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gadaudebeli kontraceptiuli abebi samedicino momsaxurebis saxelmZRvanelo meore gamocema _ 2004

gadaudebeli kontracepciis saerTaSoriso konsorciumi

wyaroebze miTiTeba mocemul saxelmZRvanelos safuZvlad udevs ojaxis dagegmvis saerTaSoriso federaciis da internacionaluri kvleviTi dawesebulebis mier SemuSavebuli damxmare wignebi (Pathfinder international, PATH) pirveli gamocema 2000 wlis oqtomberSi daibeWda. gansakuTrebuli wvlili, mocemul gamocemaSi, Semdeg pirebs miuZRviT: elisabed raimondi, iusuf ahmedi, Saron kempi, merilin edmundsi, duglas haberi, karlos xuedo-toledo, valeri konCelniki, sunita mitali, xose david ortici, karen ostea, hama rojo, jef spaileri, jeims truseli, paul van luki da elena fon herenceni. meore gamocemis ganaxlebisaTvis, konsorciumi madlobas uxdis elisabed raimonds, enjel kabrias, david graims, siuzan makinTaiars, ilze melingailiss, klavdia moriseis, rafaelasCaiavons, haris solomons, perger teodoras, fatiha terkis, jeims trusels, andre ulmans, elena fon hercens, ana uilsons, da beveli uinkofs.

gadaudebeli kontraceftiuli abebi samedicino momsaxureobis damxmare saxelmZRvanelo 2004; gadaudebeli kontracefciis saerTaSoriso konsorciumi-a.S.S. q. vaSingtoni; gadaudebeli kontracefciis saerTaSoriso konsorciumi.

gadaudebeli kontraceptiuli abebi samedicino momsaxureobis damxmare saxelmZRvanelo meore gamocema _ 2004.

gadaudebeli kontraceptiuli abebi samedicino momsaxurebis saxelmZRvanelo meore gamocema _ 2004

Sinaarsi winasityvaoba ................................................................................................................................... 4 gadaudebeli kontraceptiuli momsaxureobis mokle aRwera ..................................... 5 1. Sesavali.......................................................................................................................................... 7 1.1 daxasiaTeba ............................................................................................................................... 7 1.2 daniSnuleba........................................................................................................................... 7 2. gadaudebeli kontracefciis abebi ..................................................................................... 7 2.1 g.k.a-s moxmarebis reJimebi ............................................................................................... 7 2.2 zemoqmedeba .......................................................................................................................... 8 2.3 efeqturoba .......................................................................................................................... 8 2.4 gverdiTi efeqtebi, prevencia da menejmenti ............................................................ 9 2.5 ukuCvenebebi ......................................................................................................................... 9 2.6 samedicino Semowmeba ....................................................................................................... 10 7.7 gansakuTrebuli sakiTxebi ......................................................................................... 10 7.8 informacia momxmareblisTvis ................................................................................. 11 7.9 konsultacia .................................................................................................................. 11 7.10 Tanamimdevroba .............................................................................................................. 12 7.11 Tu momxmarebeli daorsulda ................................................................................... 12 7.12 regularuli kontracefciis dawyeba an, ganaxleba. gk.a-s moxmarebis Semdeg .............................................................................................. 12 3. g.k.a-Ti momaragebis sistema .............................................................................................. 13 1.1 axalgazrdebi ................................................................................................................. 14 1.2 qalebi, romlebmac sqesobrivi Zaladoba ganicades .......................................... 14 cxrili 1. g.k.a-s formulebi ......................................................................................................... danarTi: Sida saSvilosno spiralis moxmareba gadaudebeli kontracepciisTvis ... 16 SeniSvnebi 3 saerTaSoriso konsorciumi gadaudebeli kontracepciis Sesaxeb .................... 19

Sesavali momxmareblis mosaxureobis gasaumjobeseblad da maTi moTxovnebis ukeT dakmayofilebisaTvis, mniSvnelovani saSualebaa gadaudebeli kontraceptivebis da ojaxis dagegmvis sxva reproduqciuli janmrTelobis programebis SeTavazeba. vinaidan arc erTi kontraceptivi ar aris 100 %-iT efeqturi da adaminebic am meTodebs srulyofilad ver iyeneben, ikveTeba gadaudebeli kontracepciis saWiroeba. gadaudebeli kontraceptiuli abebi (g.k.a), mosaxmarad martivi da xelmisawvdomia. g.k.a-s SeZena TiTqmis yvela dasaxlebul punqtSia SesaZlebeli. mas Tan erTvis momsaxureobis specialuri bukleti, im meTodebis ganmartebiT, romelic SeiZleba gamoviyenoT g.k.a-s moxmarebis Semdeg, orsulobis Tavidan asacileblad. kontrceptiul programebSi didi mniSvneloba eniWeba ganaTlebas (informaciis swor da droul miwodebas).

qalebma sasurvelia icodnen am mniSvnelovani meTodis arsebobis Sesaxeb manam, sanam maT es dasWirdebaT. g.k.a-s kontraceptiuli zemoqmedebis periodi moklea, (efeqti sustdeba am saSualebis miRebis yoveli dRis an, saaTis dagvianebis SemTxvevaSic ki), mkurnaloba unda daiwyos dauyovnebliv, daucveli an, arasakmarisad daculi sqesrivi aqtis Semdeg. Tu ojaxis dagegmvis organizaciebi droulad miawvdian qalebs informacias an, moamarageben maT g.k.a-Ti, momxmarebels miecema saSualeba Tavi daicvas arasasurveli orsulobisagan daucveli sqesobrivi kavSiris an, kontraceptiuli marcxis SemTxvevaSi. am bukletebis rekomendaciebSi aisaxeba saerTaSoriso eqspertebis gamokvlevebi, gadaudebeli kontraceptiuli saSualebebis Sesaxeb. rekomendirebulia adgilobrivi organizaciebisaTvis, rogorc aucilebeli saxelmZRvanelo saSualeba.

gadaudebeli kontraceptiuli momsaxureobis mokle aRwera gadaudebeli kontraceptiuli abebi (g.k.a) aris mniSvnelovani saSualeba im qalebisaTvis, romlebmac hqondaT daucveli sqesobrivi kontaqti an, sxva kontraceptiuli meTodebis gamoyenebisas marcxi ganicades da romlebisTvisac orsuloba arasasurvelia. bolo sami wlis ganmavlobaSi Catarebulma gamokvlevebma gviCvenes, rom g.k.a yvelaze usafrTxo da efeqturi saSualebaa. daniSnuleba orsulobis prevencia daucveli an, arasakmarisad daculi sqesobrivi kavSiris Semdeg. reJimi am bukletSi ganixileba ori reJimi: â&#x20AC;˘ mxolod-levonorgestrelis reJimi. 1.5 levonorgestrelis erTi an, ori abi, 0,75-TiTo miiReba 12 saaTis SualediT. â&#x20AC;˘ kombinirebuli estrogen _ progestinis reJimi. eTinol estradiolis 100mg-iani ori abi plus 50mg levonorgestreli 12 saaTis SualediT. orive reJimis SemTxvevaSi, medikamentebis miReba sasurvelia daiwyos sqesobrivi kavSiris Semdeg, dauyovnebliv. am saSualebebis pacientze zemoqmedebis efeqturoba mniSvnelovnad klebulobs sqesobrivi kavSiridan drois gasvlis Sesabamisad. sqesobrivi kavSiris Semdeg 5 dRis (120sT-s) ganmavlobaSi orive reJimi efeqturia. ufro xangrZlivi dagvianebis SemTxvevebi gamokvleuli ar aris. g.k.as kategoriis orive reJimis produqcia xelmisawvdomia umravles dasaxlebul adgilebSi. (ix. cxrili 1 an, www.cecinfo.org). mxolod-levonorgestrelis reJims upiratesoba eniWeba imitom, rom is ufro efeqturia da naklebi gverdiTi efeqtebi axasiaTebs.

zemoqmedeba cnobilia, rom g.k.a-s ovulaciis win miRebis SemTxvevaSi, sakvercxeebidan kvercujredis gamoyofis Seferxeba an, dagvianeba xdeba. g.k.a agreTve aferxebs spermis SeerTebas kvercxujredTan an, ukve gamoyofili kvercxujredis mimagrebas saSvilosnos kedelze. g.k.a-s orive reJimi, romlebic ganxilulia mocemul bukletSi, uZluria ukve dadgenili orsulobis SemTxvevaSi. efeqturoba gamokvlevebma gviCvenes, rom mxolodlevonorgestrelis reJimis moxmarebis SemTxvevaSi, orsulobis riski sqesobrivi kavSiris erTi aqtis Semdeg 60%-dan 93 %-mde da ufro metad klebulobs. xolo, kombinirebuli reJimis SemTxvevaSi ki 56%-dan 89 %-mde. pirdapiri SedarebiT, kombinirebul reJimze efeqturi, mxolod-levnorgestrelis reJimi aRmoCnda. orive reJimis efeqturoba matulobs sqesobrivi aqtis Semdeg g.k.a-s dauyovnebeli miRebis SemTxvevaSi. g.k.a imdenad efeqturi ar aris, ramdenadac Tanamedrove, regularuli moxmarebis kontraceptiuli saSualebebi. gverdiTi efeqtebi orive reJimis gverdiTi efeqtebia: gulisreva, pirRebineba, daRliloba, Tavis tkivili, Tavbrusxveva, sarZeve jirkvlebis mgrZnobeloba da uwesrigo vaginaluri gamonadeni an, sisxldena. kombinirebul reJimTan SedarebiT, mxolod-levonorgestrelis miRebis SemTxvevaSi gulisreva, da pirRebineba naklebad aRiniSneba. qalebis umravlesobas mkurnalobis Semdeg, aReniSnebaT menstruaciis erTi kviriT dagvianeba an, adre dawyeba.

gulisreva da pirRebinebis prevencia gulisrevisa da pirRebinebis Semcirebis saukeTeso saSualebaa kombinirebuli reJimis nacvlad, mxolod-levonorgestrelis miReba. pirebineba Tavs iCens pirveli abis miRebis Semdeg, ori saaTis ganmavlobaSi. Zlieri pirRebinebis SemTxvevaSi unda ecadoT miiRoT meore abic. Tu es SeuZlebelia, g.k.a vaginalurad unda dainiSnos. ukuCveneba arc erTi ukuCveneba cnobili ar aris. g.k.a-s ar uniSnaven qalebs dadasturebuli orsulobiT, radgan am SemTxvevaSi efeqti ar iqneba.. gamokvleva yvela cnobil viTarebaSi g.k.a uvnebelia. misi miRebis win gamokvlevebis Catareba da testireba saWiro ar aris. zepiri an, werilobiTi instruqciis miRebis Semdeg, momxmarebels TviTon SeuZlia gansazRvros ramdenad marTebulia misTvis am preparatis miReba. menstruaciis dagvianebis SemTxvevaSi, SesaZlebelia Catardes testi orsulobis gamosaricxad. nebismier SemTxvevaSi g.k.a-s miReba ar unda gadaidos raime kvleviTi proceduris Catarebis gamo. gansakuTrebuli SemTxvevebi • ZuZuTi kveba: miuxedavad imisa, rom ZuZuTi kvebis periodSi g.k.a-s moxmarebis ukuCveneba ar arsebobs, zogierTi eqsperti rekomendacias iZleva, rom Cvili gamoikvebos abebis miRebamde. abis miRebis Semdeg eqvsi saaTis ganmavlobaSi gamowvelili rZe uvargisia. • sqesobrivi kavSiri 120 saaTis gasvlis Semdeg: g.k.a-s moxmareba SesaZlebelia, magram pacients unda Sevatyo-

binoT, rom mocemul periodSi preparatis efeqturoba Seswavlili ar aris. ganxiluli unda iqnas swrafi momedebis SidasaSvilosnos yelis spiralis gamoyenebis albaToba. • warsulSi momxdari, erTze meti, daucveli sqesobrivi aqti: g.k.a moqmedebs 120 saaTis ganmavlobaSi momxdari yvela sqesobrivi aqtis Sedegze. • g.k.a-s ganmeorebiTi moxmareba: gk.a-s mravaljeradi, ganmeorebiTi moxmareba SesaZlebelia, magram unda vicodeT, rom sxva kontraceptiuli saSualebebis regularuli moxmareba orsulobisagan ufro efeqtur da xangrZliv dacvas uzrunvelyofs. • g.k.a-s moxmareba sqesobriv kavSiramde: abebis miRebis Semdeg, wamlis zemoqmedebis xangrZlivoba cnobili ar aris. momxmarebels unda vurCioT sxva xangrZlivi moxmarebis kontraceptiuli saSualebebi orsulobisagan dasacavad. • daucveli sqesobrivi kavSiri arfertilur periodSi: vinaidan ganayofierebisaTvis usafrTxo periodis gansazRvra sirTuleebTan aris dakavSirebuli, rekomendirebulia miviRoT g.k.a. yoveli daucveli an, arasakmarisad daculi aqtis Semdeg. • sxva abebis paraleluri moxmareba: momxmarebelma unda gaiaros konsultacia, Tu ramdenad misaRebia wamlebis erTmaneTze zemoqmedeba da Sesabamisad imoqmedos (2.7 nawili). • sxva formulebis moxmareba: Tu ki, aq aRwerili saSualeba xelmisawvdomi araa, SeiZleba vixmaroT kombinirebuli estragestinis abebi, romlebic Seicaven progestin noreTindrons, levonorgestrelis nacvlad.

informacia momxmareblisaTvis informacia g.k.a-s da masTan dakavSirebuli sakiTxebis Sesaxeb momxmarebels miewodeba: piradad, telefoniT an, werilobiT. momxmareblisTvis aucilebeli informacia: • momxmarebelma abebi unda miiRos dauyovnebliv, sqesobrivi kavSiris Semdeg. • g.k.a-s moxmarebis periodSi, Tu menstruacia erT kviraze meti xniT daigvianebs, qalma unda mimarTos Sesabamis samedicino dawesebulebas da miiRos SesaZlebeli orsulobis Tavidan acilebisaTvis zomebi. • Tu momxmarebeli ganicdis uwesrigo sisxldenas an, tkivils muclis qveda nawilSi, igi unda daukavSirdes samedicino personals; dasaSvebia saSvilosnos gare orsulobis riski. • momxmarebelma g.k.a-s miRebis Semdeg, unda miiRos sxva kontraceptiuli saSualeba. g.k.a ar aris Sesaferisi medi-

kamenti xangrZlivi moxmarebisaTvis. • g.k.a ar icavs momxmarebels Sidsis an, sxva sqesobrivi gziT gadamdebi infeqciebisagan. konsultaciis dros marTebuli iqneba momxmarebels mivawodoT infomacia g. k.a-s efeqturobaze, gverdiT efeqtebze, moqmedebis meqanizmze, sxva kontraceptiul meTodebze da sqesobrivi gziT gadamdebi infeqciebisagan dacvis saSualebebze. qals, momavalSi gamosayeneblad, kondomi unda SevTavazoT da mivaswavloT Tu sad SeuZlia miiRos misTvis saWiro momsaxureoba. momxmarebels kosultacia, ganusjelobis da mxardaWeris principiT unda Cautardes. moqmedebis gegma Tu momxmarebels aReniSneba uwesrigo sisxldena muclis qveda aris tkivilis TanxlebiT, raime SekiTxva an, raime mizezi gaaCnia SeSfoTebisaTvis, mas dauyovnebliv unda SevTavazoT specialistTan misvla.

samedicino momsaxureobisaTvis gadaudebeli kontraceptiuli abebis saxelmZRvanelo 1. Sesavali

• rodesac kontraceptiuli saSualeba ar iqna moxmarebuli;

miuxedavad kontracepciis maRalefeqturi da xelmisawvdomi saSualebebisa, bevri orsuloba qalis survilis gareSe da mis mier daugegmavad xdeba. daugegmavi orsuloba, arasaimedo abortebis gamo, paTologiebis da sikvdilianobis maRal risks Seicavs. rac SeiZleba acilebuli iqnas, gadaudebeli kontraceptiuli abebis moxmarebis SemTxvevaSi.

• rodesac kontraceptivi moixmares magram arasworad an, warumateblad;

1.1 daxasiaTeba

• kondomis dazianebis, Camosrialebis an, araswori moxmarebis SemTxvevebi; • kombinirebuli kontraceptiuli abebis miRebis orjer an, metad TanamimdevrobiT gamotovebis SemTxvevaSi; • mxolod-progestinis (mini-abis) miRebis 3 saaTiT an, ufro meti xniT dagvianebis SemTxvevaSi.

gadaudebeli kontraceptiuli abebi (g.k.a) aris kontracefciis hormonaluri saSualeba, romelic daucveli an, arasakmarisad daculi sqesobrivi kavSiris Semdeg, saSualebas iZleva Tavidan aviciloT arasasurveli orsuloba g.k.a-s, iSviaTad, gansazRvraven rogorc “Semdgomi dilis” an, “koitusis Semdgom” abebad. umjobesia vixmaroT termini “gadaudebeli kontracepciis abebi”, radgan es saxelwodeba momxmareblisaTvis mniSvnelovan informacias Seicavs: am abebiT mkurnalobas xangrZlivi mimdinareoba ar aqvs. es saxelmZRvanelo ganixilavs g.k.a-s moxmarebis or reJims: I reJimi - mxolod progestinis (levongestrelis) reJimi II reJimi - progestinis (levonogestrelis) kombinacia estrogenTan (eTil estradiolTan). Sida saSvilosnos spiralis moxmarebis mokle mimoxilva mocemulia danarTSi.

• rodesac 2 kviraze metiT dagvinebulia mxolod-progestinis kontraceptiuli ineqcia depot-medroqsiprogesteron acetati an, norTesteronis enanTati);

1.2 daniSnuleba

• Sida saSvilosno spiralis gamovardna;

g.k.a iniSneba orsulobis prevenciis mizniT daucveli an, arasakmarisad daculi sqesobrivi kavSiris Semdeg:

• sqesobrivi Zaladobis SemTxvevaSi, rodesac qali efeqturi kontraceptiuli saSualebebiT ar iyo daculi.

• kombinirebuli estrogen plus progestinis yoveTviuri ineqcia dagvianebulia 7 dReze meti periodiT; • kontraceptiulma hormonalurma kanis salbunma, rgolma adgili Seicvala, maTi moTavseba moxda adre an, dagvianebiT; • diafragmis an, xufis adgilis Secvla, dazianeba an, adre amoReba; • ar ganxorcielda koitusis drouli Sewyveta (mag. evakulacia vaginaSi an, gare genitaliebze); • spermiciduli tabletis uvargisoba an, abis sqesobriv kavSiramde dadnoba; • ganayofierebisaTvis arasasurveli dReebis dadgenisas, Secdoma menstruaciuli ciklis gamoangariSebis dros:

2. gadaudebeli kontraceptiuli abebi 2.1 g.k.a-s moxmarebis reJimi mocemuli saxelmZRvanelo gadaudebeli kontraceptiuli abebis moxmarebis or reJims ganixilavs: â&#x20AC;˘ mxolod-levonorgestrelis miRebis reJimi: 1.50mg. levongestreli erTxel orjer an, 0.75mg. orjer 12 saaTis SualediT. â&#x20AC;˘ kombinirebuli estrogen-progestinis reJimi: 100mkg eTinil estradioli plus 0.50mg levonorgestreli, romelic miiReba 12 saaTis Semdeg. SeniSvna: levonorgestrels, plus igive raodenobis monaTesave, magram araaqtiur Semadgenel nawils ewodeba norgestreli. orive reJimiT mkurnaloba unda daiwyos dauyovnebliv sqesobrivi aqtis Semdeg, radgan efeqti mcirdeba drois gasvlis Sesabamisad. adreuli monacemebi gvauwyeben, rom orive reJimi efeqturia sqesobrivi aqtis Semdeg 72 saaTis ganmavlobaSi. zogierTi instruqcia da Zveli saxelmZRvanelobi gvirCeven g.k.a miviRoT drois xangrZlivobis am mocemul CarCoSi. maSin rodesac,momdevno gamokvlevebma dagvanaxa, rom es saSualeba agrZelebs saSualo xarisxis zemoqmedebas 72 saaTidan _ 120 saaTamde. sqesobrivi aqtis 120 saaTis Semdeg moxmarebuli g.k.a-s zemoqmedebis Sesaxeb, monacemebi ar mogvepoveba. sxvadasxa qveynebSi orive reJimi xelmisawvdomia. produqts Tan erTvis g.k.a-s saSualebis moxmarebisaTvis saWiro instruqcia. g.k.a-s saSualebebi SeiZleba Sedgebodnen sxvadasxva Cveulebrivi moxmarebis kontraceptiuli abebisagan (ix. cxrili 1 an, www. cecifo. Org).mxolod-levonorgestrelis reJims mieniWeba upiratesoba, radgan igi ufro efeqturia da dakavSirebulia gulisrevis nakleb riskTan.

2.2 zemoqmedeba rogorc yvela hormonaler saSualebas, g.k.a-sac, zemoqmedebis sxvadasxvanairi gzebi axasiaTebs. am wamlis zemoqmedebis zusti meqanizmi Zneli gansasazRvria, radgan damokidebulia iseT faqtorebze, rogoricaa: qalis menstruaciuli cikli; rodis moxda sqesobrivi kavSiri da rodis iqna miRebuli g.k.a. gamokvlevebma gviCvenes, rom rodesac g.k.a miiReba ovulaciis win (orive reJimis SemTxvevaSi), misi zemoqmedeba gamoixateba am ukanasknelis SeferxebiT an, gadavadebiT. sxva gamokvlevebma gviCvenes endometritis histologiuri da bioqimiuri cvlilebebi, g.k.a-s kombinirebuli reJimiT mkurnalobis Semdeg. aqedan gamomdinare, SeiZleba vivaraudoT, rom g.k.a aferxebs ganayofierebuli kvercxujredis endometriul aTvisebas. g.k.a-s moqmedebis meqanizmis SesaZlo variantia dabrkolebis Seqmna spermis moZraobasa da SeRwevad unarianobaSi, magram jer-jerobiT es ar aris dadasturebuli klinikuri gamokvlevebiT. g. k.a.-s efeqturobis statistikuri maCvenebelis mixedviT SegviZlia vivaraudoT, rom mxolod ovulaciis SeferxebiT, SeuZlebelia efeqturobis im maRali donis miRweva, romelsac viRebT g.k.a-s moxmarebis SemTxvevaSi. g.k.a-s xSirad medikamentozur abortTan aigiveben, magram es marTebuli ar aris, es preparati efeqturia mxolod sqesobrivi kavSiris Semdgom ramodenime dRis ganmavlobaSi, manam, sanam orsuloba dadgindeba. medikamentozuri aborti ki aris dadgenili orsulobis Sewyvetis araqirurgiuli gza. periodi sqesobriv kavSirsa da dadgenil orsulobas Soris 5 dRea, romlis ganmavlobaSi ganayofierebuli kvercxujredi unda miemagros saSvilosnos kedels. g.k.a ki orsulobis prevencias, drois am periodis ganmavlobaSi axdens. gamokvlevebi cxadyofen, rom g.k.a-s moxmarebis arc erTi reJimi

ar Sewyvets ukve dadgenil orsulobas an, raime zians miayenebs ganviTarebad embrions. 2.3 efeqturoba statistikas, romelsac iyeneben kontraceptiuli meTodebis efeqturobis Sesafaseblad, gviCvenebs xangZlivi periodis ganmavlobaSi am kontraceptiuli saSualebebis momxmarebeli qalebis ricxvis Tanafardobas daorsulebul qalebis raodenobasTan. am statistikas mniSvneloba ar aqvs g.k.a-s moxmarebis SemTxvevaSi, radgan es preparati erTjeradi moxmarebisTvis aris gankuTvnili. g.k.a-s kontraceptiuli efeqturoba gamoixateba terminiT “acilebuli wiladi” (“prevented fraction”), rac warmoadgens mosalodneli orsulobis da acilebuli orsulobis Tanafardobas. am Sefardebis gansazRvra ar aris ioli, radgan bevr savaraudo monacemTan gvaqvs saqme, romelTa sizuste Zneli dasamtkicebelia. aqedan gamomdinare aRniSnuli efeqturobis amsaxveli cifrebi SesaZlebelia zusti ar iyos. miuxedavad imisa, rom zemoT aRniSnul statistikaSi adgili SeiZleba hqondes uzustobas, g. k.a. mkurnalobis erTaderTi xelmisawvdomi saSualebaa daucveli sqesobrivi kontaqtis Semdgom. da udavoa is faqti, rom g.k.a (gansakuTrebiT levonorgestrelis reJimis) moxmareba namdvilad ufro efeqturia vidre saerTod arafris. 5000 qalze Catarebulma oTxma gamokvlevam gvaCvena, rom levongestrelis moxmarebis dros, orsulobis Tavidan acilebis procentuli raodenoba 60%dan 93%-mdea. xolo, 3800 qalze Catarebulma rva gamokvlevam cxadyo, rom g.k.a-s kombinirebuli reJimis dros orsulobis prevencia 74%-ia. sxvadasxa gamokvlevebSi proporciebi cvalebadobas 56%-dan 89%-mde ganicdian.am ori reJimis pirda-

pirma Sedarebam dagvanaxa, rom levonorgestrelis reJimi mniSvnelovnad efeqturia kombinirebul reJimTan SedarebiT. orsulobis SefardebiTi ricxvia 0.36. mxolod- levonogestrelis reJimi erTi mesamediT efeqturia kombinirebulTan SedarebiT. mrvalricxovanma gamokvlevebma dagvanaxes, orive reJimis gamoyeneba miT ufro efeqturia, rac ufro adre miviRebT abebs sqesobrivi kavSiris Semdeg. Tanamedrove gamokvlevebisgan gansxvavebiT, zogierTi adreuli gamokvleva ar gviCvenebs drois faqtoris zemoqmedebas mkurnalobis Sedegze. rac Seexeba g.k.a-s moxmarebas sqesobrivi kavSiridan 120 saaTis Semdeg, monacemebi ar mogvepoveba da aqedan gamomdinare, ver vimsjelebT am periodSi preparatis moxmarebis efeqturobaze. g.k.a-s yovedRiuri moxmareba, rogorc Cveulebrivi kontraceptiuli saSualebisa, ar aris marTebuli Semdegi mizezebis gamo: xangrZlivi periodiT moxmarebis SemTxvevaSi g.k.a naklebad efeqturia, vidre sxva Tanamedrove kontraceptiuli saSualebebi. g.k.a-s erTjeradi moxmarebis Sedegis procentuli statistika SeuZlebelia pirdapir SevadaroT xangrZlivi moxmarebis kontraceptiuli saSualebebis statistikas, magram SesaZlebelia iTqvas, rom xangrZlivad, magaliTad, erTi wlis ganmavlobaSi misi moxmarebis SemTxvevaSi, orsulobis saerTo riski ufro maRali iqneba, vidre Cveulebrivi kontraceptiuli saSualebebis, rogoricaa mamakacis kondomi an sxv moxmarebis SemTxvevaSi. garda amisa, g.k.a-s Zalian xSiri moxmareba gamoiwvevs met gverdiT efeqtebs (mag. rogoricaa menstruaciuli ciklis areva), da mTlianobaSi hormonebis gadaWarbebuli doziT miRebas. monacemebi g.k.a-s xSiri da xangrZlivi moxmarebis Sedegad gamowveuli garTulebebis Sesaxeb ar moipoveba.

2.4 gverdiTi efeqtebi, prevencia da menejmenti miuxedavad imisa rom, sikvdilianoba an, seriozuli garTulebebi preparatis moxmarebis dros ar aRiniSneba, samedicino TvalsazrisiT umniSvnelo, magram Semawuxebeli gverdiTi efeqtebi xSirad iCenes Tavs kerZod: gulisreva da pirRebineba g.k.a-s mxolod-levenorgestrelis reJimis moxmarebis SemTxvevaSi gulisreva Tavs iCens qalebis 18 %-Si, piirRebineba ki 4 %-Si. kombinirebuli reJimis SemTxvevaSi ki, gulisrevas adgili aqvs 43 %-sa da pirRebinebas 16 %_Si. SedarebiTma gamokvlevam gviCvena, rom mxolod_ levenorgestrelis reJimi nakleb gulisrevas da pirRebinebas iwvevs.. unda aRiniSnos, rom am simptomebma SesaZlebelia Tavi iCinon mkurnalobis Semdgom, sami dRis ganmavlobaSi. prevencia gulisrevis da pirRebinebis minimumamde dayvanis saukeTeso saSualebaa mxolod_levonorgestrelis rejimis moxmareba. am reJimis moxmarebis dros, gulisreva da pirebineba imdenad iSviaTia, rom profilaqtikis mizniT, antiemetikuri saSualebebis daniSvnas, Cveulebriv safuZveli ar aqvs. maSin rodesac kombinirebuli reJimis SemTxvevaSi antiemetikuri saSualebebis daniSvna xSirad saWiro xdeba. Tu erTi saaTiT adre, g.k.a-s pirveli abis miRebamde davlevT meklizinis(50m. g) erT abs, gulisreva mcirdeba 30%--iT, pirRebineba ki 60 %-iT. pacientebi, romlebic meklicins iyeneben, unda gavafrTxiloT, rom am preparatma SeiZleba wyurvilis SegrZnebis momateba gamoiwvios. kombinirebuli reJimis dawyebamde, erTi saaTiT adre miRebulma 100mg. metoqsopromidmac SeiZle-

ba gulisrevis SegrZnebis Semcireba gamoiwvios. am wamlebis ufro dabalma dozam, iseve rogorc sxva antiemetikurma saSualebebma, SesaZlebelia gulisrevis SegrZneba moxsnan, magram maTi moqmedeba jer Seswavlili ar aris. SeuZlebelia viwinaswarmetyveloT, Tu g.k.a-s romel momxmarebels eqneba gulisrevis SegrZneba an, pirRebibeba da an, romel qals uSvelis antiemetikuri saSualebebi. g.k.a-s preparatebis sakvebTan miRebas, gulisrevis riskis Semcirebaze gavlena ar aqvs. menejmenti eqspertebis umravlesobis azriT, g.k.a-s preparatis miRebis Semdgom, ori saaTis ganmavlobaSi Tu pirRebinebas hqonda adgili, am preparatis igive doza ganmeorebiT unda iqnes miRebuli. Zlieri perRebinebis SemTxvevaSi ki, g.k.a vaginalurad dainiSneba. mecnierebis mier dadgenilia, rom hormonebi vaginaluri mukozidan kargad Seiwoveba. menstruaciuli ciklis dagvianeba momxmarebels informacia unda mivawodoT, rom g.k.a-s preparatis miReba ar iwvevs dauyovnebliv menstruaciuli ciklis aRdgenas. (g.k.a-s momxmareblis mcdari warmodgena). menstruacia erTi kviriT igvianebs an, erTi kviriT adre modis. menejmenti Tu ki, g.k.a-s miRebis Semdeg, menstruacia erTi kviris dagvianebiTac ar movida, unda vivaraudoT orsuloba da momxmarebels vurCioT Sesabamisi procedurebis Catareba (mag. testi orsulobaze). uwesrigo vaginaluri gamonadeni g.k.a-s moxmarebis SemTxvevaSi, Sesa-

Zlebelia adgili hqondes uwesrigo vaginalur sisxldenas an, gamonadens. sxvadasxva gamokvlevebSi, am gverdiTi efeqtis procentuli Sefardebis ricxvi mniSvnelovnad gansxvavdeba. qalebis 0 %-dan 17 %-mde, ganicdis araâ&#x20AC;&#x201C;menstruaciul sisxldenas wamlis moxmarebis Semdgom pirveli kviris ganmavlobaSi. menejmenti g.k.a-s miRebis Sedegad, uwesrigo sisxldena, saSiSi ar aris. igi mkurnalobis gareSec gaivlis. magram mxedvelobaSi misaRebia is SesaZleblobac, rom g.k.a-s miRebis Semdgomi uwesrigo sisxldena ufro seriozul mizezTan aris dakavSirebuli, kerZod, saSvilosnos gare orsulobasTan. Tu sisxldenas daerTo saSvilosnos gare orsulobisaTvis damaxasiaTebeli sxva simptomebi, (rogoricaa muclis qveda nawilis tkivili), pacientma Sesabamisi zomebi unda miiRos. g.k.a-s sxva gverdiTi efeqtebi g.k.a-s mier gamowveuli SesaZlebeli gverdiTi efeqtebia: muclis tkivili, ZuZus mgrZnobeloba, Tavis tkivili, Tavbrusxveva da gulisreva. es gverdiTi zemocmedeba. Tavs iCens mkurnalobis ramodenime dRis Semdeg da Cveulebriv, 24 saaTis ganmavlobaSi gaivlis. menejmenti ZuZus mgrZnobelobisa da Tavis tkivilisagan gamowveuli diskomfortis mosaxsnelad SieZleba miviRoT tkivilgamayuCebeli. zegavlena orsulobaze maRal-dozian kontraceptul saSualebebze Catarebulma gamokvlelebma gviCvenes, rom, g.k.a-s adreul orsulobaSi moxmarebis SemTxvevaSi, arc orsuls da arc Canasaxs isini ar azianeben.. g.k.a-s moxmareba ar zrdis saSvilos-

nos gare orsulobis absolutur risks, aramed rogorc yvela kontraceptiuli saSualeba, orsulobis prevenciis Sedegad amcirebs mas. 2.5 ukuCvenebebi ar arsebobs monacemebi, rom g.k.a mavnea janmrTelobisaTvis. miuxedavad amisa, preparats yuTSi Tan erTvis ukuCvenebebis iseTive sia, rogorc yvela sxva kontraceptiul saSualebas, magram eqspertebis azriT, mkurnalobis periodis simciris gamo, es ukuCvenebebi g.k.asTvis damaxasiaTebeli ar aris. qalebs visac ukve hqondaT saSvilosnos gare orsuloba, SeuZliaT gamoiyenon g.k.a im qalebs, romlebsac orsuloba ukve daudasturdaT, es preparati ar daeniSnebaT. magram im SemTxvevaSi, Tu orsuloba mxolod, eWvis qveS aris, g,k,a-s daniSvna SesaZlebelia, radgan viciT, rom es preparati arsebul orsulobas zians ar miayenebs. aris SemTxvevebi, rodesac qali orsuladaa, magram man es ar icis. am SemTxvevaSi g.k.a-s moxmareba efeqturi araa. 2.6 samedicino Semowmeba vinaidan qalma TviTon unda gansazRvros hqonda Tu ara mas daucveli sqesobrovi kavSiri da radgan cnobilia, rom g.k.a usafrTxoa momxmareblisaTvis, samedicino gamokvlevis erTaderTi mizania gansazRvros, namdvilad saWiro Tu ara g.k.a-s daniSvna (mag. qali ukve orsuladaa), an, rodesac sxva saxis gadaudebeli kontraceptiuli saSualebebi ufro mizanSewonilia (mag. saSvilosnos Sida spirali). samedicino Semowmeba unda Caataros maRali kvalifikaciis mqone specialistma. klinikuri procedurebis Catareba (mag. testi orsulobaze, arteriuli wnevis gazomva, laboratoriuli testebi, Svilosnos Semowmeba), saWiro ar aris, magram aucileblobis SemTxvevaSi an, qalis

surviliT SeiZleba maTi Catarebac. testi orsulobaze gvexmareba im SemTxvevaSi, Tu qals menstruaciuli cikli daugvianda. samedicino procedurebis Catarebis gamo, g.k.a-s miReba ar unda Sewydes an, ar unda gadaidos. 2.7 gansakuTrebuli sakiTxebi meZuZuri qali mSobiarobis Semdeg eqvsi Tvis ganmavlobaSi qalTa umravlesoba meZuZuria. maT menstruaciuli cikli ar aqvT da aqedan gamomdinare ar saWiroeben g.k.a-s. magram is qali, romelsac Cvili xelovnur kvebaze hyavs an, romelsac mSobiarobis Semdeg menstruaciuli cikli aRudga, orsulobis riskis winaSe dgas. g.k.a-s erTjerad miRebas ar SeuZlia mniSvnelovani gavlena moaxdinos qalis rZis raodenobaze an, xarisxze. zogierTi specialistis azriT hormonis daudgeneli raodenoba SeiZleba gadavides dedis rZeSi. maTi rekomendaciiT meZuZurma dedam bavSvi g.k.a_s miRebis win unda gamokvebos da Semdegi eqvsi saaTis ganmavlobaSi gamowvelili rZe aRar ixmaros. magram samecniero gamokvlevebi amis gakeTebis aucileblobas ar adastureben. g.k.a-s moxmareba koitusis aqtis 120 saaTis gasvlis Semdeg sqesobrivi kavSiris damyarebis 120 saaTis Semdeg, g.k.a-s xmarebis Sesaxeb monacemebi ar moipoveba. magram, orsulobaze eWvis SemTxvevaSi misi moxmareba marTebuli iqneboda. cnobilia, rom es preparati safrTxes ar uqmnis arc qals da arc embrions. ufro efeqturi iqneba, qalma Caidgas spilenZis saSvilosnos Sida spirali (ix. danarTi). g.k.a_s moxmareba, erTze meti daucveli sqesobrivi aqtis SemTxvevaSi. g.k.a_ze uari ar unda iTqvas im SemTx-

vevaSic, Tu ki qals erTze meti daucveli an, arasakmarisad daculi sqesobrivi kavSiri hqonda, garda im SemTxvevisa, rodesac orsuloba ukve dadasturebulia. momxmarebeli unda gavafrTxiloT, rom g.k.a-s efeqturoba klebulobs sqesobriv aqtsa da preparatis moxmarebas Soris intervalis gazrdasTan erTad. qalebi unda davarwmunoT, dauyovnebliv ixmaron g.k.a, ar daelodnon sqesobrivi kavSiris seriul ganmeorebas. miuxedavad warsuli sqesobrivi kavSirebis simravlisa, mocemul SemTxvevaSi, g.k.a-s daniSnuleba erTjeradad unda Sesruldes. g.k.a-s sistematiuri moxmareba es kontraceptiuli saSualeba ar aris gankuTvnili sistematiuri moxmarebisaTvis, magram msgavsi reJimebis da oraluri kontraceptiuli saSualebebis maRali doziT moxmarebis gamocdileba cxadyofs, rom maTi limitirebulad ganmeorebiTi moxmareba garTulebebs ar iwvevs. g.k.a-ze qalma uari ar unda Tqvas mxolod imitom, rom is adre gamoiyena, Tundac igive menstruaciuli ciklis farglebSi. yvela im qalebs, romlebic xmaroben g.k.a-s, gansakuTrebiT ki maT, vinc es saSualeba ganmeorebiTad ixmara, unda mivawodoT informacia sxva kontraceptiuli saSualebebis Sesaxeb da vurCioT Tu rogor aicilon momavalSi kontraceptiuli marcxi. im SemTxvevaSi, rodesac orsuloba arasasurvelia da ar arsebobs usafrTxo saaborto momsaxureoba, g.k.a-s ganmeorebiTi moxmareba namdvilad mizanSewonilia. g.k.a-s moxmareba sqesobrivi aqtis win monacemebi, Tu ramden xans moqmedebs g.k.a misi miRebis Semdeg, ar moipoveba. savaraudod, misi sqesobrivi aqtis win miReba iseve efeqturia, rogorc aqtis

Semdeg. magram, Tu SesaZlebelia, qalma umjobesia sxva kontraceptiuli saSualebebi an, meTodebi gamoiyenos. g.k.a-s gamoyeneba arafertilur periodSi cnobilia, rom ganayofiereba sqesobrivi aqtis Sedegad, xorcieldeba ovulaciis wina da Semdgom periodSi (xuTi Svidi dRis ganmavlobaSi). Teoriulad am periodis ganmavlobaSi g.k.a-s moxmareba saWiro ar aris. magram, praqtikulad am periodis gansazRvra Zalzed Znelia. aqedan gamomdinare, qalma mocemuli preparati unda miiRos yoveli daucveli an, arasakmarisad daculi sqesobrivi aqtis Semdeg, roca ki gauCndeba eWvi, rom is orsulobis safrTxis winaSe dgas. wamlebis urTierTmoqmedeba g.k.a-s da sxva medikamentebis urTierTmoqmedebis Sesaxeb monacemebi ar moipoveba. savaraudoa, rom g.k.a iseve moqmedebs sxva medikamentebze, rogorc misi msgavsi kontraceptiuli abebi. am SemTxvevis sruli ganxilva mocemuli saxelmZRvanelos kompetenciaSi ar Sedis, magram ramodenime rekomendacia SesaZlebelia mogawodoT. kontraceptiuli abebis Tanadroulma moxmarebam iseT wamlebTan, rogoricaa refampicilini, SesaZlebelia kontraceptiuli saSualebis efeqturoba Seasustos. agreTve, g.k.a-s erTi, ori an damatebiTi dozebis miRebis SemTxvevaSi, mxedvelobaSi unda miviRoT hormonebis moWarbebuli raodenoba. sxva ganmartebebi erTerTma gamokvlevam gviCvena rom, radgan progestinis abebis formulis moxmareba gvaZlevs igive Sedegs da gverdiT efeqtebs, rasac standartuli levonorgestrelis kombinirebuli formula.

ukansknelis xelmiuwvdomobis SemTxvevaSi, gadaudebeli kontracefciuli saSualebis daniSnulebiT, levonorgestrelis magivrad SesaZlebelia vixmaroT progestinis Semcveli oraluri kontraceptiuli abebi. 2.8 informacia mxmareblisaTvis Sesabamisi informacia momxmarebels SesaZlebelia mivawodoT piradad, telefoniT an, werilobiT. (mag. broSuris an, preparatis anotaciis saxiT). es informacia unda Seicavdes Semdeg mTavar sakiTxebs: • momxmarebelma, g.k.a-s maqsimaluri Sedegis misaRwevad, abebi sqesobrivi kavSiris Semdeg dauyovnebliv unda miiRos. Tu mas ar eqna pirRebineba wamlis miRebis Semdegi ori saaTis ganmavlobaSi, damatebiTi dozis miReba saWiro ar aris,. • g.k.a-s miRebis Semdeg, momxmarebels menstruacia Tu ar daewyo mosalodneli vadis erTi kviris dagvianebiTac, man mxedvelobaSi unda miiRos orsulobis SesaZlebloba da Sesabamisi zomebi miiRos. • Tu momxmarebels aReniSneba uwesrigo sisxldena an, tkivili muclis qveda areSi, man unda mimarTos specialists. SesaZlebelia saSvilosnos gare orsuloba. • g.k.a ar aris xangrZlivi, sistematiuri moxmarebisaTvis Sesaferisi kontraceptiuli saSualeba. am miznisaTvis gamoiyeneba standartuli kontraceptiuli saSualebebi. • g.ka. ar icavs Sidsisgan an, sxva sqesobrivi gziT gadamdebi infeqciebisgan. Tu momxmarebels eWvi aqvs am daavadebebze, g.k.a-s moxmarebis SemTxvevaSic ki unda Caitaros Sesabamisi analizebi. idealuri varianti iqneba, Tu momxmarebels mivawvdiT informacias ara marto g.k.a-s efeqturobaze, gverdiT movlenebze da misi moqmedebis meqanizmze, aramed sxva kontraceptiul saSualebebsa da sqe-

sobrivi gziT gadamdebi daavadebebis prevenciis saSualebebzec. unda gvaxsovdes, rom momxmarebels imaze meti informacia ar unda mivawodoT, ramdenis aTvisebac mas SeuZlia. zog SemTxvevaSi, momxmarebels ar ainteresebs rCevebis miReba sxvadasxva Temebze (mag. kontraceptiuli saSualebebis sxva meTodebze, an g.k.a-s moqmedebis meqanizmze), magram miuxedavad amisa, mas uari ar unda vuTxraT g.k.a-s miwodebaze. 2.9 rCeva-darigeba orma gamokvlevam gviCvena, rom qalebis umravlesobas, imisaTvis rom usafrTxod da efeqturad gamoiyenon g.k.a ar sWirdebaT konsultacia janmrTelobis dacvis muSakebTan. SesaZlebelia, maT rCevadarigeba werilobiTi saxiT miiRon. am SemTxvevaSi momxmarebeli ukeTesad aiTvisebs miwodebul informacias. konsultaciis dros unda gaviTvaliswinoT sxvadasxva mizezebi ris gamoc qali, (romelsac esaWiroeba g.k.a,) SeiZleba nerviulobdes da SeSfoTebuli iyos: mag. kontraceptiuli saSualebis uSedego xmarebis gamo dabneuloba, gaupatiurebis Sedegad miRebuli travma, eWvi sqesobrivi gziT miRebul infeqciaze da sxv. konsultantma, ramdenadac SesaZlebelia, mxari unda dauWiros qalis arCevans da Tavi Seikavos komentarebisagan. megobruli damokidebuleba konsultaciis dros, xels uwyobs qalis mier infomaciis ukeT aTvisebas. momxmarebels, Tu SesaZlebelia, unda mivawodoT, rogorc werilobiTi ise zepiri instruqcia. ilustrirebuli instruqcia exmareba iseT momxmarebels, romlis ganaTlebis donec dabalia. konsultaciis dros unda waxalisdes momxmareblis aqtiuroba. magaliTad, konsultantma SeiZleba ikiTxos, Tu ra icis man g.k.a-s Sesaxeb an, ganixilos momxmareblis sxva kontracep-

tiuli saSualebebis moxmarebis gamocdileba. konsultaciis dros, SeiZleba gairkves Tu rogor icavs momxmarebeli Tavs sqesobrivi infeqciebisagan. qalis Sexedulebebis dadasturebiT an SesworebiT ukeTesi Sedegi miiReba, vidre mxolod informaciis miwodebiT. ramdenadac SesaZlebelia, uzrunvelyaviT konsultaciis konfidencialuroba. im SemTxvevebSi, rodesac konsultaciis Catareba ganmartoebiT SeuZlebelia (mag. afTiaqebSi), momxmarebels urCieT daukavSirdes ojaxis dagegmvis momsaxureobis punqts, raTa miiRos damatebiTi informacia da rCeva - darigeba regularuli kontraceptiuli meTodebis Sesaxeb. daarwmuneT momxmarebeli, rom miuxedavad maTi asakisa da ojaxuri mdgomareobisa, maT mier miwodebuli informacia da is faqti rom isini itareben mkurnalobas, sruliad konfidencialuria. 2.10 Tanamimdevroba g.k.a-s moxmarebis Semdeg, sxva zomebis miReba saWiro ar aris garda SemTxvevebisa, rodesac momxmarebeli raime problemis winaSe dadgeba kerZod: • dasWirda mimdinare kontraceptiuli meTodis Sesaxeb konsultacia an, kontraceftivi; • menstruacia dagvianda erT kviraze metiT; • aqvs tkivili muclis qveda areSi an ,uwesrigo sisxldena; • eWvi aqvs orsulobaze; • saWiroebs sxva saxis momsaxureobas an konsultacias; • raime sxva mizezebi. 2.11 Tu momxmarebeli daorsulda arsebobs ramodenime mizezi, rodesac momxmareblma, g.k.a-s miRebis Semdeg SeiZleba aRmoaCinos rom orsuladaa. es mizezebia: g.k.a-m ar imoqmeda; igi orsulad iyo g.k.a-s miRebamde an, g.k.a-s

miRebis Semdgomma koitalurma aqtma gamoiwvia misi daorsuleba. romelime am SemTxvevaSi: • SevTavazoT momxmarebels yvela SesaZlebeli saSualeba da TviTon gadawyvitos romlis gamoyenebaa mis mdgomareobaSi yvelaze marTebuli. pativi vceT da mxari davuWiroT mis gadawyvetilebas. • Tu qalis gadawyvetileba orsulobis SenarCunebaa, daarwmuneT, rom ar arsebobs g.k.a-s miRebis Semdgomi teratogenuli efeqti. gamokvlevebi cxadyofen, rom g.k.a ar iwvevs saSvilosnos gare orsulobis riskis zrdas. 2.12 g.k.a-s miRebis Semdeg regularuli kontraceptiuli saSualebebis moxmarebis dawyebis an, ganaxlebis msurvelebs kontraceptiuli saSualebebi, konsultacia unda Cautardes da momaragdes Cveulebrivi kontraceptiuli saSualebebiT, (mag. kondomiT). SesaZlebelia qalma survili gamoTqvas adre dawyebuli kontraceptiuli meTodis ganaxlebisa an, axlis dawyebisa. Tu g.k.a-s moTxovnis mizezi Cveulebrivi kontraceptiuli saSualebis uvargisobaa, (mag. kondomis uxarisxoba an, oraluri kontraceptiuli abis miRebis daviwyeba), gaarCieT momxmarebelTan es mizezi da momavlisaTvis dasaxeT amis Tavidan acilebis gzebi. zogierT SemTxvevaSi, g.k.a-s saWiroeba migviTiTebs mimdinare kontraceptiuli meTodis Secvlis aucileblobaze. kargi iqneba, Tu riskis faqtoris jgufis momxmarebels, (mag. gardamavali asakis pirebs, jgufebs, sadac xSiria partniorebis cvla, an, pirebs mWidrod dasaxlebuli sacxovrebeli adgilebidan), CautardebaT konsultacia, Tu rogor daicvan Tavi ara marto arasasurveli orsulobisagan, aramed sqesobrivi infeqciebisganac.

g.k.a-s moxmarebis Semdeg kontraceptiuli saSualebebis moxmarebis ganaxleba, an, Tavidan dawyeba • kacis an, qalis kondomi- gamoiyeneba sqesobrivi aqtis dros; • saSvilosnos yelSi mosaTavsebeli meqanikuri saSualebebi (diaphragm or cervical cap) - gamoiyeneba sqesobrivi aqtis dros; • kontraceptiuli qafi, abebi, Jele, kremi an safeni - gamoiyeneba sqesobrivi aqtis dros; • oraluri kontraceptiuli abebi, hormonaluri kontraceptiuli safeni an vaginaluri rkali - ori meTodidan pirveli ufro efeqturia, radgan misi gamoyeneba ufro adrea SesaZlebeli; a. momxmarebels SeuZlia am meTodis gamoyeneba g.k.a-s miRebis dRidanve. Tu qali axal meTods iwyebs, man abebis axlad gaxsnili yuTidan unda dalios wamali, ixmaros axali safeni an rkali. Tu igi adre xmarobda mocemul saSualebebs, (mag. g.k.a daeniSna, imitom, rom man gamotova abis miReba, safenma an rkalma adgili Seicvales), maSin mas SeuZlia ganagrZos yvela am saSualebis moxmareba Zveli yuTidan. am SemTxvevaSi mas unda gavaxsenoT, rom safeni, rkali an abebi efeqturobas kargaven vargisianobis vadis gasvlis Semdeg. momxmareblebs, SeiZleba uwesrigo sisxldena aReniSnos, manam sanam menstruaciuli cikli mouwesrigdebaT. b. momxmarebelma unda daucados menstruaciuli ciklis mowesrigebas, da Semdeg daiwyos meTodi, misi moxmarebis standartuli wesis Sesabamisad. am SemTxvevaSi, man menstruaciis mowesrigebamde meqanikuri kontraceptiuli saSualebebi unda ixmaros an, Tavi Seikavos sqesobrivi kavSirisgan.

ineqciebi mxolod-progestinis da kombinirebuli yovelTviuri ineqcia momxmarebelma menstruaciuli ciklis dawyebis Semdgomi Svidi dRis ganmavlobaSi unda daiwyos. manamde, Tavi unda Seikavos sqesobrivi kavSirisgan an, damcavi meqanikuri saSualebebi gamoiyenos. implantantebi unda Caidgas menstruaciuli ciklis dawyebis Semdeg, Svidi dRis ganmavlobiSi. sanam momxmarebeli implantantebs Caidgams, Tavi unda Seikavos sqesobrivi aqtiurobisagan. Sida-saSvilosno spirali unda Caidgas normaluri menstruaciuli ciklis dawyebis Semdeg. manamade momxmarebelma Tavi unda Seikavos sqesobrivi aqtisagan an, ixmaros barieruli kontraceptiuli saSualebebi. SeniSvna: im SemTxvevaSi Tu momxmarebels unda, rom xangrZlivi periodis ganmavlobaSi gamoiyenos S.s.s. da amisaTvis saWiro gamokvlevas Caitarebs, spilenZis spirali g.k.a-s kargi Semcvleli saSualebaa. (ix. damateba). ojaxis dagegmvis bunebrivi meTodebi ojaxis dagegmvis bunebrivi meTodebiT dagegmva SesaZlebelia daviwyoT g.k.a-s miRebis Semdgom, pirvelive menstruaciis dasrulebisTanave. manamde momxmarebelma Tavi unda Seikavos sqesobrivi aqtisagan an, gamoiyenos alternatiuli kontraceptiuli meTodebi (mag. kondomi). qalis an, kacis sterilizacia operacia unda Catardes mxolod momxmareblis mtkice, garantirebuli Tanxmobis Semdeg. qalma es gadawyvetileba stresul mdgomareobaSi ar unda miiRos. gadadeT sterilizacia qalis pirvel menstruaciamde imis dasarwmuneblid, rom igi or-

sulad araa. sterilizaciis proceduris Catarebamde qalma Tavi unda Seikavos sqesobrivi aqtisagan an, ixmaros orsulobisagan Tavdacvis saSualebebi.

3. g.k.a-Ti momaragebis sistemebi ukve aRiniSna, rom g.k.a im SemTxvevaSia efeqturi, Tu mas movixmarT dauyovnebliv, sqesobrivi kavSiris Semdeg. unda vecadoT, rom qals informacia movawodoT am preparatis Sesaxeb manam, sanam misi moxmarebis saWiroeba Seeqmneba. amas SesaZlebelia mivaRwioT Semdegi saSualebebiT: • regularuli profilaqtikuri an, ojaxis dagegmvis kabinetSi vizitebis dros, qals sistematiurad mivawodoT informacia. • movaTavsoT informacia g.k.a-s Sesaxeb veb gverdze an, telefonebis avto-mopasuxeze. • sxva kontraceptiul saSualebebTan erTad gavavrceloT werilobiTi informacia g.k.a-s Sesaxeb. • seqsualuri ganaTlebis programebSi SevitanoT informacia g.k.a-s Sesaxeb. • g.k.a-s gavukeToT reklama mas-mediis sainformacio saSualebebiT. gansakuTrebiT mniSvnelovania, informacia droulad mivawodoT: mozardebs, romlebic jer sqesobrivad aqtiurebi ar arian; qalebs, romlebic xSirad arasworad iyeneben kontraceptiul saSualebebs, emigrant muSebs da maT meuRleebs da, pirebs sqesobrivi Zaladobis Semdeg. mniSvnelovania, rom qali uzrunvelyofili iyos g.k.a-Ti, dauyovnebliv, saWiroebis warmoSobis SemTxvevaSi. g.k.a_s moxmarebis wesi martivia, imisaTvis, rom usafrTxod da efeqturad movixmaroT es preparati., saWiro ar aris winaswari samedicino gamokvleva da viziti eqimTan. imisaTvis rom gavamartivoT g.k.a-s moxmareba, arsebobs ramodenime midgoma:

• winaswar movamaragoT qali g.k.a-Ti an, Sesabamisi receptiT; • mivawodoT g.k.a-s daniSnuleba telfoniT, momxmareblis piradad naxvis gareSe. • Tu es nebadarTulia adgilobrivi kanonmdeblobiT, treiningebi CautaroT med. debs, mean qalebs, afTiaqis muSakebs, sazogadoebrivi jan.dacvis muSakebs da konsultanebs, romlebic muSaoben sqesobrivi Zaladobis sakiTxebze, raTa qalebi droulad moamaragon g.k.a-Ti • sanam momxmarebeli mimarTavs specialists, manamade is kontaqtSi Sedis sazogadoebrivi janmrTelobis dacvis muSakTan. davrwmundeT, rom maT informacia aqvT g.k.a-s xelmisawvdomobis Sesaxeb; • davarigoT g.k.a arasamedicino dawesebulebebis, (rogoricaa sazogadoebriv sawyisebze dafuZnebuli dawesebulebebi, skolebi, socialuri samarketinge seqtoris da komerciuli seqtoris anu. afTiaqebis) saSualebiT; • movamaragoT g.k.a-Ti savaWro dawesebulebebi; g.k.a-s yvela momxmarebels unda Cautardes specialuri treiningi. treiningSi unda Sediodes Semdegi: miTiTebebi g.k.a_s moxmarebis Sesaxeb, g.k.a-s rekomendirebuli reJimebi, misi efeqturoba, gverdiTi efeqtebi da menejmenti, ukuCvenebebi, moxmarebis Tanamimdevroba samedicino Semowmeba da rCeva -darigebebis miwodeba. da kidev, radgan g.k.a damxmare meTodia treiningis dros momxmarebels unda miewodos saWiro informacia sxva kontraceptiuli saSualebebis Sesaxeb. treiningis programis misaRebad mimarTeT gadaudebeli kontraceptiis saerTaSoriso konsorciums an, veb. gverds: www.cecinfo.org. 3.1 axalgazrdebi programa gansakuTrebulad zrunavs, rom axalgazrdebs miawodos informacia, gadaudebeli kontraceptiuli saSuale-

bebis Sesaxeb. arsebuli siZneleebi, romlebsac axalgazrda qalebi SeiZleba Sexvdnen: • ar ician g.k.a-s arseboba; • ar endobian an, rcxveniaT klinikaSi wasvla; • ar ician am klinikis arsebobis Sesaxeb; • maTTvis mosaxerxebeli ar aris klinikis muSaobis saaTebi; • eSiniaT ginekologiuri gasinjvis; • nerviuloben momsaxure personalis kritikuli damokidebulebis gamo; programebi unda SemuSavdes imgvarad, rom axalgazrdebs hqondeT maqsimaluri komforti (mag. daarwmunon informaciis konfidencialurobaSi, preparatis xelmisawvdomobaSi, momsaxureobis zomier fasebSi da miRebis saaTebis gadatanis SesaZleblobaSi – gasakuTrebiT saRamos saaTebze da SabaT-kviraze). 3.2 qalebi, romlebmac seqsualuri Zaladoba ganicades gansakuTrebuli yuradReba eqceva im qalebs, romlebmac seqsualuri Zaladoba ganicades. g.k.a-s mommarageblebma yuradReba unda miaqcion Semdeg faqtebs: • am qalebma SesaZlebelia ar ician, rom arsebobs orsulobis prevenciis saSualeba, romelic SeiZleba gamoyenebuli iqnes sqesobrivi Zaladobis Semdeg; • qalebs ar surT gaamxilon Zaladobis faqti da aqedan gamomdinare, ar eZeben daxmarebas; • fiqroben rom maT daadanaSauleben momxdari faqtis gamo; • saWiroeben sqesobrivi gziT SeZenili daavadebebis diagnostirebas da mkurnalobas; programis menejerebma da provaiderebma unda uzrunvelyon g.k.a-s maragiT is dawesebulebebi, sadac dazaralebulma qalma SesaZlebelia daxmareba iTxovos. es dawesebulebebia: policiis ganyofilebebi, saswrafo daxmarebis ganyofilebebi da sxv.

cxrili 1 g.k.a-s formulebi formula (TiTo abi) mxolod levonorgestrelis reJimi

kombinirebuli reJimi

dasaxeleba

lng 1.5 mg lng 0.75 mg

doza erTi an ori abi

imediat n, levonel- 2 abi erT 2, norlevo, plan-b, miRebaze 12sT. intervaliT post-dei, postinor-2, vika, mibikela

ee 50mg+ lng 0.25 mg an ee 50 mcg + ng 0.50 mg

e-gen-c euginoni, fertilani, imediati, neoginoni, nordioli, ogestreli, ovrali, ovrani, preveni, tetraginoni

2 abi + 2 abi 12sT-s Semdeg

ee 20mcg +lng0.10 mg

alessi, levliti, aviani, loeti

5 abi+ 5 abi 12 sT.-s SualediT

ee 30 mcg + lng 0.15 mg anna, levleni, an levora, ee 30 mcg + ng 0.30 mg lo/femenali, lo/ovrali, lou-ogestreli, mikroginoni 30, nordette, rigevidoni Semoklebebis ganmarteba: ee _ eTil estradioli ng _ norgestreli

4 abi + 4 abi 12 sT-s SualediT

lng _ levonorgestreli

rodesac iyenebT oralur kontracefciul abebs, romlis firfitazec 28 abia, anu, bolo Svidi abi ar unda iyos gamoyenebuli. abebis miReba yvela reJimis SemTxvevaSi sqesobrivi kavSiris Semdeg dauyovnebliv unda daviwyoT. abebis miRebis dawyebis optimaluri vada 120 sT-ia sqesobrivi kavSiris Semdeg. cxrilis Sedgenis dro: 2008 w-s oqtomberi. axali cxrili SeiZleba moviZioT veb gverdze: www.cecinfo.org.

danarTi: Sida saSvilosno spiralis moxmareba spilenZis Sss SeiZleba gamoviyenoT, rogorc gadaudebeli kontracepciis saSualeba. igi mosaxerxebli kontraceptiuli saSualebaa im qalebisaTvis, romlebsac aqvT stabiluri sqesobrivi urTierToba, romlebsac surT misi moxmareba xangrZlivi periodis ganmavlobaSi da romlebic Sss-s gamoyenebisaTvis aucilebel regularul gamokvlevebs itareben. menstruaciuli ciklis Semdeg, 7 dRis ganmavlobaSi Cadgmuli Sss yvelaze efeqturi kontraceptiuli saSualebaa, romelic orsulobis risks 99%-iT amcirebs. Sss-s Cadgma saWiroebs kvalifikaciis maRal dones da sistematiur samedicino meTvalyureobas. orsulobis, saSvilos-

nos anTebiTi procesebis da sxva infeqciebis gamosaricxad, momxmarebelma gamokvleva unda Caitaros. xSir SemTxvevaSi, sqesobriv aqts, romlis Semdegac saWiroa gadaudebeli kontraceptiuli saSualebis moxmareba, sqesobrivi infeqciebis didi riski gaaCnia. am SemTxvevaSi Sss ar warmoadgens optimalur kontraceptiul saSualebas. Semdgomi informaciis misaRebad Sss-s moxmarebis Sesaxeb mimarTeT IPPF Medical and Service Delivary Guidelines. yvelaze Tanamedrove informacia g.k.a-s Sesaxeb SeiZleba movipovoT IPPF,Regantâ&#x20AC;&#x2122;s Collage, Inner Circle, Regentâ&#x20AC;?s Park, London NWI 4NS, UK; Web site: www. ippf. Org

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gadaudebeli kontracepciis saerTaSoriso konsorciumis Sesaxeb gadaudebeli kontracefciis saeraTaSoriso konsorciumis misiaa, ojaxis dagegmvis da reproduqciuli janmrTelobis organizaciebis saSualebiT gaavrcelos gadaudebeli kontraceptiuli saSualebebi da mTel msoflioSi qveynis lokaluri pirobebis Sesabamisad, uzrunvelyos maTi efeqturi moxmareba. gansakuTrebuli yuradReba eqceva ganviTarebad qveynebs. konsorciumis Svidma damaarsebelma qveyanam, Tavidanve gaamaxvila yuradReba specialurad arCeul “sademonstracio” qveynebSi g.k.a-s wardgenaze. radgan gaizarda daintereseba gadaudebeli kontracepciiT, konsorciumma gazarda wevrTa raodenoba. gadaudebeli kontraceptiuli momsaxureobis ukeT organizebisaTvis. konsorciumis miznebia: • • •

•

warmoadgendes gadaudebel kontracepciaze informaciis mimwodebel avtoritetul wyaros; xeli Seuwyos g.k.a-s miznobriv da usafrTxo gamoyenebis gavrcelebas; warmoadgendes kontraceptivebis da maT Sesaxeb informaciis miwodebis, saganmanaTleblo da damakavSirebel strategiuli dagegmvis organos; gaaadvilos informaciis gacvla konsorciumis wevrebs da sxva jgufebs Soris, romlebic muSaoben kontraceptiuli saSualebebis Sesaxeb codnis gaRmavebasa da xelmisawvdomobaze; imisaTvis, rom saxalxo seqtoris organizaciebma da kerZo sawarmoebma awarmoon meti raodenobiT maRalxarisxiani kontraceptiuli saSualebebi, xeli Seuwyos maT TanamSromlobas; ganaviTaros da ganavrcos swrafi kontracefciis axali meTodebi; konsorciumi miesalmeba arakomerci-

uli organizaciebis gawevrianebis survils, ganviTarebad qveynebSi kontraceptiuli produqciis da momsaxureobis xarisxis gasaumjobeseblad. gawevrianebis msurvelebi unda daukavSirdnen gadaudebeli kontracefciis saerTaSoriso konsorciumis koordinators: E-mail: info@cecinfo.org Web site: www.cecinfo.org internacionaluri konsorciumi dainteresebulia regionaluri qselebis CamoyalibebaSi imisaTvis, rom g.k.a-m ufro advilad gadalaxos adgilobrivi barierebi. organizaciebis Sesaxeb informaciis miReba SesaZlebelia Semdeg misamarTebze: • afrika: EC Afrique. Website: www.ec-afrique.org; E-mail: ec-afrique@pcnnairobi.org; Mail: Ecafrique secretariat, Population Council, PO Box 17643, 00500 Nairobi, Kenia. • laTinuri amerika: gadaudebeli kontracefciis laTinuri amerikis konsorciumi (LACEC). Web site:www.clae. info; E-mail: vschiappa@icmer.org; Mail: Instituto Chileno de Medicina Reprodactiva (ICMER), Jose Victorino Lastarria 26, Depto. 21, Santiago, Chile. • azia (samxreT-aRmosavleTi): Asia Pacific Network on Emergency Contraception (APNEC). Web site: N?A; E-mail: equintillan@piwh.org; mail: Pacific Institute for Women’s Health, 3450 Wilshire Boulevard, Suite 1000, Los Angeles, CA 90010 USA. • arabeTis regioni: arabregion@cecinfo. org. • aRmosavleT evropa, balkaneTi: europeregion@cecinfo.org. damatebiTi informaciisaTvis mimarTeT: veb gverds: www.cecinfo.org.