kombinirebuli oraluri da saineqcio kontraceptivebi
kombinirebuli oraluri kontraceptivebi (kok)
ganmarteba
kombinirebuli oraluri kontraceptivebi warmoadgens maRalefeqtur,
sinTezur estrogen-progestagenur preparatebs, romlebic icavs qals
arasasurveli orsulobisagan.
kok-i, masSi Semavali estrogenisa da progestagenis kombinaciis
mixedviT iyofa or ZiriTad tipad: monofazuri da mravalfaziani.
• monofazuri _ 21 aqtiuri tabletidan TiToeuli Seicavs estrogenisa
da progestagenis Tanabar raodenobas
• mravalfaziani: orfaziani (bifazuri) da samfaziani (trifazuri).
• orfaziani (bifazuri) _ 21 aqtiuri tabletidan TiToeuli Seicavs
estrogenis ucvlel dozas, xolo progestagenis doza izrdeba
ciklis meore fazaSi
• samfaziani (trifazuri) _ 21 aqtiuri tableti Seicavs estrogenisa
da progestagenis sam sxvadasxva kombinacias: estrogenis
Semcveloba izrdeba mxolod meore fazaSi, progestagenis
Semcveloba izrdeba safexurebrivad sam etapad.
estrogenuli komponentis Semadgenlobis mixedviT kok-i iyofa:
• maRaldoziani _ 1 tableti Seicavs 50 mkg e. e.*
• dabaldoziani _ 1 tableti Seicavs 30-35 mkg e. e.
• mikrodozirebuli _ 1 tableti Seicavs 15-20 mkg e. e.
(3, 6 _ xarisxi `A~)
moqmedebis meqanizmi
kok-is moqmedebis meqanizmi vlindeba reproduqciuli sistemis sxvadasxva
doneze: hipoTalamusi _ hipofizi _ sakvercxeebi _ saSvilosno _
saSvilosnos milebi.
• Trgunavs ovulacias. kok-is moqmedebiT mcirdeba hipoTalamusis
mier rilizing-hormonis da hipofizis mier gonadotropuli
hormonebis sekrecia, ris Sedegadac sakvercxeSi estrogenis
* e.e. _ eTinilestradioli
1
gamomuSaveba orjer mcirdeba da ovulacia iTrguneba. sakvercxeebi
mcirdeba zomebSi da Seicavs mraval atreziul folikuls.
• endometriumi proliferaciul fazaSi ganicdis swraf regress da
naadrev sekreciul transformacias. zogjer aRiniSneba
atrofiuli cvlilebebic, romelsac aqvs antiimplantaciuri
efeqti.
• mcirdeba saSvilosnos milebis peristaltika, rac aqveiTebs maTSi
spermatozoidebis moZraobas.
• icvleba cervikaluri lorwos bioqimiuri Semadgenloba _
qveiTdeba sialis mJava. aseve cikluri cvlilebebis ararsebobis
gamo cervikaluri lorwo sqeldeba da masSi spermatozoidebis
SeRweva Zneldeba.
(3, 5 _ xarisxi `A~)
efeqturoba
kok-is efeqturoba Seadgens:
0,3 orsulobas 100 qalze/weliwadSi, praqtikulad, sworad da
regularulad gamoyenebis SemTxvevaSi;
6-8 orsulobas qalze/weliwadSi usistemod, araregularulad gamoyenebis
SemTxvevaSi.
(2 _ xarisxi `A~)
kontracepciuli upiratesobebi
• maRali da swrafi efeqturoba
• meTodis Seqcevadoba
• qals eZleva SesaZlebloba akontrolos fertiloba
• gverdiTi movlenebis simcire
• gamoyenebis siadvile
• gamoyenebis win ar aris aucilebeli saSos mxrivi gasinjva
• ar ukavSirdeba sqesobriv aqts
• SedarebiT iafia (Tu SevadarebT abortis xarjebs)
• SeiZleba gavrcelebuli iyos kvalificiuri arasamedicino
personalis mier
• menstruaciuli ciklis adeqvaturi kontroli
(3, 5, 6 _ xarisxi `A~)
2
arakontracepciuli upiratesobebi
samedicino praqtikaSi kok gamoiyeneba ara marto kontracepciuli, aramed
arakontracepciuli mizniTac, romelsac aqvs Tavisi upiratesobebi:
• mcirdeba saSvilosnosgare orsulobis sixSire
• mcirdeba mcire menjis Rrus organoebis anTebiTi daavadebebis
sixSire
• mcirdeba menstruaciuli gamonadeni
• mcirdeba sarZeve jirkvlebis keTilTvisebiani daavadebis (fibrozul-
kistozuri mastopaTia) riski
• mcirdeba sakvercxis, endometriumisa da koloreqtaluri kibos
ganviTarebis riski
• qreba an mcirdeba premenstruaciuli daZabuloba da dismenoreis
simptomebi
• mcirdeba rkinadeficituri anemiis riski (menstruaciuli gamonadenis
Semcirebis xarjze)
• dadebiTad moqmedebs endometriozis mimdinareobaze
• mcirdeba saSvilosnos miomis ganviTarebis riski
• mcirdeba sakvercxis retenciuli warmonaqmnebis sixSire
• xasiaTdeba samkurnalo efeqtiT hiperandrogenuli (akne, hirsutizmi,
seborea) mdgomareobebisas
• gamoiyeneba saSvilosnodan disfunqciuri sisxldenebis, uSvilobis
samkurnalod
• izrdeba Zvlis simkvrive
• ixsneba `arasasurveli orsulobis SiSi~
• SesaZlebelia morigi menstruaciis `gadaweva~ gamocdis, Sejibrebis,
dasvenebis dros an samedicino CvenebiT
(3, 5, 6, 7 _ xarisxi `A~)
naklovanebebi
• miRebis wesis darRveva zrdis arasasurveli orsulobis risks
• saWiroebs kvalificiur konsultacias
3
• yoveldRiuri gamoyeneba _ saWiroebs mudmiv motivacias. gulmaviwyoba
zrdis orsulobis risks.
• efeqturoba qveiTdeba zogierT wamalTan erTdrouli miRebisas
(barbituratebi, antituberkulozuri preparatebi)
• ar icavs sqesobrivi gziT gadamdebi daavadebebisagan (maT Soris B
hepatitis virusi da aiv/Sidsi)
• SesaZloa fertilobis aRdgenis Seferxeba (1-2% SemTxvevaSi)
• Zalian iSviaTad SesaZlebelia seriozuli garTulebebi: infarqti
insulti, filtvis an Tavis tvinis Trombozi (Sesabamisad 1, 3 an da
11-mde SemTxveva 100 000 qalze, romlebic iyeneben kok-s)
• aucilebelia uwyveti momarageba
(3, 5, 6, 7 _ xarisxi `A~)
mdgomareobebi, romlebic kok-is gamoyenebis dawyebamde moiTxovs winaswar
samedicino Sefasebas
janmos klasifikacia:
kategoria 1: kok-i SeuzRudavad gamoiyeneba nebismieri
situaciaSi.
kategoria 2: kok-i umetes SemTxvevaSi SeuzRudavad
gamoiyeneba, radganac sargebloba metia, vidre
Teoriuli da/an dadasturebuli riski.
kategoria 3: kok-is gamoyeneba rekomendebuli ar aris,
radganac Teoriuli an dadasturebuli riski metia
vidre sargebloba. kok-i gamoiyeneba mxolod im
SemTxvevaSi, Tu ki sxva meTodi ar aris xelmisawvdomi.
kategoria 4: kok-is gamoyeneba ar SeiZleba.
(2 _ xarisxi `A~)
kok-is gamoyenebis ukuCvenebebia:
• orsuloba
• mSobiarobis Semdeg 6 Tve ZuZuTi kvebis dros
• mSobiarobis Semdeg 3 kvira ara meZuZur dedebSi
4
ki
meTodis
gamoyeneba
SeiZleba
ara
meTodis
gamoyeneba
rekomendebu-
li ar aris
• sasqeso gzebidan daudgineli genezis sisxldena
• gul-sisxlZarRvTa daavadebis mravlobiTi risk-faqtorebis arseboba.
garTulebebiT mimdinare gulis sarqvlebis daavadebebi
• Tromboflebiti, Tromboemboliuri daavadebebi, Tavis tvinis sisxlis
mimoqcevis darRveva, cerebro-vaskuluri insultebi, miokardiumis
infarqti (anamnezSi)
• Trombogenuri mutacia _ sisxlis Sededebis darRvevebi
• Sakiki nevrologiuri simptomebiT
• 35 wlis zeviT sigaretis moweva (dReSi 15 da meti sigareti)
• arteriuli hipertonia
T/A sistoluri ≥ 160 diastoluri ≥ 100 mm vwy sv (me-4 kategoria),
an sistoluri ≥ 140-159 diastoluri ≥ 90-99 mm vwy sv (me-3 kategoria)
• Saqriani diabeti sisxlZarRvovani garTulebebiT, an sxva
sisxlZarRvovan daavadebebTan erTad, an 20 wlis xangrZlivobiT
• ZuZus kibo amJamad
• RviZlis mwvave daavadeba (hepatiti).
• RviZlis keTilTvisebiani an avTvisebiani simsivne, RviZlis cirozi,
dekompensaciis stadiaSi
• qirurgiuli operacia xangrZlivi imobilizaciiT
(2 _ xarisxi `A~)
orsuloba (dadasturebuli an saeWvo)
kategoria 4. kok-i ar gamoiyeneba orsulobis dros. Tu preparatis miRebis
fonze orsuloba dadasturda saSvilosnos RruSi, saWiroa Sewydes kok-is
gamoyeneba. Tanamedrove monacemebiT kok-is miReba ar zrdis
mkvdradSobadobis, TviTnebiTi abortisa da Tandayolili mankis
ganviTarebis risks. miuxedavad amisa, orsulobis adreul vadazec ki
rekomendebuli araa preparatebis gamoyeneba.
Tu menstruaciis dagvianebisas orsulobis gamoricxva ver xerxdeba, kok-is
miReba unda gadavaddes Semdeg menstruaciamde. am SualedSi qalma unda
gamoiyenos kontracepciis sxva meTodi (mag. barieruli).
5
ZuZuTi kveba
kategoria 4. Tu qali ZuZuTi kvebavs bavSvs da ar iyenebs lam-s,
mSobiarobidan 6 Tvis ganmavlobaSi mizanSewonili araa kok-is miReba,
radganac masSi Semavali estrogeni gadis dedis rZeSi da axalSobilze
SesaZlebelia mavne zegavlena iqonios. aseve cnobilia, rom mSobiarobidan
pirveli 6 kviris ganmavlobaSi estrogeni amcirebs laqtaciis process. Tu
qali ar iyenebs lam-s, mSobiarobidan 6 Tvemde sasurvelia gamoiyenos
kontracepciis sxva meTodi (mag: sSs, barieruli, sufTa progestagenuli
abebi da sxva).
kategoria 3. Tu qali mSobiarobis Semdgom periodSi ar kvebavs
ZuZuTi, kok-is dawyeba SeuZlia mSobiarobidan mxolod 3 kviris Semdeg,
radganac, pirveli 3 kviris ganmavlobaSi estrogenuli komponenti zrdis
Trombis warmoqmnis risks. aseve, mSobiarobidan pirveli 3-6 kviris
ganmavlobaSi ovulaciis naklebi albaTobaa da amdenad qalebi orsulobis
dabali riskis qveS imyofebian.
sasqeso gzebidan daudgeneli genezis sisxldena
kategoria 4. Tu qals aReniSneba sisxldena saSodan, sanam sisxldenis
swori diagnozi ar dadgindeba, rekomendebuli araa kok-is gamoyeneba,
radganac kok-s SeuZlia menstruaciebs Soris periodSi sisxldena SeaCeros
da SeniRbos ZiriTadi problema (mag: saSvilosnos Rrus an saSvilosnos
gare orsuloba, mcire menjis Rrus sxva paTologia da iSviaTad
genitaluri traqtis kibo). saWiroa Catardes srulyofili ginekologiuri
gamokvleva da kategoria ganisazRvros mxolod amis Semdeg.
kategoria 2. diagnozis dadgenis Semdeg Tu dadasturda disfunqciuri
sisxldena saSvilosnodan, kok-is miReba mizanSewonilia samkurnalo
mizniTac.
gul-sisxlZarRvTa daavadebebi
kategoria 4. gul-sisxlZarRvTa daavadebebis dros _ gulis iSemiuri
daavadeba (amJamad da adre), stenokardia, garTulebuli gulis sarqvlebis
daavadeba (filtvismieri hipertenzia, winagulebis fibrilaciis riski,
qvemwvave baqteriuli endokarditi anamnezSi), lipiduri metabolizmis
aTerogenuli darRvevebi, arteriuli an venuri Trombozi, Trombogenuri
6
mutacia (magaliTad: leidenis V faqtori, proTrombinis mutacia, protein
S, protein C da antiTrombinis ukmarisoba) _ rekomendebuli araa kok-is
miReba, radgan man SeiZleba Seqmnas daavadebebis ganviTarebis damatebiTi
riski (estrogenis efeqti).
Tavis tvinis sisxlZarRvebis dazianeba
kategoria 4. Tu qals anamnezSi aReniSneba insulti da Tavis tvinis
sisxlZarRvebis sxva dazianeba, rekomendebuli araa kok-is miReba.
sisxlis Sededebis darRvevebi
kategoria 4. Tu qals aReniSneba Rrma venebis Trombozi an filtvis
embolia amJamad an anamnezSi, an didi qirurgiuli operacia da xangrZlivi
imobilizacia, rekomendebuli araa kok-is miReba.
kategoria 2. Rrma venebis Trombozi / filtvis emboliis ojaxuri anamnezi,
didi operacia araxangrZlivi imobilizaciiT, `mcire~ qirurgia
imobilizaciis gareSe.
Sakiki (Tavis tkivili)
kategoria 4. Tu qals aReniSneba Sakiki kerovani nevrologiuri
simptomebiT (mag: metyvelebis unaris droebiTi dakargva, mxedvelobis
velebis gamovardna da a.S.), nebismier asakSi, rekomendebuli ar aris kok-is
miReba. misma gamoyenebam SeiZleba Seqmnas insultis damatebiTi riski
(estrogenis efeqti).
gamokvlevebiT damtkicda, rom qalebis is jgufi, romelTac aReniSnebaT
aura, imyofebian insultis ganviTarebis ufro maRali riskis qveS vidre
isini, visac aura ara aqvs. auris mqone pacientebSi kok-is gamoyenebisas 2-4-
jer izrdeba insultis riski, vidre im qalebSi, romlebic kontracepciis
am meTods ar iyeneben.
kategoria 3. Sakiki kerovani nevrologiuri simptomebis gareSe ≥ 35 wlis
asakSi.
kategoria 2. Sakiki kerovani nevrologiuri simptomebis gareSe < 35 wlis
asakSi.
7
35 wlis da meti asakis mweveli qalebi
kategoria 4. aRniSnuli asakis qalma ar unda miiRos kok-i, Tu eweva dReSi
≥ 15 sigarets.
35 wlis da ufro meti asakis mweveli (intensiuri an araintensiuri) qalebi
imyofebian infarqtis, insultis da sisxlis Sededebis sxva problemebis
gazrdili riskis qveS. aseT SemTxvevebSi kok-is miReba qmnis Trombis
warmoqmnis damatebiT risks (estrogenis efeqti)
kategoria 3. asaki ≥ 35 _ sigareti <15 dReSi
kategoria 2. asaki < 35
maRali arteriuli wneva
kategoria 4. qalebma, romelTac aReniSnebaT arteriuli wneva ≥160/100
mm.vwy.sv. (sisxlZarRvovani problemebiT an maT gareSe), ar unda miiRon
kok-i.
kategoria 3. Tu eqimTan orjer ganmeorebiTi vizitis dros qals
arteriuli wneva aReniSna 140-159/90-99 mm.vwy.sv., man ar unda miiRos kok.
sasurvelia SeirCes kontracepciis sxva meTodi (spermicidi, kondomi da
a.S.). janmrTel qalebSi kok-is miReba iwvevs arteriuli wnevis mxolod
umniSvnelo cvlilebas. hipertenziis dros ki, is qmnis insultis,
miokardiumis mwvave infarqtis da periferiuli arteriebis dazianebis
damatebiT risks (estrogenis efeqti). wamlis miReba unda Sewydes, Tu
pirveli ramdenime Tvis ganmavlobaSi vlindeba arteriuli wnevis
mniSvnelovani mateba an arteriuli sisxlZarRvebis daavadeba.
kategoria 2. anamnezSi maRali arteriuli wneva orsulobis dros, Tumca
amJamad arteriuli wneva normis farglebSi.
Saqriani diabeti
kategoria 3/4. progresuli da didxans mimdinare (>20 welze) Saqriani
diabeti, sxvadasxva garTulebebiT: sisxlZarRvovani, neiropaTia,
retinopaTia, nefropaTia.
aRniSnuli mdgomareobebis dros qalebma ar unda miiRon kok, radganac
masSi Semavali estrogeni zrdis Trombis warmoqmnis damatebiT risks.
8
kategoria 2. qalebs, insulin damokidebuli an insulin damoukidebeli
Saqriani diabetiT seriozuli garTulebebis gareSe, ZiriTadad SeuZliaT
kok-is miReba.
kategoria 1. anamnezSi diabeti orsulobis dros.
ZuZus kibo
kategoria 4. Tu qals aReniSneba ZuZus kibo amJamad an anamnezSi, ar unda
miiRos kok-i. cnobilia, rom sarZeve jirkvelis kibo hormondamokidebuli
simsivnea da kok-is miRebam SeiZleba gazardos simsivnis progresirebis
riski.
kategoria 1. sarZeve jirkvlebis keTilTvisebiani daavadeba.
kategoria 1. sarZeve jirkvlebis kibos ojaxuri anamnezi. kok-is gamoyeneba
aRniSnuli kategoriis qalebSi ar iwvevs sarZeve jirkvlebis kibos
gazrdil risks imaTTan SedarebiT, visac analogiuri anamnezi hqonda da
kok-s ar iyenebda. Tu aRiniSneba sarZeve jirkvlis kibos ganmapirobebuli
genis BRCA1 tipis mutacia, kok-is gamoyenebam SeiZleba umniSvnelod
gazardos zemoT aRniSnuli kibos riski.
RviZlis daavadebebi
kategoria 4. simptomuri siyviTle, virusuli hepatiti, dubin-jonsonis
sindromi, rotoris sindromi warmoadgens kok-is miRebis ukuCvenebas,
radganac aRniSnuli mdgomareobis dros kok-Si Semavali steroidebi
mTlianad ver metabolizdeba RviZlSi, ramac SeiZleba damatebiTi ziani
moutanos qalis janmrTelobas.
qalebma hepatitis dros ar unda miiRon kok manam, sanam ar moxdeba RviZlis
funqciuri maCveneblebis normalizeba (uxSiresad siyviTlis gaqrobidan 3-5
Tvis Semdeg).
RviZlis simsivneebi, cirozi
kategoria 4. RviZlis keTilTvisebiani (adenoma) da avTvisebiani (hepatoma)
simsivne, mZime (dekomepensirebuli) cirozi warmoadgenen kok-is miRebis
ukuCvenebas, radganac preparatis miRebam SeiZleba gaauaresos zemoT
aRniSnuli mdgomareobebi.
9
naRvlis buStis daavadebebi
kategoria 3. Tu qals, amJamad aReniSneba naRvlis buStis daavadeba da
imyofeba medikamenturi mkurnalobis qveS, sasurvelia kok-i ar miiRos,
garda im SemTxvevebisa, roca kontracepciis sxva ufro Sesaferisi
meTodebi xelmisawvdomi ar aris.
kok-ma SeiZleba gamoiwvios naRvlis buStis daavadebis riskis mcire
gazrda. arsebobs agreTve mosazreba, rom kok-s SeuZlia gamoiwvios
naRvlis buStis arsebuli daavadebebis gauareseba.
kategoria 2. qolecisteqtomiis Semdeg kok-is gamoyeneba SeiZleba.
kategoria 2. asimptomuri mdgomareobis dros, kok-is gamoiyeneba SeiZleba.
qirurgiuli operacia xangrZlivi woliTi reJimiT.
kategoria 4. xangrZlivi imobilizacia zrdis venuri sisxlis Sededebis
momatebis risks. Tu SesaZlebelia, kok-is miReba unda Sewydes qirurgiuli
Carevidan (roca saWiroa xangrZlivi imobilizacia) 4 kviriT adre da mis
Semdeg 2 kviris ganmavlobaSi.
kategoria 3. antikonvulsantebis (fenitoini, barbituratebi, karbamezepini,
primidoni) valprois mJavas garda da antituberkulozuri (rifampicini)
preparatebis miReba.
aRniSnuli preparatebis miRebis fonze dabaldoziani kok-is
efeqturoba mcirdeba, radgan maTi didxans miReba iwvevs RviZlis
fermentebis aqtiurobis momatebas, rac iwvevs estrogenisa da
progestagenis metabolizmis daCqarebas da preparatebis efeqturobis
Semcirebas.
menstruaciebs Soris periodSi sisxliani gamonadeni SeiZleba
miuTiTebdes estrogenis da progestagenis daqveiTebul doneze. am
SemTxvevaSi saWiroa maRaldoziani (estrogenis maRali done) kok-is
gamoyeneba, an unda SeirCes kontracepciis sxva meTodi.
antimikozuri preparatis (grizeofulvini) miReba
kategoria 2. ramdenadac grizeofulvini, romelic iwvevs estrogenis
da progestagenis metabolizmis gazrdas, Cveulebriv mxolod xanmokle
10
periodis ganmavlobaSi (2-4 kvira) gamoiyeneba, qalebs, romlebic mas
sokovani infeqciis samkurnalod iyeneben, SeuZliaT kok-is miRebis
gagrZeleba da paralelurad damatebiTi meTodis (mag: kondomi) gamoyeneba
momdevno menstruaciis dawyebamde.
(2 _ xarisxi `A~)
kok-is miRebis dawyeba da gamoyenebis reJimi
kok-is miRebis dawyeba SesaZlebelia regularuli menstruaciuli ciklis
dros:
• menstruaciuli ciklis dawyebidan 5 dRis ganmavlobaSi
• menstruaciuli ciklis nebismier dros, Tu sakmarisi safuZveli
arsebobs imisi, rom qali orsulad ar aris
• Tu kok-is miReba iwyeba menstruaciuli ciklis dawyebidan 5 dRis
Semdeg, qals rekomendacia eZleva Tavi Seikavos sqesobrivi
kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi 7 dRis
ganmavlobaSi (kondomi / spermicidi)
(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)
amenoreis dros:
• kok-is miRebis dawyeba SeiZleba nebismier dros, Tu sakmarisi
safuZveli arsebobs imisi, rom qali orsulad ar aris. aseT
SemTxvevaSi qalma sasurvelia Tavi Seikavos sqesobrivi kavSirisagan
an gamoiyenos kontracepciis damatebiTi meTodi 7 dRis ganmavlobaSi
(kondomi / spermicidi)
(1 _ xarisxi `A~, 8, 9 _ xarisxi `B~)
mSobiarobisa da abortis Semdeg:
• mSobiarobidan 6 Tvis Semdeg, Tu qali ZuZuTi kvebavs bavSvs
• mSobiarobidan 3 kviris Semdeg, Tu qali ZuZuTi ar kvebavs bavSvs
• abortis Semdeg kok-is gamoyeneba SeiZleba maSinve. amasTan
kontracepciis damatebiTi meTodis gamoyeneba saWiro ar aris
(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)
11
gamoyenebis reJimi:
• qali Rebulobs TiTo tablets yoveldRe 21 dRis ganmavlobaSi
(erTsa da imave dros). isvenebs 7 dRe da me-8-e dRidan iwyebs axal
firfitas.
• Tu firfita Seicavs 28 tablets (bolo 7 tableti arahormonulia da
SeiZleba Seicavdes rkinas an vitamins), qali kok-s Rebulobs uwyveti
reJimiT, anu 28 tabletis damTavrebis Semdeg qali Sesvenebis gareSe
tabletebis miRebas iwyebs axali firfitidan.
(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)
• prof. a. xomasuruZis mier SemuSavebuli modifikaciis mixedviT
monofazuri tabletebis raodenoba unda gaizardos an Semcirdes
menstruaciuli ciklis xangrZlivobis mixedviT. mag: 30 dRiani
menstruaciuli ciklis SemTxvevaSi qali Rebulobs TiTo tablets
yovel dRe 23 dRis ganmavlobaSi; 26 dRiani menstruaciuli ciklis
SemTxvevaSi – TiTo tableti erTxel dReSi 19 dRis ganmavlobaSi da
a.S. 7 dRiani Sesvenebis wesi SenarCunebulia.
sxva hormonuli meTodidan kok-ze gadasvla
• SeiZleba Sualedis gakeTebis gareSe, mxolod im pirobiT, rom wina
meTodi gamoyenebuli iyo rekomendaciis mixedviT. aseT SemTxvevaSi
Semdgom menstruaciamde mocda aucilebeli ar aris.
• Tu wina meTodi warmoadgenda ineqcias, kok-is dawyeba SeiZleba
Semdgomi ineqciis savaraudo dRes. aseT SemTxvevaSi kontracepciis
damatebiTi meTodis gamoyeneba saWiro ar aris.
(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)
arahormonuli kontracepciidan (sSs-s garda) kok-ze gadasvla
• kok-is miRebis dawyeba SeiZleba menstruaciuli ciklis dawyebidan
5 dRis ganmavlobaSi. kontracepciis damatebiTi meTodis gamoyeneba
saWiro ar aris.
• aseve, kok-is miRebis dawyeba SeiZleba wina meTodis Sewyvetidan
maSinve, an nebismier dros, Tu sakmarisi safuZveli aris imisi, rom
qali orsulad ar aris. Tu kok-is miRebis dawyeba xdeba
12
menstruaciuli ciklis dawyebidan 5 dRis Semdeg, qals rekomendacia
eZleva Semdgomi 7 dRis ganmavlobaSi Tavi Seikavos sqesobrivi
kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi.
(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)
sSs-dan (levonorgestreliani sSs-s CaTvliT) kok-ze gadasvla
• kok-is miRebis dawyeba SeiZleba menstruaciuli ciklis dawyebidan 5
dRis ganmavlobaSi. kontracepciis damatebiTi meTodebis gamoyeneba
saWiro ar aris, sSs amoRebuli unda iyos am periodSi.
• aseve kok-is miRebis dawyeba SeiZleba nebismier dros, Tu sakmarisi
safuZveli aris imisa, rom qali orsulad ar aris.
_ Tu aRniSnuli menstruaciuli ciklis ganmavlobaSi qali aqtiuri
sqesobrivi cxovrebiT cxovrobda da menstruaciis dawyebidan
gasulia 5 dReze meti, aseT SemTxvevaSi amoReba rekomendebulia
Semdgomi menstruaciuli ciklis dros
_ Tu aRniSnuli menstruaciuli ciklis ganmavlobaSi qali
sqesobrivi cxovrebiT ar cxovrobda da menstruaciis dawyebidan
gavida 5 dReze meti, qals rekomendacia eZleva Semdgomi 7 dRis
ganmavlobaSi Tavi Seikavos sqesobrivi kavSirisagan an gamoiyenos
kontracepciis damatebiTi meTodi. Tu zemoT xsenebul kontracepciis
damatebiT meTodad sSs iTvleba, maSin misi amoReba unda moxdes
Semdgomi menstruaciuli ciklis dros.
• Tu qals aqvs araregularuli menstruaciuli gamonadeni an
amenorea, kok-is miRebis dawyeba SeiZleba im rekomendaciiT, romelic
miTiTebulia: `kok-is miRebis dawyebaSi amenoreis dros~.
(1 _ xarisxi `A~, 12, 13 _ xarisxi `B~)
kok-is miRebis Semdeg fertilobis aRdgena
kok-is did upiratesobas warmoadgens misi miRebis Semdeg
fertilobis swrafi aRdgena. hipoTalamus – hipofiz – sakvercxeebis
funqcionireba 90%-Si aRdgeba 2-6 Tvis ganmavlobaSi. SemTxvevaTa 2%-Si
SeiZleba adgili hqondes hipofizis gonadotropuli funqciis
hiperdamuxruWebis sindroms da Sesabamisad amenoreas. aRniSnuli
mdgomareoba ZiriTadad gvxvdeba maRaldoziani preparatebis gamoyenebisas
13
6 da meti Tvis ganmavlobaSi. amenorea SeiZleba ganviTardes endometriumis
atrofiuli cvlilebebis Sedegad, romelic Seqcevadi procesia.
endometriumis funqciuri Sris aRdgenis Semdeg menstruacia TavisTavad
aRdgeba an SesaZlebelia saWiro gaxdes estrogenebiT mkurnaloba.
(1, 3 _ xarisxi `A~)
preparatebiT momarageba
• eqimma qals unda misces kok-is wliuri maragi (damokidebulia
qalis survilze, ramden xans gegmavs igi kok-is miRebas) Tu eqims
gaaCnia kontraceptivebiT (kok-iT) programuli uzrunvelyofa. an
urCios, qalma TviTon izrunos maragis Seqmnaze.
• maragis Sevsebis sistema moqnili unda iyos, romelic qals
saSualebas miscems Tavisuflad miiRos kontracepciis saWiro
raodenoba misTvis mosaxerxebel dros
• janmo-s eqspertebis monacemebiT eqimis mier qalisTvis kok-is
gacema raodenobis TvalsazrisiT SezRuduli ar unda iyos,
radganac hormonuli kontracepciis gamoyenebis dros
arasasurveli (an iZulebiTi) Sesveneba zrdis daugegmavi
orsulobis risks
(1 _ xarisxi `A~)
meTvalyureoba _ ganmeorebiTi viziti
• kok-is gamoyenebisas qali eqimTan unda mivides yovelwliurad
• kok-is miRebis dawyebidan 3 Tvis Semdeg aucilebelia eqimTan
ganmeorebiTi viziti
• qalma eqims unda mimarTos nebismier dros kontracepciasTan
dakavSirebuli romelime gverdiTi movlenis an sxva raime
problemis warmoqmnis SemTxvevaSi an Tu qals surs kontracepciis
aRniSnuli meTodis Secvla
(1 _ xarisxi `A~)
konsultireba
kontracepciis meTodis SerCeva xdeba: reproduqtologis, mean-ginekologis
da ojaxis eqimis mier.
14
qals unda mieces zusti instruqcia kok-is:
• moqmedebis meqanizmze
• gverdiT movlenebze (ix. gverdiTi movlenebi)
• sayuradRebo niSnebze (ix. sayuradRebo niSnebi)
• kok-is miRebis dawyebaze (ix. kok-is miRebis dawyeba)
• reJimze (ix. gamoyenebis reJimi)
• gamotovebul abebze (ix. protokoli gverdiTi movlenebi, Sefaseba,
marTva)
• ganmeorebiT vizitze (ix. meTvalyureoba _ ganmeorebiTi viziti)
• fertilobis aRdgenaze
kok-is gverdiTi movlenebis klasifikacia
estrogendamokidebuli efeqti progestagendamokidebuli efeqti
• Tavis tkivili
• T/A-is momateba (arteriuli wnevis
momateba)
• gaRizianeba
• gulisreva, Rebineba
• Tavbrusxveva
• mastodinia (sisavsis SegrZneba
sarZeve jirkvlebSi)
• qloazma (orsulobis msgavsi
laqebi saxeze)
• varikozuli venebis mdgomareobis
gauareseba
• kontaqturi linzebis autanloba
• sxeulis wonaSi momateba
• Tavis tkivili
• depresia
• advilad daRla
• akne
• libidos daqveiTeba
• saSos lorwovani garsis
simSrale
• varikozuli venebis mdgomareobis
gauareseba
• sxeulis wonaSi momateba
15
estrogenuli efeqtis ukmarisoba
(estrogenis SefardebiT mcire doza)
progestagenuli efeqtis ukmarisoba
(progestagenis SefardebiT
mcire doza)
• Tavis tkivili
• depresia
• gaRizianeba
• sarZeve jirkvlebis zomaSi Semci-
reba
• libidos daqveiTeba
• saSos lorwovani garsis simSra-
le
• menstruaciaTa Soris sisxliani
CamonaSali ciklis dasawyisSi
da/an SuaSi
• mcire menstruaciuli gamonadeni
• Warbi menstruacia
• menstruaciaTa Soris sisxliani
CamonaSali ciklis meore fazaSi
• menstruaciis Seferxeba
16
sayuradRebo niSnebi kok-is miRebisas
qalma unda mimarTos samedicino dawesebulebas maSinve, Tu
SeamCnia qvemoT aRwerili romelime niSani:
• Zlieri tkivili gulmkerdSi an qoSini
• Zlieri Tavis tkivili an mxedvelobis darRveva, metyvelebis
moSla
• Zlieri tkivili qvemo kidurebSi
• Zlieri tkivili muclis areSi
• siyviTle
sisxliani gamonadenis ararseboba: 21 tabletiani firfitis
damTavrebis SemTxvevaSi an 7 araaqtiuri tabletis miRebis
periodSi, romelic SeiZleba iyos orsulobis niSani.
(3, 7 _ xarisxi `A~)
kok-is miRebis dawyebamde rekomendebuli gamokvlevebi da analizebi,
pacientis saWiroebebisa da moTxovnilebebis mixedviT:
klasi
• sarZeve jirkvlebis gamokvleva _ C
• mcire menjis Rrus/sasqeso organoebis gamokvleva _ C
• saSvilosnos yelis kiboze skriningi _ C
• standartuli laboratoriuli analizebi _ C
• hemoglobinis gansazRvra sisxlSi _ C
• sggi-iT daavadebis riski
anamnezis Sekreba da saerTo gasinjva _ C
• sggi/Sids-is gamovlenis skrininguli
laboratoriuli analizebi _ C
• arteriuli wnevis gazomva _ *
klasi _ `C~ _ aRniSnuli gamokvlevisa da analizis Catareba ar
uzrunvelyofs kontracepciis am konkretuli meTodis uSiSrad
gamoyenebas da efeqturobas.
* _ gamokvlevis Catareba rekomendebulia.
17
kombinirebuli saineqcio kontraceptivebi (ksk)
ganmarteba
kombinirebuli saineqcio kontraceptivebi Seicavs xanmokle
moqmedebis (bunebriv) estrogens da xangrZlivi moqmedebis progestagens.
saineqcio preparatebi TandaTanobiT Seiwoveba ineqciis Semdeg 28 dRis
ganmavlobaSi. erTi ineqcia keTdeba TveSi erTxel.
ksk-s tipebi
• 25 mg depo-medroqsiprogesteron acetati da 5 mg estradiol
cipionati (ciklofemi, cikloprovera, lunela da novafemi)
• 50 mg noreTisteron enantati da 5 mg estradiol valerati
(mesijina da noriginoni)
radganac ksk-Si Semavali estrogeni ufro fiziologiuria da
naklebad Zlieri, vidre kok-Si Semavali sinTezuri estrogeni, ksk-s
gamoyenebisas gamovlenili estrogendamokidebuli gverdiTi movlenebi
SeiZleba gansxvavdebodes kok-is gverdiTi movlenebisagan. ksk-s
moklevadianma gamokvlevebma aCvena, rom kok-Tan SedarebiT igi umniSvnelod
moqmedebs arteriul wnevaze, hemostazze, sisxlis Sededebaze, lipidebis
metabolizmze da RviZlis funqciaze.
ksk-i warmoadgens kontracepiis SedarebiT axal meTods, amdenad maTi
xangrZlivi gamoyenebis epidemiologiuri monacemebi am etapze mcirea.
amasTan, kok-is miRebisas hormonuli datvirTvis moxsna SeiZleba
preparatis miRebis SewyvetiT, xolo ksk-s gamoyenebisas hormonis
zemoqmedeba grZeldeba xangrZlivad.
janmo-s samuSao jgufis dakvniTi masala, romelic kok-is
gamoyenebaze arsebobs, umetes SemTxvevaSi misaRebia ksk-ze, magram ara
yvela SemTxvevaSi. amitom ksk-s gamoyenebisas pacientebis mdgomareobis
kvalifikaciis dros janmo-s samuSao jgufi orinetirebuli iyo kok-is da
pk-s (progestagenuli kontraceptivebi) kategoriebze da SearCia saSualo
maT Soris. Tumca mZime formis paTologiebis dros (mag: gulis iSemiuri
daavadeba) klasifikacia aris igive, rac kok-is dros. amitom aRniSnuli
kategoriebi aris winaswari da axali monacemebis mixedviT gadasinjvas
eqvemdebareba.
18
(2 _ xarisxi `A~)
ksk-s moqmedebis meqanizmi (ix. kok-i)
efeqturoba
ksk-s efeqturoba Seadgens 0,05 orsuloba 100 qalze/weliwadSi,
sworad da regularulad gamoyenebis SemTxvevaSi. 3 orsuloba 100
qalze/weliwadSi araregularulad gamoyenebis SemTxvevaSi.
(2 _ xarisxi `A~)
kontracepciuli upiratesobebi
• maRali efeqturoba
• meTodis Seqcevadoba
• SeiZleba daculi iyos kontracepciis meTodis gamoyenebasTan
dakavSirebuli konfedencialoba
• gamoyenebis siadvile
• gamoyenebis win ar aris aucilebeli saSosmxrivi gasinjva
• ar moiTxovs maragis gakeTebas
(3 _ xarisxi `A~)
naklovanebebi
• zogierT SemTxvevaSi iwvevs menstruaciuli ciklis xasiaTis
Secvlas (adreul stadiaze araregularuli _ mcire raodenobiT
sisxliani gamonadeni)
• damokidebulia gamomyenebelze (pacienti klinikaSi unda movides
30 dReSi erTxel)
• ar icavs sqesobrivi gziT gadamdebi daavadebebisagan (maT Soris B
hepatitis virusi da aiv/Sidsi)
(3 _ xarisxi `A~)
ksk-is gamoyenebis Cvenebebi
ksk SeiZleba gamoiyenon im qalebma, romlebsac:
• aviwydebaT tabletebis yoveldRe miReba
• progestagenuli saineqcio kontraceptivebis fonze aReniSnebodaT
araregularuli sisxliani CamonaSali
(7 _ xarisxi `A~)
19
ksk-s gverdiTi movlenebi
• menstruaciuli ciklis cvlilebebi. ufro naklebad gvxvdeba,
vidre progestagenuli saineqcio kontraceptivebis gamoyenebis
dros. pirveli cikli aris mokle (10-20 dRe), romlis Semdeg
aRiniSneba yovelTviuri sisxldena. araregularuli sisxldena
aRiniSneba SemTxvevaTa 30%-Si pirveli 3 Tvis ganmavlobaSi. ksk-s
gamomyeneblebis umravlesobas pirveli wlis bolos aReniSnebaT
regularuli menstruaciuli cikli
• amenorea ar aRiniSneba
• sxva mcire gverdiTi movlenebia: wonaSi momateba, Tavis tkivili
(3 _ xarisxi `A~)
ukuCvenebebi, kategoriebi, urTierTqmedeba sxva medikamentebTan da
gegmiuri gamokvlevebi ix. kok-is Sesabamis nawilSi
ksk-s gamoyenebis dros gansxvavebuli kategoriebi mocemulia qvemoT:
sigaretis moweva
kategoria 2. asaki < 35 w.
kategoria 2. asaki ≥ 35 w. sigareti < 15 dReSi
kategoria 3. asaki ≥ 35 w. sigareti ≥ 15 dReSi
naRvlis buStis daavadeba
kategoria 2. qolecisteqtomiis Semdeg
kategoria 2. medikamenturi mkurnalobis Semdeg
kategoria 2. daavadeba amJamad
kategoria 2. usimptomod mimdinare
RviZlis cirozi
kategoria 2. msubuqi forma (kompensirebuli)
kategoria 3. mZime forma (dekompensirebuli)
(2 _ xarisxi `A~)
20
ksk-s ineqciis gakeTebis vadebi
regularuli menstruaciuli ciklis dros:
• menstruaciuli ciklis dawyebidan 7 dRis ganmavlobaSi.
kontracepciis damatebiTi meTodis gamoyeneba saWiro ar aris
• menstruaciuli ciklis nebismier dros, Tu sakmarisi safuZveli
arsebobs imisa, rom qali orsulad ar aris
• Tu ineqcia keTdeba menstruaciuli ciklis dawyebidan 7 dRis
Semdeg, qals eZleva rekomendacia Tavi Seikavos sqesobrivi
kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi 7
dRis ganmavlobaSi
amenoreis dros:
• ksk-s ineqcia SeiZleba nebismier dros, Tu sakmarisi safuZveli
arsebobs imisi, rom qali orsulad ar aris. aseT SemTxvevaSi,
qalma sasurvelia Tavi Seikavos sqesobrivi kavSirisagan an
gamoiyenos kontracepciis damatebiTi meTodi ineqciidan 7 dRis
ganmavlobaSi
mSobiarobisa da abortis Semdeg:
• Tu mSobiarobidan gavida 6 Tveze meti, qali agrZelebs ZuZuTi
kvebas da aqvs amenorea, ksk-s ineqcia keTdeba `amenoreis~
Sesabamisi rekomendaciis mixedviT
• Tu mSobiarobidan gavida 6 Tveze meti, qali ZuZuTi kvebavs da
aqvs regularuli menstruaciuli cikli, ksk-s ineqcia keTdeba
`regularuli menstruaciuli ciklis~ rekomendaciis mixedviT
• Tu mSobiarobidan gavida 3 da meti kvira, qali ZuZuTi ar kvebavs
da aqvs amenorea, ksk-s ineqciis gakeTeba SeiZleba nebismier dros,
Tu sakmarisi safuZveli arsebobs imisa, rom qali orsulad ar
aris. amasTan qals eZleva rekomendacia Tavi Seikavos sqesobrivi
kavSirisagan, an gamoiyenos kontracepciis damatebiTi meTodi
ineqciidan 7 dRis ganmavlobaSi
21
• Tu mSobiarobidan gavida 3 da meti kvira, qali ZuZuTi ar kvebavs
da menstruaciuli cikli aRdga, ksk-s ineqcia keTdeba
`regularuli menstruaciuli cikli~-s rekomendaciis mixedviT
• abortis Semdeg maSinve SeiZleba ksk-s ineqciis gakeTeba. amasTan
kontracepciis damatebiTi meTodis gamoyeneba saWiro ar aris
ksk-s gamoyenebis reJimi:
• ksk-s ganmeorebiT ineqciebs Soris Sualedi Seadgens 4 kviras
• Tu rekomendebuli intervalis dacva ver xerxdeba, ineqciis
gakeTeba SeiZleba vadaze 1-7 dRiT adre. Tumca aseT SemTxvevaSi
SesaZlebelia dairRves menstruaciuli cikli
• Tu rekomendebuli intervalis dacva ver xerxdeba, ineqciis
gakeTeba SeiZleba 1-7 dRiT gvian. 7 dReze meti gadacilebis
SemTxvevaSi SeiZleba mxolod im pirobiT, Tu sakmarisi safuZveli
arsebobs imisi, rom qali orsulad ar aris. aseT SemTxvevaSi qals
eZleva rekomendacia Tavi Seikavos sqesobrivi kavSirisagan an
gamoiyenos kontracepciis damatebiTi meTodi 7 dRis ganmavlobaSi
(1 _ xarisxi `A~, 10, 11 _ xarisxi `B~)
sxva hormonuli meTodidan ksk-ze gadasvla
(ix. kok-is Sesabamis nawilSi)
arahormonuli kontracepciidan (sSs-s garda) ksk-ze gadasvla
• ksk-s ineqciis gakeTeba SeiZleba ukve gamoyenebuli meTodis
SewyvetisTanave, Tu sakmarisi safuZveli aris imisi, rom qali
orsulad ar aris. aseT SemTxvevaSi kontracepciis damatebiTi
meTodis gamoyeneba saWiro ar aris
• Tu menstruaciis dawyebidan ar gasula 7 dReze meti, aseT
SemTxvevaSi kontracepciis damatebiTi meTodis gamoyeneba saWiro
ar aris
• Tu ksk-s ineqcia keTdeba menstruaciuli ciklis pirveli 7 dRis
Semdeg, qals eZleva rekomendacia Tavi Seikavos sqesobrivi
kavSirisagan an gamoiyenos kontracepciis damatebiTi meTodi 7
dRis ganmavlobaSi
22
sSs-dan (levonorgestrel-sSs-s CaTvliT) ksk-ze gadasvla
• ksk-s ineqciis gakeTeba SeiZleba menstruaciuli ciklis
dawyebidan pirveli 7 dRis ganmavlobaSi. sSs amoRebuli unda
iyos am periodSi. kontracepciis damatebiTi meTodis gamoyeneba
saWiro ar aris
• nebismier dros, Tu safuZveli arsebobs imisa, rom qali orsulad
ar aris
• Tu qals aqvs araregularuli menstruaciuli gamonadeni an
amenorea, ksk-s ineqcia keTdeba `amenoreis~ rekomendaciiT
(1 _ xarisxi `A~, 8, 9 _ xarisxi `B~)
fertilobis aRdgena
• ksk-s ineqciis Semdeg fertilobis aRdgenis Sesaxeb gamokveTili
monacemebi amJamad ar aris
(1, 2 _ xarisxi `A~)
konsultireba
ksk-s ineqciis gakeTebamde qalTan unda Catardes konsultireba,
romelic moicavs:
• meTodis upiratesobebs da naklovanebebs, efeqturobas, risks da
sargebels, gverdiT movlenebs da Rirebulebas
• ojaxis dagegmvis alternatiul meTodebs
• sigaretis mowevas da masTan dakavSirebul sisxlZarRvovan
garTulebebs
• ineqciebis vadebs
23
24
sayuradRebo niSnebi ksk-s gamoyenebis dros
• Zlieri tkivili muclis areSi
• Zlieri tkivili gulmkerdis areSi, xvela, sunTqvis
ukmarisoba
• Zlieri Tavis tkivili
• mxedvelobis dakargva an dabindva
• mZafri tkivili barZayis an wvivis areSi
• kanis da Tvalebis siyviTle
• Zlieri sisxliani gamonadeni
• diskomforti an sxva problemebi ineqciis adgilze
(3, 7 _ xarisxi `A~)
ksk-s ineqciis dawyebamde skrininguli kiTxvari
anamnezis Sekrebis mizania sxvadasxva risk faqtorebis aRmoCena da maTi
gaTvaliswineba ksk-s ineqciis dawyebamde
qals dausviT Semdegi kiTxvebi:
ara ki1. menstruacia dagvianebulia an fiqrobT, rom orsulad
xarT?2. ZuZuTi kvebavT 6 Tvemde asakis axalSobils?3. eweviT sigarets (dReSi ramdens) da xarT >35 welze? 4. gaqvT Tavis tkivili, xSirad erT mxareze, pulsirebadi,
Tavbrusxveva, diskomforti sinaTlesa da xmaurze?5. gaqvT xolme maRali arteriuli wneva?6. Tu gqoniaT rodisme mwvave sisxlZarRvovani moSla
(insulti, stenokardiuli Seteva, barZayis an filtvis
arteriis Trombozi)?7. gaqvT Tu ara Saqriani diabeti?8. gqoniaT (an amJamad gaqvT) sarZeve jirkvlis kibo?9. gqoniaT (an amJamad gaqvT) RviZlis raime seriozuli
daavadeba an siyviTle?10. amJamad xom ar iRebT antituberkulozur an
antiepilefsiur wamlebs?11. gaqvT sisxldena sqesobrivi kavSiris Semdeg an
menstruaciebs Soris periodSi, rac TqvenTvis uCveuloa?
25
Tu qali Tundac erT kiTxvaze pasuxobs "diax", CautareT gamokvleva. mieciT kondomi kontracepciis sxva meTodis SerCevamde.
Tu qali yvela aRniSnul kiTxvaze pasuxobs - "ara"-mas SeuZlia ksk-is gamoyeneba
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Здравоохранения //«Свод Практических Рекомендаций по применению
средств контрацепции»//, Женева, Издание второе, 2005г. `xarisxi A.~
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Репродуктивное здоровье и исследования Всемирная Организация
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использования методов контрацепции»//, Женева, Третье издание, 2004г.
`xarisxi A.~
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`xarisxi A.~
5. Hatcher R. A., Trussell J, Stewart F. et all. Contraceptive Technology.
Eighteenth Revised Edition. N Y, Ardent Media, 2004. `xarisxi A.~.
6. IPPF Guidlines –Medical and Service delivery Guidlines 2004/ 254-268.
`xarisxi A.~.
7. Paul D. Blumental, Noel Mclntosh. Краткое руководство по
репродуктивному здоровью и контрацепции. Второе издание, 1996, стр. 404.
`xarisxi A.~.
8. Petta CA et al. Delayed first injection of the once-a-month injectable
contraceptive containing 25 mg of medroxyprogesterone acetate and 5 mg E (2)
cypionate: effects on ovarian function. Fertility & Sterility, 2001. `xarisxi B.~.
9. Petta CA et al. Delayed first injection of the once-a-month injectable
contraceptive containing 25 mg of medroxyprogesterone acetate and 5 mg
estradiol-cypionate: effects on cervical mucus. Contraception, 2001. `xarisxi
B.~.
10. Wilcox AJ, Dunson D, Baird DD. The timing of the “fertile window” in the
menstrual cycle: day specific estimates from a prospective study. British Medical
journal, 2000. `xarisxi B.~.
26
11. Wilcox AJ, Dunson DB, Weinberg CR, Trussell J, Baird DD. Likelihood of
conception with a single act of intercourse: providing benchmark rates for
assessment of post-coital contraceptives. Contraception, 2001. `xarisxi B.~.
12. Westhoff C et al. Quick start: novel oral contraceptive initiation method.
Contraception 2002. `xarisxi B.~.
13. Westhoff C et al. Bleeding patterns after immediates vs. conventional oral
contraceptive initiation: a randomized, controlled trial. Fertility and Sterility,
2003. `xarisxi B.~.
avtorebi: prof. a. xomasuriZe, med. doqt. n. marsagiSvili,
med. doqt. g. cercvaZe, med. doqt. T. maRularia.
Eeqspertebi: prof. j. qristesaSvili. Mmed. Ddoqt. Z. boxua, med. Ddoqt.
N n. parunaSvili
27
kok-is klinikuri protokoli
(gaTvaliswinebulia reproduqtologebisaTvis,
mean-ginekologebisaTvis da ojaxis eqimebisaTvis)
kok-is miRebis dawyebamde skrininguli kiTxvari
anamnezis Sekrebis mizania sxvadasxva risk faqtorebis aRmoCena da maTi
gaTvaliswineba kok-is miRebis dawyebamde
dausviT qals Semdegi kiTxvebi:
ara ki1. menstruacia dagvianebulia an fiqrobT, rom orsulad
xarT?2. ZuZuTi kvebavT 6 Tvemde asakis axalSobils?3. eweviT sigarets (dReSi ramdens) da xarT >35 welze? 4. gaqvT Tavis tkivili, xSirad erT mxareze, pulsirebadi,
Tavbrusxveva, diskomforti sinaTlesa da xmaurze?5. gaqvT xolme maRali arteriuli wneva?6. Tu gqoniaT rodisme mwvave sisxlZarRvovani moSla
(insulti, stenokardiuli Seteva, barZayis an filtvis
arteriis Trombozi)?7. gaqvT Tu ara Saqriani diabeti?8. gqoniaT (an amJamad gaqvT) sarZeve jirkvlis kibo?9. gqoniaT (an amJamad gaqvT) RviZlis raime seriozuli
daavadeba an siyviTle?10. amJamad xom ar iRebT antituberkulozur an
antiepilefsiur wamlebs?11. gaqvT sisxldena sqesobrivi kavSiris Semdeg an
menstruaciebs Soris periodSi, rac TqvenTvis uCveuloa?
12. ramdeni dRis win dagewyoT ukanaskneli menstruacia?
28
Tu qali Tundac erT kiTxvaze pasuxobs "diax", CautareT gamokvleva. mieciT kondomi kontracepciis sxva meTodis SerCevamde.
Tu qali yvela aRniSnul kiTxvaze pasuxobs - "ara"-mas SeuZlia kok-is gamoyeneba da gadadiT me-12-e kiTxvaze
• Tu qals ukanaskneli menstruacia daewyo bolo 5 dRis ganmavlobaSi,
SeuZlia exlave daiwyos kok-is miReba.
• Tu qals ukanaskneli menstruacia daewyo 5 dReze meti xnis win da am
periodSi iyenebda kontracepciis romelime meTods (TavSekavebis
CaTvliT), mieciT kok da uTxariT - axlave daiwyos misi miReba da
auxseniT, rom uaxloesi 7 dRis ganmavlobaSi kondomi da/an
spermicidi gamoiyenos.
• Tu qals ukanaskneli menstruacia daewyo 5 dReze meti xnis win da am
periodSi ar iyenebda kontracepciis romelime meTods (TavSekavebis
CaTvliT), mieciT kok da uTxariT, rom misi miReba daiwyos momdevno
menstruaciis pirveli 5 dRis ganmavlobaSi.
29
gverdiTi movlenebi, maTi Sefaseba, marTva
gverdiTi
movlena
Sefaseba marTva
gulisreva,
Rebineba,
Tavbrusxveva
• daadgineT, tabletebs xom
ar Rebulobs diliT an
uzmoze
• SeamowmeT orsulobaze
(testi orsulobaze)
• urCieT qals tabletebi
miiRos Zilis win
vaxSmis Semdeg an
vaxSmis dros
• orsulobis dadgenis
SemTxvevaSi qalma
tabletebis miReba
unda Sewyvitos. da
gagzavnili unda iyos
specialistTan
(ginekologi,
reproduqto-logi). Tu
orsuloba ar
dadasturda, auxseniT
qals, rom es movlenebi
gaivlis 1-2 Tvis
ganmavlobaSi, kok-is
miRebis fonze an
mieciT Zalian mcire
doziani kok-i
(20mkg.e.e.).
• Tu problema
autanelia, Sewyvitos
kok-is miReba.
daexmareT mas
kontracepciis sxva
30
meTodis SerCevaSi.
• amenorea • hkiTxeT qals, rogor
iRebda tabletebs, xom ar
daaviwyda erTi an
ramodenime tabletis
miReba?
• SeamowmeT orsulobaze
(saSvilosnos RruSi,
saSvilosnosgare):
anamnezi, testi
orsulobaze, gasinjva.
• tabletebis gamotoveba
zrdis orsulobis
risks. Tu qalma
gamotova an daagviana
tabletis (erTi an
ramodenime) miReba, is
gamokvleuli unda iyos
orsulobaze.
• orsulobis dadgenis
SemTxvevaSi qali
gaagzavneT
ginekologTan an
reproduqtologTan.
Tu qali gadawyvitavs
orsulobis
SenarCunebas, man
tabletebis miReba
unda Sewyvitos. qals
unda aexsnas, rom kok-
Si Semavali estrogeni
da progestageni
xanmokle miRebisas
orsulobis adreul
stadiaze nayofze
uaryofiT gavlenas ar
axdens.
• Tu pacienti iRebda 21
tabletian firfitas,
daaviwyda erT kviriani
Sesvenebis gakeTeba
menstruaciisaTvis da
uwyveti reJimiT miiRo
tabletebi,
31
ganuviTardeba amenorea.
mieciT axsna-
ganmarteba, rom es
saSiSi araa. Tu qali
ukmayofiloa,
dauniSneT mas
maRaldoziani kok-i (50
mkg e.e.).
• Tu qali swori reJimiT
iRebda tabletebs da
aReniSneba amenorea,
daamSvideT da
auxseniT, rom
amenoreis SemTxvevaSi
mis sxeulSi an
saSvilosnoSi sisxli
ar grovdeba.
progestagenis mcire
dozis mudmivi
moqmedebiT
endometriumis sisqe
mcirdeba, rac iwvevs
sisxldenis Semcirebas
an mTlianad Sewyvetas.
Tu is ganagrZobs
dabaldoziani kok-is
(30-35 mkg e.e.) miRebas,
amenorea Cveulebriv
SenarCundeba. urCieT
qals, ganmeorebiT
momarTos klinikas, Tu
amenorea kvlav
Semawuxebeli iqneba.
• vaginaluri
sisxldena/
• hkiTxeT qals rogor
iRebda tabletebs, xom ar
• Tu qals aviwydeba
tabletebis miReba,
32
CamonaSali daaviwyda erTi an
ramodenime tabletis
miReba?
• kok-s miReba axali
dawyebulia
• SeamowmeT ginekologiur
daavadebebze (menjis Rrus
anTebiTi daavadeba),
orsulobaze
(saSvilosnos RruSi,
eqtopiuri), arasrul
abortze (teqsti
orsulobaze)
• ginekologiur
SeaxseneT wamlis
miRebis wesebi da
auxseniT, rom
tabletebis gamotoveba
zrdis orsulobis
risks. Tu SemdgomSi
mas kvlav aviwydeba
tabletebis miReba,
SeurCieT
kontracepciis sxva
meTodi.
• daamSvideT, uTxariT,
rom
sisxldena/CamonaSali
SesaZlebelia kok-is
gamoyenebis pirveli
sami Tvis ganmavlobaSi
da umravles
SemTxvevaSi mcirdeba
gamoyenebis meoTxe
Tvidan. Tu
sisxldena/CamonaSali
Semawuxebelia,
gadaiyvaneT SedarebiT
maRaldozian kok-ze, an
daexmareT qals
kontracepciis sxva
meTodis SerCevaSi.
33
daavadebebze eWvis
SemTxvevaSi ojaxis eqimi
qals agzavnis Sesabamis
specialistTan
(ginekologTan,
reproduqtologTan)
• kok-is fonze qalma
daiwyo axali
medikamentebis miReba (mag.
rifampicini)
• Tu saxezea
ginekologiuri
problemebi, CaatareT
Sesabamisi mkurnalobis
kursi.
• mieciT maRaldoziani
kok-i (50 mkg.e.e.), an
daexmareT qals
kontracepciis sxva
meTodis SerCevaSi.
• maRali
arteriuli
wneva ≥160/100
_ me-4
kategoria
≥140-159/90-99 _
me-3 kategoria
• Tu arteriuli wnevis
momateba
ganpirobebulia kok-is
gamoyenebiT, qalma
unda Sewyvitos
preparatebis miReba.
daexmareT qals
kontracepciis sxva
meTodebis SerCevaSi.
• kok-is miRebis
Sewyvetis Semdeg 3
Tvis ganmavlobaSi Tu
ar moxda arteriuli
wnevis normalizeba,
qali gaagzavneT
Sesabamis
specialistTan
gamokvlevaze.
34
• tkivili
gulmkerdis
areSi
(gansakuTreb
iT Tu is
dakavSirebu
lia fizikur
datvirTvasT
an)
• SeamowmeT gul-
sisxlZarRvTa
daavadebebze, arteriuli
wneva, guliscemis sixSire
• Tu gamoikveTa gsd-is
niSnebi, gaagzavneT
gamokvlevaze. qals
mieciT rekomendacia
Sewyvitos kok-is
gamoyeneba, daexmareT
kontracepciis sxva
meTodis SerCevaSi
• Tavis
tkivili
(mxedvelobis
darRveviT)
• daadgineT, Seicvala Tu
ara Tavis tkivilis
xasiaTi da intensivoba
kok-is miRebis dawyebis
Semdeg.
• CaatareT fizikuri
gasinjva, SeamowmeT
arteriuli wneva.
aucileblobis
SemTxvevaSi gamoikvlieT:
Tvalis fskeri da
nevrologiuri statusi
• Tu Tavis tkivili
susti xasiaTisaa da
iSviaTia, qali
daamSvideT da mieciT
tkivilgamayuCebeli
wamali. 1 Tvis Semdeg
mdgomareoba SeafaseT
ganmeorebiT.
• Tu kok-is miRebis
dawyebis Semdeg
Seicvala Tavis
tkivilis intensivoba
(tkivilis gaZliereba,
mxedvelobis cvlileba,
metyvelebis unaris
darRveva an dakargva),
SewyviteT kok-is
gamoyeneba da
daexmareT qals
kontracepciis sxva
(arahormonuli)
meTodis SerCevaSi.
• sarZeve
jirkvlebis
daWimuloba
• SeamowmeT orsulobaze • orsulobis SemTxvevaSi
imoqmedeT ise, rogorc
es zemoTaa aRniSnuli
35
an
mtkivneulob
a (mastalgia)
(ix. amenorea).
• gasinjeT s/jirkvali: _
kvanZi an kista -gamonadeni
an galaqtorea (Tu ar
kvebavs ZuZuTi)
• Tu qali orsulad ar
aris, sarZeve
jirkvlebis
mtkivneuloba gaivlis
3 Tvis Semdeg.
• Tu fizikuri gasinjviT
gamovlinda kvanZi an
gamonadeni, romelic
saeWvoa kiboze (mag:
mkvrivi, palpaciis
dros umtkivneulo an
moZraobaSi SezRuduli
kvanZi, romelic ar
icvleba mensturaciis
dros), qali gaagzavneT
Sesabamis gamokvlevaze.
• hkiTxeT qals, Tu amCnevs
s/jirkvlebis
daWimulobas Tvis
mxolod garkveul dros
(mag. menstruaciis
dawyebamde)
• urCieT qals, moeridos
kofeins, Sokolads da
a.S. da auxseniT, rom
s/jirkvlebSi mimdinare
cikluri cvlilebebi
(daWimuloba,
mtkivneuloba)
damokidebulia
estrogen/progestagenis
dozis cvlilebaze.
qali gadaiyvaneT ufro
dabaldozian kok-ze. magram Tu ukve imyofeba
yvelaze dabaldozian kok-
ze da preparatis miRebis
dawyebidan gavida 3 Tveze
36
meti, daexmareT mas
kontracepciis sxva
meTodis SerCevaSi.
• depresia • ganixileT xasiaTis
cvlilebebi
• Tu qals depresia
gauRrmavda kok-is
miRebis Semdeg,
daexmareT
kontracepciis sxva,
arahormonuli meTodis
SerCevaSi, an kok-i
SearCieT progestagenis
dabali doziT.
• Tu xasiaTis cvlileba
kok-s ar gamouwvevia,
SeiZleba maTi miRebis
gagrZeleba.
• SesaZlebelia
piridoqsinis (B6)-s
miReba 50 mg dReSi 2
Tve.
• libidos
daqveiTeba
• ganixileT libidos
cvlilebebi
• Tu kok-s ar
gamouwvevia libidos
daqveiTeba, SeiZleba
maTi miRebis
gagrZeleba. Tu qali
fiqrobs, rom libidos
daqveiTebis mizezi
preparatebia, daexmareT
mas kontracepciis sxva
meTodis SerCevaSi.
• akne • hkiTxeT, rogor da ra
sixSiriT iwmends saxes?
• Cveulebriv kok-is
miRebis dros akne
umjobesdeba da qreba.
37
• xom ar imyofeba amJamad
didi stresis qveS?
Tumca, zogierT
SemTxvevaSi, man
SeiZleba ar imoqmedos
da misi gauaresebac ki
gamoiwvios. qali
gadaiyvaneT naklebi
androgenuli efeqtis
mqone progestagenis
Semcvel kok-ze.
rekomendebulia saxis
gawmenda dReSi orjer
da saxis cximiani
kremebis
gamoyenebisagan Tavis
Sekaveba. Tu
mdgomareoba ar
Seicvala, daexmareT
qals sxva meTodis
SerCevaSi (ara
hormonuli).
• siyviTle • Tu siyviTle gamovlinda
kok-is miRebis dawyebis
Semdeg, SeamowmeT qali
hepatitze, RviZlis
keTilTvisebian an
avTvisebian simsivneze,
cirozze, naRvlis buStis
daavadebaze.
• kok-Si Semavali
hormonebi,
praqtikulad ar
moqmedebs RviZlis
funqciaze. Tu
siyviTle
ganpirobebulia
virusuli hepatitiT,
SewyviteT hormonuli
preparatebis miReba da
daexmareT qals sxva
arahormonuli meTodis
SerCevaSi srul
gamojanmrTelebamde
(anu simptomebis
38
gaqrobidan an RviZlis
funqciis
normalizaciidan 3
Tve).
• Tu siyviTle
ganpirobebulia
RviZlis simsivniT an
ciroziT, SewyviteT
kok-is gamoyeneba,
gagzavneT qali
Sesabamis gamokvlevaze,
daexmareT mas
kontracepciis sxva
meTodis SerCevaSi.
• Tu siyviTle
ganpirobebulia
naRvlis buStis
daavadebiT, SewyviteT
kok-is gamoyeneba da
daexmareT qals sxva
Sesaferisi meTodis
SerCevaSi.
• Rebineba kok-
is miRebidan
2 saaTis
ganmavlobaSi
• aseT SemTxvevaSi qalma
unda miiRos kidev erTi
aqtiuri tableti
• mwvave
Rebineba an
faRaraTi (24
sT-ze meti
xangrZlivob
iT)
• hkiTxeT qals, gagrZelda
Tu ara es 24 saaTze met
xans (am SemTxvevaSi
gamotovebuli iqneba 2
tableti)
• mwvave Rebinebam an
faRaraTma SeiZleba
tabletebis
efeqturobaze
imoqmedos. am
SemTxvevaSi, qalma unda
39
gaagrZelos
tabletebis miReba (Tu
es SesaZlebelia) da
gamoiyenos
kontracepciis
saTadarigo meTodi
manam, sanam faRaraTis
da Rebinebis Sewyvetis
Semdeg 7 aqtiur
tablets miiRebs.
• aqtiuri
tabletis
gamotoveba
(30-35 mkg.
eTinilestra
dioli)
• qals daaviwyda 1 an 2
aqtiuri (hormonuli)
tableti
• qals daaviwyda 3 da meti
aqtiuri (hormonuli)
tableti
• rac SeiZleba adre
miiRos gamotovebuli
aqtiuri (hormonuli)
tableti da
Cveulebrivi sqemiT
gaagrZelos preparatis
miReba ciklis
bolomde, anu 1
tableti erTxel
dReSi. kontracepciis
damatebiTi meTodis
gamoyeneba saWiro ar
aris.
• rac SeiZleba adre
miiRos gamotovebuli
aqtiuri (hormonuli)
tabletebi anu dReSi 2
tableti (erTi
diliT/erTi saRamos, an
2 tableti
erTdroulad) da
Semdegi tabletebis
miReba gaagrelos
Cveulebrivi sqemiT:
1Atableti erTxel
40
dReSi, Semdgomi 7 dRis
ganmavlobaSi saWiroa
Tavi Seikavos
sqesobrivi
kavSirisagan, an
gamoiyenos
kontracepciis
damatebiTi meTodi
(kondomi)
_ Tu tabletebi
gamotovebuli iyo mesame
kviraze unda miiRos
firfitaze darCenili
aqtiuri (hormonuli)
tableti da axali
firfita daiwyos Semdegi
dRidan. amasTan saWiro
aRar aris 7 araaqtiuri
tabletis miReba.
_ Tu tableti
gamotovebuli iyo pirvel
kviras da adgili hqonda
daucvel sqesobriv
kavSirs, aseT SemTxvevaSi
qalma unda mimarTos
gadaudebel kontracepcias.
• Tu tabletis
gamotovebis Semdeg
qals daewyo
menstruaciis msgavsi
sisxldena, urCieT mas
tabletebis miReba
Sewyvitos da axali
firfita daiwyos 7
dRis Semdeg.
41
• araaqtiuri
(`Semaxsenebe
li~)
tabletis
gamotoveba
• qals daaviwyda
`Semaxsenebeli~
tabletebis miReba meoTxe
kviraSi
• 28 tabletiani
firfitis miRebis
SemTxvevaSi, Tu qals
daaviwyda "Semaxsene-
beli" -araaqtiuri
tabletebis miReba,
saWiro ar aris
damatebiT saTadarigo
meTodis gamoyeneba.
urCieT qals gadaagdos
gamotovebuli
araqtiuri tabletebi
da preparatis miReba
gaagrZelos
Cveulebrivi sqemiT, anu
erTi tableti erTxel
dReSi.
(1, 4 _ xarisxi `A~, 10, 11 _ xarisxi `B~)
42
rodis SeiZleba kok-is miRebis dawyeba
regularuli menstrua-ciuli ciklis dros
amenoreis dros
abortis Semdeg
mSobiarobis Semdeg
_ menstruaciuli ciklis
dawyebidan 5 dRis
ganmavlobaSi
_ menstruaciuli ciklis
nebismier dros, Tu sakmarisi
safuZveli arsebobs imisi,
rom qali orsulad ar aris
_ Tu kok-is miReba iwyeba
menstruaciuli ciklis daw-
yebidan 5 dRis Semdeg, qals
rekomendacia eZleva Tavi
Seikavos sqesobrivi
kavSirisagan, an gamoiyenos
kontracepciis damatebiTi
meTodi 7 dRis ganmavlobaSi
(kondomi /sper-micidi)
_ kok-is miRebis dawyeba
SeiZleba nebismier
dros, Tu sakmarisi
safuZveli arsebobs
imisi, rom qali
orsulad ar aris. aseT
SemTxvevaSi qalma
sasurvelia Tavi
Seikavos sqesobrivi kav-
Sirisagan an gamoiyenos
kontracepciis
damatebiTi meTodi 7
dRis ganmavlobaSi
(kondo-mi/spermicidi)
_ abortis Semdeg
kok-is gamoyeneba
SeiZleba maSinve.
amasTan
kontracepciis
damatebiTi
meTodis
gamoyeneba saWiro
ar aris.
qali ZuZu-
Ti kvebavs
bavSvs
qali ZuZu-
Ti ar
kvebavs
bavSvs
_
mSobiarobi
dan 6 Tvis
Semdeg
_
mSobiarobi
dan 3 kvi-
ris Semdeg
(1, 2 _ xarisxi `A~)
43
kok-is gamoyenebis reJimi
21 tabletiani
firfita
28 tabletiani
firfita
_ erTi tableti erTxel
dReSi 21 dRis ganmavlobaSi
(erTsa da imave dros).
Sesveneba 7 dRe, me-8 dRidan
saWiroa axali firfitis
dawyeba.
_ erTi tableti erTxel
dReSi (erTsa da imave dros)
28 dRis ganmavlobaSi (bolo
7 tableti arahormonulia da
SeiZleba Seicavdes rkinas an
vitamins). anu erTi firfitis
damTavrebis Semdeg Sesvenebis
gareSe saWiroa axali fir-
fitis dawyeba.
(1, 2 _ xarisxi `A~)
44
kok-is urTierTqmedeba sxva medikamentebTan
xSirad gamoyenebuli an
daniSnuli wamlebi
gverdiTi efeqtebi komentarebi da
rekomendaciebitkivilgamayuCeblebi _
acetaminofeni
(tailenoli,
paracetamoli da sxv.)
tkivilgamayuCebeli
efeqtis SesaZlo
daqveiTeba (wamlebis
eqskreciis gaZliereba)
Tvalyuri adevneT
tkivilgamayuCebel
efeqts
antibiotikebi * -
grizeofulvini da
rifampicini.
ar arsebobs kliniku-
rad dadasturebuli
efeqti penicilinebisTvis,
tetraciklinebisTvis,
cefalosporinebisTvis
da sxva xSirad
gamoyenebuli
antibiotikebisaTvis.
aRniSnuli
antibiotikebis miRebisas
SeiZleba kontracepciis
hormonuli meTodis
miReba da Cveulebriv
saWiro aRar aris
kontracepciis
damatebiTi meTodis
gamoyeneba
kok-is kontracepciuli
efeqtis daqveiTeba,
gansakuTrebiT
dabaldoziani kok-is
SemTxvevaSi 30-35 mkg
eTinil estradioli (ee)
daexmareT qals,
aarCios
kontracepciis sxva
meTodi an
gamoiyeneT abebi
estrogenis ufro
maRali
SemcvelobiT (50 mkg
ee) an kontracepciis
damatebiTi meTodi
(mag. kondomi)
antidepresantebi
(elavili, norpramini,
tofranili da sxv.)
SesaZloa
antidepresantuli
efeqtis gaZliereba
gamoiyeneT
sifrTxiliT.
antidepresantebis
dabali dozebi
praqtikulad
usafrTxoa
45
hipotenziuri preparatebi
meTildopa (dopegiti),
aldometi da sxv.
SesaZloa hipotenziuri
efeqtis Sesusteba
gamoiyeneT kok da
ksk sifrTxiliT,
gaakontroleT
arteriuli wnevakrunCxvis sawinaaRmdego
barbituratebi
(fenobarbitali da sxv.)
karbamezapini
(tegretoli) fenitoini
(dilantini) primidoni
(misolini)
kok da ksk
kontracepciuli efeqtis
Semcireba,
gansakuTrebiT
dabaldoziani kok-is
miRebis SemTxvevaSi.
SesaZloa fenitoinis
efeqtis gazrda
daexmareT qals
aarCios
kontracepciis sxva
meTodi an
gamoiyeneT
maRaldoziani kok
(50 mkg ee) an
kontracepciis
damatebiTi meTodi
(mag. kondomi)beta blokatori
(korgardi, inderali,
lopresori, tenormini)
SesaZloa beta
blokatoruli efeqtis
gazrda
akontroleT gul-
sisxlZarRvTa
mdgomareobabronqodilatatorebi
Teofilini (bronkotabsi,
maraqsi, primateni,
quibron tedrali, Teo-
duri da sxv.)
Teofilinis efeqtis
gaZliereba
akontroleT
Teofilinis dozis
gadaWarbebis
simptomebi
hipoglikemiuri
(diabineze, orinaze,
tolbutamidi, tolinaze)
SesaZloa
hipoglikemiuri efeqtis
daqveiTeba
akontroleT Saqari
sisxlSi iseve,
rogorc nebismier
diabetian qalSitrankvilizatorebi
benzodiazepini (ativani,
libriumi, seraqsi,
tranqseni, valiumi,
qsanaqsi da sxva)
SesaZloa
trankvilizatorebis
efeqtis gaZliereba an
Sesusteba, maT Soris
fsiqomotoruli
darRvevebi
gamoiyeneT
sifrTxiliT.
Cveulebrivi dozebi,
rogorc wesi,
mniSvnelovan
efeqtebs ar iwvevs.
* ramdenadac grizeofulvini, romelic iwvevs estrogenisa da
progestagenis metabolizmis gazrdas, Cveulebriv mxolod xanmokle
46
periodis ganmavlobaSi (2-4 kvira) gamoiyeneba, qalebs, romlebic iReben mas
mikozuri infeqciis samkurnalod, SeuZliaT gaagrZelon kok-is miReba. maT
unda gamoiyenon kontracepciis damatebiTi meTodi grizeofulvinis miRebis
periodSi da misi Sewyvetis Semdeg momdevno menstruaciis dawyebamde.
(7 _ xarisxi `A~)
47