmedeT, ise rogorc es zemoTaaaRniSnuli (ix. ame-

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• mwvave faRaraTi anRebineba (24 sT-ze meti xangrZlivobiT).

gamotovebuli abebi

• hkiTxeT qals , gaugrZelda Tu ara Rebinaba an mwvave faRaraTi 24 sT- ze met xans.

_ Tu qals daaviwyda 1 tabletis mi- Reba.

_ Tu qals daaviwyda zedized 2 an meti tabletis miReba

norea).

• progastagenis daba-li doza ar zrdis sisxlis Sededebis risks.

• Tu sisxlis Sedede-bis problemebi ga-movlinda SewyviteT abebis gamoyeneba da gaagzavneT pacientispecialistTan dama-tebiTi gamokvleve-bis Casatareblad.

• aseT SemTxvevaSi qa-lma unda miiRos pa-is damatebiTi erTi abi da gaagrZelos danarCeni abebis mi-Reba Cveulebrivi sqemiT anu erTi abi dReSi erTxel.

• am SemTxvevaSi qalma SeZlebisdagvarad unda gaagrZelos abebis miReba da ga-moiyenos kontracep-ciis damatebiTi me-Todi (kondomi, sper- cidi) an Tavi Seika-vos sqesobrivi kav-Sirisagan momdevno2 dRis ganmavlobaSi

• erTi abis gamotove- bis SemTxvevaSi me-2

dRes rac SeiZleba adre unda iqnes mi-Rebuli gamotovebu-li tabletebi da danarCni abebis miRe-ba gagrZeldes sqe-mis mixedviT anu Ti-

To abi dReSi erT-

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( 1-A, 2-A, 4-A , 6-B , 11-B, 12-B ).

xel ciklis bolo-mde. am SemTxvevaSi

qalma ori momdevno dRis ganmavlobaSi Tavi unda Seikavos sqesobrivi kavSiri-sagan an gamoiyenos kontracepciis dama-tebiTi meTodi (ba-

rieruli/spermicidi)

• saWiroebis SemTxve-vaSi SeiZleba qalma mimarTos gadaude-bel kontracepcias.

• Tu qalma gamotova 2 an orze meti abi. man unda miiRos 2 tableti (diliT erTi da saRamos erTi an saRamos 2 tableti erdroulad) vidre ar miiRebs yvela gamotovebul abs da 2 dRis ganma-vlobaSi Tavi unda Seikavos sqesobrivi kavSirisagan anda gamoiyenos kontra-cepciis damatebiTi meTodi (kondomi /spermicidi).

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