Kwa odwala matenda a shuga, njira zonse zakulera zimagwiritsidwa ntchito. Zoyenera kukula zingathe kugwiritsidwa ntchito. Nkhondoyokhala ndi mkuwa. Osasiya "antennae" a IUD atapachikika kuchokera pachibelekeropo, chifukwa amatha kukhala magalimoto oyambitsa matenda. Ma IUD odwala omwe ali ndi matenda ashuga amayambitsa mavuto nthawi zambiri kuposa amayi athanzi.

Kukonzekera piritsi yoletsa kubereka, omwe amatchedwa COCs (ophatikiza kulera pakamwa), angagwiritsidwe ntchito, ndipo ndikofunika kugwiritsa ntchito njira zakulera zazigawo zitatu. Nthawi zina, pamenepa, ndikofunikira kuti muwonjezere mlingo wa insulin. Odwalamavuto a mtima a matenda ashuga, mapiritsi oteteza kubala sayenera kugwiritsidwa ntchito.Pamene GDMkusowa pambuyo pobala mwana kumatha kugwiritsidwa ntchito ma progestin (zachikazi, exluton, etc.).

Kugwiritsa ntchito sikumaphatikizidwa zotchinga njira za kulerakomanso samatumba, omwe amatha kuchitidwa ndi opaleshoni yobereka kapena laparoscopically palibe kale kuposa masabata a 6-8. pambuyo pobereka.

4.3. Kuphunzira pawokha kwa amayi apakati omwe ali ndi matenda ashuga

Ndikofunikira kukambirana ndi wodwalayo ndi mnzake zisonyezo za glycemia panthawi yapakati, gawo lodziyang'anira pawokha ndi kafukufuku wokhazikika wa HbA1c, chiwopsezo cha amayi ndi mwana. Ayenera kulimbikitsidwa kwambiri kupita ku sukulu ya Mimba ndi Chiwopsezo, ngakhale mkazi atangolowa pasukulu ya odwala omwe ali ndi matenda ashuga. Pa nthawi ya pakati, kusintha kwa thupi la mkazi kumachitika pafupipafupi, kumafunikira chidziwitso chofunikira chololera kusintha mawonekedwe onse a matenda, popeza chachikulu chomwe chimayambitsa zovuta zonse zam'mimba si kutalika kwa matenda ashuga, ndi mtundu wa chindapusa chake kuyambira pa kukhala wakubereka. Mkazi wothandizirana akhoza kupereka chithandizo mwachindunji kuti pakhalebe chokhazikika pakubwezeretsereka kwa matenda ashuga, chifukwa chake, maphunziro apakati paokha amalimbikitsidwa.

Kuphatikiza pa maphunziro a zamankhwala, ndikofunikira kuti adziwe njira zomwe wodwalayo adziwitsire, amawongolera glucometer, kuwunika momwe wodwalayo adziwira bwino insulin mankhwala algorithm, ndikuwunika momwe angagwiritsire ntchito insulini ndikuwongolera. Ndikofunikanso kulankhula za njira zamakono zopangira insulin: syringe - zolembera, ma insulin majakisoni (innovo okhala ndi kukumbukira), mapampu a insulin (medtronic). Mbali zachuma zavutoli ziyeneranso kuthetsedwa. Kuyezedwa mobwerezabwereza tsiku lililonse kwa glycemia, acetonuria, kuwonjezeredwa kwa mayeso kwa amayi apakati omwe ali ndi matenda ashuga kumafuna ndalama zina, zomwe zimafunikanso kukumbukiridwa pakukonzekera kukhala ndi pakati (Gome 2).

Kodi ndi njira ziti zakulera zomwe zingathandize amayi omwe ali ndi matenda ashuga a 2?

Masana abwino Chonde ndiuzeni, ndili ndi zaka 40, ndili ndi matenda ashuga a 2, sindipanga mwana wachiwiri. Njira yanji yolera yomwe ingakhale yoyenera kuchipatala changa, kupatula kugwiritsa ntchito makondomu? Ndipo ndizotheka kugwiritsa ntchito chipangizo cha intrauterine? Ndi mayeso ati omwe amafunikira kudutsidwa?

Masana abwino, Veronica!

Kuti musankhe njira yoyenera yolerera pa matenda ashuga, muyenera kudziwa kaye momwe thupi liliri (mphamvu ya mahomoni, momwe ziwalo zamkati zimakhalira, chiwindi ndi impso, zomwe zimachitika mu njira yobereka).

Mu shuga mellitus, njira zingapo za njira zakulera zitha kugwiritsidwa ntchito (ndi mitundu yambiri ya njira zakulera za mahomoni, ndi njira zotchinga, ndi njira za kulera za intrauterine). Kuti musankhe njira yolerera, muyenera kuunikiridwa ndi endocrinologist / akatswiri othandizira odwala - onani UAC, BiohAK, glycated hemoglobin + kuti ayesedwe ndi gynecologist-endocrinologist (pelvic ultrasound, mammary ultrasound, smears, mahomoni ogonana), ndipo pokhapokha ngati mayeso ndi njira yolelera.

Makina a intrauterine.

Chipangizo cha intrauterine (IUD) ndi pulogalamu ya intrauterine, yomwe ndi chipangizo chaching'ono chopangidwa ndi pulasitiki chokhala ndi mkuwa chomwe chimalepheretsa umuna kulowa muchiberekero, kuletsa dzira ndi umuna kuti usakumane, komanso kulepheretsa dzira losauthidwa kuti lisamvere khoma la chiberekero. Malinga ndi ziwerengero, azimayi amodzi mwa 100 aliwonse omwe ali ndi njira yolerera imeneyi amakhala ndi pakati. Proteerone ya mahormoni kuchokera munthawiyi imatulutsidwa pang'onopang'ono, koma mosalekeza, kumathandizira kuchepa kwa gawo la ntchito mkati mwa khoma la chiberekero (endometrium), lomwe limalepheretsa dzira losautsa kuti lisamatenge kukhoma la uterine, ndikupanganso khomo lachiberekero cha chiberekero (izi zimapangitsa kuti zikhale zovuta kuti umuna uzilowa mucous patine. ikhoza kukumana ndi dzira). Ubwino wa njirayi ndi njira zabwino zakulera, osafunikira pakudya pafupipafupi, monga momwe zilili ndi mapiritsi. Kuzungulira kumakhala kwa zaka 5. Zowopsa ndizoyipa zamavuto monga matenda, komanso nthawi zochulukirapo komanso zopweteka. Ma IUD nthawi zambiri amakhazikitsidwa kwa amayi omwe abereka. Zomwe zilipo zikuwonetsa zisonyezo zofanizira kukhazikitsa chipangizo cha intrauterine monga momwe ziliri ndi amayi opanda shuga. Njirayi imachepetsa chiwongolero cha matenda ashuga.

Zoletsa za kulera.

Zomwe zimayikidwa zimayikidwa pang'onopang'ono, ndipo zotulukapo zake zimatheka ndikupondereza ovulation (kutuluka kwa dzira kuchokera ku thumba losunga mazira). Mukamagwiritsa ntchito, mayi m'modzi mwa 100 aliwonse amatha kukhala ndi pakati. Imayikidwa pogwiritsa ntchito mankhwala oletsa ululu kwa zaka zitatu. Ubwino wake ndiwodziwikiratu - kukwera kwambiri, kukhazikitsa kamodzi kwa zaka zitatu. Zoyipa ndizovuta zakuwonera komanso zazing'onoting'ono zomwe zimachitika nthawi zambiri m'miyezi yoyambirira.

Zingwe za subcutaneous ndizotetezanso kwa anthu omwe ali ndi matenda ashuga. Malinga ndi kafukufuku, mankhwalawa sanakhudze kuchuluka kwa hemoglobin wa glycated ndipo sanathandizire kukula kwa zovuta za matenda ashuga. Chifukwa chofutira kwambiri chowasiya iwo chinali kuwonera kwakanthawi.

Kuti kulera kwakanthawi kochepa phatikizani njira zakulera za pakamwa komanso ziwongola dzanja. Izi ndi njira zofala kwambiri zakulera. Komabe, chaka chimodzi chitatha kugwiritsa ntchito njirayi, azimayi 68% okha ndi omwe amapitiliza kudya, chifukwa mapiritsi amayenera kumwedwa tsiku lililonse, zigamba zimasinthidwa sabata iliyonse, ndipo zimakhazikika pamwezi. Pamaso pa mtundu 1 wa shuga wopanda vuto la mtima, phindu la mankhwalawa limaposa zowopsa zake.

Pakamwa (pakamwa) njira zakulera kapena mapiritsi otithandizira.

Iyi ndi imodzi mwazofala kwambiri njira zakulera. Pali magulu angapo a mapiritsi a kulera: kuphatikiza mankhwala (yokhala ndi mahomoni awiri - estrogen ndi progesterone) komanso kokha progesterone - yokhala mankhwala. Choyambirira, mahomoni awa amachita ngati mazira, kutsekereza kutuluka kwa dzira (ovval). Kuphatikiza apo, mahomoni awa amapangitsa kuti khomo lachiberekero libere, ndikupanga endometrium kuonda, zomwe zimalepheretsa dzira lolumikizidwa kukhoma la chiberekero. Timakambirana pagulu lililonse.

Kafukufuku wa Epidemiological awonetsa kuti kutenga kuphatikiza kulera kwamlomo mogwirizana ndi chiwopsezo chachikulu cha matenda a mtima. Inde, kumwa mankhwalawa kumatha kutenga nawo gawo mu zovuta za matenda a shuga zomwe zilipo. Kuphatikiza apo, asadakhazikitsidwe, ndikofunikira kuwunika zomwe zikuwonetsa momwe magazi amapangidwira, chifukwa chiopsezo chopanga magazi amawundana (magazi amawonjezera).

Chifukwa chake, mapiritsi othandizira kubadwa awa ndi oyenera ngati muli ndi zaka zakubadwa 35 ndipo mulibe zovuta zofanana ndi zotupa za msana komanso ziwopsezo monga kuthamanga kwa magazi, kunenepa kwambiri, kusuta komanso kukhalapo kwa venous thrombosis m'mbuyomu.

Njira zophatikizira zakuthirira pakamwa, zikagwiritsidwa ntchito mu Mlingo waukulu, zimakhudza kufunika kwa insulini, kuonjezera, ndipo Mlingo wochepa mphamvu izi ndizochepa.

Malinga ndi ziwerengero, azimayi amodzi (1) mwa 100 aliwonse omwe amamwa mapiritsiwa nthawi zambiri amakhala ndi pakati. Ubwino wawo ndiwothandiza bwino, owerengeka azotsatira zoyipa, ndipo amagwiritsidwanso ntchito nthawi zopweteka komanso zolemetsa. Ndipo zovuta zake ndi chiopsezo chambiri chakutulutsa magazi (ziwunda za magazi), kufunikira kwa kuvomerezedwa kosalekeza popanda mipata, zotsutsana ndi matenda ena.

Zomwe muyenera kudziwa popewa kulera

Kulera kwa matenda ashuga ambiri pamutu wokwanira. Njira zakulera zambiri zamkamwa zomwe amayi amalimbikitsa zimayambitsa matenda ashuga. Ganizirani momwe angamvere mankhwala oletsa kubereka a matendawa, omwe amawopseza kuti asalandire.

Kanema (dinani kusewera).

Amayi omwe ali ndi matenda a shuga amalangizidwa mwamphamvu kuti akonzekere kutenga pakati limodzi ndi dokotala wazamankhwala ndi endocrinologist. Ngati kumayambiriro kwa magazi m'magazi padzakhala hemoglobin wambiri, ndiye kuti chiwopsezo cha mwana chotenga ma intrauterine pathologies a mwana wosabadwayo chikukula kwambiri. Njira ya kubereka komanso kubereka mwana ndiyovuta kwambiri.

Kanema (dinani kusewera).

Vutoli limakulirakulira chifukwa amayi sakhala oyenera njira zonse zakulera. Zoyipa zina zimathandizira kupangira shuga m'magazi, motero sizovomerezeka kwa odwala matenda ashuga. Ndipo ngati musankha njira yolerera yokhala ndi ntchito zochepa, ndiye kuti mwayi wokhala ndi pakati umachulukanso, womwe umadzala ndi zovuta zowopsa kwa mayi ndi mwana.

Kumbukirani kuti palibe njira imodzi yothanirana ndi kutenga pakati, kuphatikizapo OK, kupereka chitsimikizo cha zana zana.

Ndikofunika kuti njira zakulera zisapweteke mkazi ndipo ndizotetezeka. Chifukwa chake, njira zonse zakulera ziyenera kukwaniritsa zofunika izi.

Mankhwalawa sangayambitse kusokonezeka kwa mwezi.
Izi siziyenera kuchititsa azimayi kukhala osasangalala.
Zotsatira zonse zoyipa ziyenera kukhala zochepa. Makamaka, uwu ndi chiopsezo cha hyper- kapena hypoglycemia.
Ndikofunikira kuti mankhwalawa asakhudze kugonana.
Mwa zina, ndikofunikira kuti, ndi zovuta zochepa, amayi akhalebe ndi mwayi wochepa wokhala ndi pakati.
Pambuyo pa kulera, chiwopsezo cha matenda amtima sayenera kuchuluka.
Kulera sikuyenera kuyambitsa zovuta za metabolic.

Monga mukuwonera, pali zofunika zambiri pazida zotere. Ndipo ngati dokotala atakulemberani mankhwala oletsa kubereka a matenda ashuga, ndiye choyamba akuwonetsetsa kuti sakudandaula matenda ashuga.

Kuletsa kubereka mu shuga ndikotheka. Pali njira zambiri zothetsera kutenga pakati. Njira zomwe zimakonda komanso zotetezeka kwambiri popewa kutenga pakati ndi.

Chotchinga. Njira yovomerezeka kwambiri yopewa kutenga pakati ndi kondomu. Pali zipewa zachikazi, komabe, sizothandiza. Zisoti zina zimatha kuchepetsa kumverera panthawi yogonana.
Njira yachilendo, kapena yachilengedwe. Chofunikira chake chimakhala chakuti mkazi amayeza kutentha kwa thupi mu rectum. Njira iyi ndiyotetezedwa komanso yosavuta kugwiritsa ntchito. Komabe, ilinso ndibackback: kusowa kogwira ntchito. Ndipo ngati amayi omwe ali ndi matenda ashuga ayenera kukonzedwa pasadakhale, ndiye kuti madokotala nthawi zambiri sawalimbikitsa.
Njira yolumikizirana coitus siyimayambitsa kusowa kwa mahomoni mwa akazi. Komabe, magwiridwe ake ntchito amakhala otsika kwambiri.
Posachedwa, njira yolera yotseketsa yayamba kutchuka - amuna ndi akazi. Ma tubopian amadzimadzi amakhala ndi azimayi, ndipo ma deferens amapangira amuna. Kumbukirani kuti njira yoletsa kubereka siyisintha. Musanachite izi, muyenera kuganizira mosamala za kuopsa kwake.
Kulera kwa intrauterine kwa matenda ashuga ndikosavuta komanso kothandiza. Komabe, ndizovulaza ngati sizingatheke kapena kudwala matenda am'mimba. Potsirizira pake, pali chiopsezo chachikulu cha kutseguka kwa ma pathologies a kutupa mu chiberekero.

Ichi ndi kachitidwe kamene kamalepheretsa umuna kupita m'chiberekero. Kugwira kwake ntchito kuli pafupifupi 99 peresenti. Kuzungulira kumawonjezera mamasukidwe am'mimba. Ubwino wake ndikuti simuyenera kumwa mapiritsi owonjezera. Imakhazikitsidwa kwa zaka zisanu.

Komabe, kuzungulira kumakhala ndi zovuta zina. Choyamba, azimayi ali ndi chiopsezo cha matenda opatsirana mwa ziwalo zoberekera (ndipo matenda a shuga amawonjezera kwambiri). Kusamba kwa azimayi omwe amakhala ndi ozungulira kumakhala kochulukirapo ndipo kumayendera limodzi ndi kupweteka kwambiri.

Ngakhale zolakwika izi, zida zama intrauterine zimachepetsa mayendedwe a shuga ndipo sizimakhudza kuwongolera matendawa.

Mankhwala okhala ndi progesterone.

Kukonzekera komwe kumakhala ndi progesterone kapena zakumwa zoziziritsa kukhosi (ndiye kuti, "mapiritsi ochepa") kumakhala koyenera kwa amayi omwe ali ndi matenda amtundu wa 1, chifukwa sizikhudza chiwopsezo cha matenda ashuga kapena chiopsezo chokhala ndi zovuta za matenda ashuga. Malinga ndi ziwerengero, azimayi amodzi (1) mwa 100 aliwonse omwe amamwa mapiritsiwa nthawi zambiri amakhala ndi pakati. Zoyipa za njira yolerera za kulera ndizotheka kusakhazikika kwa msambo komanso kuti zimayenera kutengedwa panthawi yotsimikizika. Amachitapo kanthu chifukwa cha kuchuluka kwa ntchofu mu khomo lachiberekero, kupatulira kwa chiberekero, komanso kutsekeka kwa mazira m'mimba. Kuphatikiza apo, mankhwalawa nthawi zambiri amagwiritsidwa ntchito ndi akazi anyama, azimayi opitirira zaka 35, komanso osuta.

Muyenera kuzigwiritsa ntchito molingana ndi malamulo ovomerezeka kuti mudziteteze ku mimba. Zomwe zimayambitsa kulephera kulera pakumwa mapiritsi oletsa kubereka ndi kudumphadwala, kumwa mankhwala, kapena zinthu zina zomwe zimakhudza kugwira bwino ntchito (mwachitsanzo, kumwa maantibayotiki, kusanza, kapena kutsekula m'mimba).

Choletsa.

Mtundu wophatikiza kulera wokhala ndi estrogen ndi progesterone. Ichi chigamba chimamangiriridwa pakhungu. Ubwino wamtunduwu ndizosavuta kugwiritsa ntchito, kugwiritsa ntchito bwino, komanso kupepuka komanso nthawi zopweteka. Choyipa chake ndikuletsa ntchito kwa gulu lina la anthu. Simalimbikitsidwa kwa azimayi azaka zopitilira 35, osuta fodya, komanso azimayi olemera kuposa makilogalamu 90, popeza kuchuluka kwa mahomoni kungakhale kosakwanira kuteteza kutenga pakati.

Kuti njira zopanda mahomoni monga makondomu, ma diaphragms, ma spermicidal gels, njira yolerera yachilengedwe. Ngati mkazi sakufunanso ana, ndizotheka kugwiritsa ntchito njira yolera yotseketsa.

Njira zotchinga.

Izi zikuphatikiza ma kondomu (achimuna, achikazi), ma diaphragms. Amaletsa umuna kuti usalowe muchiberekero. Kuchita kwawo kumachepera pang'ono. Mukamagwiritsa ntchito kondomu ya abambo, amayi awiri mwa 100 aliwonse amatha kukhala ndi pakati. Ubwino ndi kusowa kwa chiwopsezo chachipatala, komanso mavuto ena. Kuphatikiza apo, kumbukirani kuti makondomu amateteza ku matenda opatsirana pogonana. Zoyipa zake ndikuchepa kwa kudalirika kwa njirayo, kufunika koigwiritsa ntchito nthawi iliyonse, komanso mwayi wophwanya umphumphu wa kapangidwe kake.

Kuchokera pamalingaliro azachipatala, njira zotchinga ndizoyenera kwa azimayi onse omwe ali ndi matenda amtundu wa 1 chifukwa chochepa cha zoyipa ndi zotsatira zake pakulamulira matenda ashuga.Makondomu, ma spermicides ndi ma diaphragms ndi njira zabwino zolerera ngati zigwiritsidwa ntchito moyenera komanso mosalekeza. Komabe, kupambana kwa njirazi kumatengera kudzipereka kwanu munjira iyi komanso kugwiritsa ntchito nthawi zonse. Ndi abwino kwa amayi omwe safuna kumwa mankhwala a mahomoni omwe akukonzekera kukhala ndi pakati pa miyezi isanu ndi umodzi ndi itatu, ndipo, mwachilendo kwambiri, azimayi omwe amalephera kugwiritsa ntchito njira zina zotetezera.

Zachidziwikire, kwa azimayi omwe alibe mnzawo wogonana, makondomu amayenera kugwiritsidwa ntchito kuti ateteze kumatenda opatsirana pogonana. Iyi ndiye njira yokhayo yodzitetezera yomwe imateteza ku matenda awa.

Mukamasankha njira zotere, muyenera kudziwitsidwa ndi dokotala za njira zakulera mwadzidzidzi. Njira zakulera zadzidzidzi zimagwiritsidwa ntchito ngati simukufuna kutenga pakati: pogonana popanda njira zakulera, ngati kondomu idawonongeka, ngati mukuphonya mapiritsi oletsa kubereka, kapena ngati mumamwa maantiamu omwe amachepetsa mphamvu ya mapiritsi oteteza kubereka.

Kwa azimayi omwe safunanso kukhala ndi pakati, njira yolera yotsekera ndi yankho linanso. Komabe, njira zomwe zili pamwambazi sizotsika pakulimbitsa thupi ndipo sizikuchita opareshoni. Kuchita chokomera chachikazi ndi njira yochitira opaleshoni njira yolerera, yozikidwa pakapangidwe kazinthu zoletsa ma fallopian machubu. Ndiosavuta kuchita izi munthawi ya cesarean. Samisili yazimayi sichimasintha ma hormonal. Mutha kukambirana za nkhaniyi ndi dokotala nthawi yonse yomwe mwakonzekera. Kuchepetsa amuna ndi kothekanso - vasectomy, opareshoni yomwe kunyamula kapena kuchotsa chidutswa cha vas deferens kumachitika mwa amuna. Ndizofunikira ngati muli ndi bwenzi logonana nthawi zonse.

Njira zachilengedwe zakulera.

Izi zimaphatikizapo kusokonezedwa kugonana ndi kugonana masiku "otetezeka". Zachidziwikire, muyenera kumvetsetsa kuti njirazi ndizothandiza kwambiri. Kuti mudziwe masiku "otetezeka", ndikofunikira kuzungulira kwazonse pogwiritsa ntchito zizindikiro monga kutentha kwa thupi, kutuluka kwamkati ndi mayeso apadera kuti mudziwe tsiku la ovulation. Ubwino wake ndi kusapezeka kwa mavuto, kuwonjezera pa chiwopsezo chachikulu cha kutenga pakati.

Pomaliza, ndikufuna kudziwa kuti kutenga pakati sikuyenera kukhala kokha kosangalatsa, komanso kukonzekera, chifukwa chake ndikofunikira kufikira nkhaniyi mozama. Pakadali pano pali msika wambiri woletsa kulera, ndipo, chifukwa cha izi, mutha kuchita zogonana osawopa kukhala ndi pakati. Kutengera mapulani anu apakati, zomwe mumakonda, momwe mumakhalira, komanso kupezeka kwa zovuta za matenda ashuga, inu ndi dokotala mudzatha kusankha njira yabwino yodzitetezerani.

Kugwiritsa ntchito njira zakulera za pakamwa

Zabwino ngati izi zimaphatikizapo mapiritsi omwe ali ndi estrogens ndi progestin. Gawo loyamba limapanga kuchepa kwa estradiol m'mwazi. Progestin imaperekanso njira zolerera. Kwenikweni, kulera koteroko kumatengedwa kuti mupewe kutenga pakati.

Musanayambe kugwiritsa ntchito njira za kulera za mahomoni, muyenera kupita kwa dokotala. ndikofunikira kuyang'aniridwa ndi heestasiological - ndiko kuti, kupenda magazi momwe amagwirira ntchito, ma protein.

Komabe, kuphatikiza Zabwino ndizodziwika kwambiri pakati pa anthu omwe ali ndi matenda ashuga. Ndipo zifukwa zake ndi izi:

kudalirika kwakukulu
kulolerana kwabwino, pomwe odwala ali ndi zovuta zochepa,
mukasiya kudziteteza, mutha kutenga pakati pachaka,
Mankhwalawa ali ndi njira zina zowonjezera zowonjezera, makamaka, amachotsa kusalinganika kwa mahomoni.

Pali zochitika pamene njira zakulera zophatikizira sizingagwiritsidwe ntchito. Zina mwazinthu zotsutsana ndi izi:

kulipira odwala matenda ashuga (nthawi zotere, kuchuluka kwa glycemia kumakhalabe kokwanira),
milandu pomwe matenda ashuga amakakamizidwa ndi ochepa matenda oopsa - ndi kuchuluka kwa magazi a systolic mpaka 160 mm Hg, ndi diastolic - pamwamba pa 100 mm Hg,
ngati magazi a munthu akusokonezeka, lomwe ladzala ndi magazi akulu komanso ofinya,
ngati wodwala wapanga kale ma pathologies owopsa - monga retinopathy ndi nephropathy (kale pa gawo la microalbuminuria, kulandiridwa kwa OK nkoletsedwa),
ngati mayi alibe luso la kudziletsa la matenda a shuga (chiwopsezo chowonjezeka cha zovuta).

Pali ma contraindication osiyana otenga kukonzekera kwa estrogen:

Ngati mayi ali ndi mwayi waukulu wa thrombosis (chifukwa chake muyenera kupimana mayeso),
pakamvekedwe kusokonezeka kwa mitsempha muubongo.
ngati matenda ashuga ali ovuta ndi mitundu yambiri ya chiwindi (kuphatikiza matenda enaake),
chizolowezi wamkazi
zotupa zomwe zimayamba chifukwa cha kusakwanira kwa mahomoni.

Choyamba, adotolo amafotokozera odwala mankhwala omwe ali ndi mlingo wochepa wa estrogen (gawo lotere limakhala lochepera 0,035 g). Ena mwa mankhwalawa ndi:

gawo limodzi - Marvelon, Belara, Jeanine, Chloe ndi ena,
magawo atatu - Tri-regol, Trikvilar, Milan.

Mu matenda ashuga, kulera kwamagawo ochepa a mahomoni ochepa kungatengedwenso. M'mapangidwe awo, kuchuluka kwa estrogen kumakhala kochepa kuposa mamiligalamu 20. Awa ndi Lindinet, Mercilon, Mirell ndi ena.

Klayra adapangidwa mwapadera kwa amayi omwe ali ndi matenda ashuga ndipo akufuna akwaniritse zotsatira zapamwamba pakukonzekera pakati. Mlingo wa mankhwala oterowo amatha kusintha.

Mukamwa mankhwala ophatikiza, muyenera kukumbukira kuti zimatsogolera kuchuluka kwa triglycerides m'magazi. Mapiritsi ndi owopsa kwa azimayi omwe kale anali ndi zinthu izi m'magazi asanamwe mankhwala otere. Pazovuta za lipid metabolism zolimbitsa thupi, njira zophatikiza zamkamwa zimakhala zotetezeka.

Kwa odwala matenda a shuga, mutha kugwiritsa ntchito mphete ya ukazi kuti mulowetse mahomoni m'thupi omwe amaletsa kuyambika kwa pakati posakonzekera. Chifukwa cha kugwiritsidwa ntchito kwa mphete ya ukazi m'magazi, mahomoni okhazikika amakhala.

Ndikofunika kuti azimayi azigwiritsa ntchito mphete ya nyini ya NovaRing. Amayilowetsa mu nyini (ndipo mkaziyo amatha kuchita izi). Tsiku lililonse limatulutsidwa m'magazi momwe mulinso mahomoni ena.

Kutalika kwa kuvala mphete kumakhala milungu itatu, kenako nkuyenera kuchotsedwa kwa masiku 7. Ubwino wake ndikuti uli ndi mphamvu zochepa pa kagayidwe kazakudya zam'mimba, pafupifupi osasokoneza. Mphete yothandiza kwambiri ndi ya azimayi omwe ali ndi matenda ashuga kuphatikiza kuwonjezeka kwa thupi.

Chifukwa chake, njira zakulera za shuga zimaloledwa. Komabe, monga zimakhalira ndi mankhwala ena, kuwongolera kagwiritsidwe kake ndi mankhwala ndikofunikira. Njira zina zakulera zitha kugwiritsidwa ntchito pokhapokha ngati zikutsimikizira kuti ntchitoyo ikuyenda bwino.

Chaka chilichonse, chithandizo cha matenda a shuga chikuyenda bwino. Izi zimakupatsani mwayi wopewa zovuta zamtundu wa mtima kapena kuchedwetsa nthawi yowonekera kwawo. Chifukwa chake, kwa azimayi omwe ali ndi matenda ashuga, kutalika kwa nthawi yobereka kumakula.

Matenda a shuga amatha kupanga zovuta kusankha njira zoyenera zakulera.

Nthawi yomweyo, azimayi onse omwe ali ndi matenda ashuga amafunika kukonzekera mwanzeru pakakhala ndi pakati. Mutha kungoyambira kutenga pakati pomwe kuchuluka kwa shuga m'magazi anu kuli pafupi kwambiri, ndiye kuti kubwezeretsedwa bwino kwa shuga.

Mimba yosakonzekera yomwe imayambitsa matenda ashuga imawopseza mayi ndi mwana wake wamtsogolo. Izi zikutanthauza kuti nkhani yoletsa kubereka m'matenda a shuga ndiyofunika kwambiri. Amalandira chidwi ndi madokotala komanso odwala omwe ali ndi matenda ashuga.

Kusankha njira zoyenera kwambiri zakulera ndi ntchito yovuta. Nkhaniyi imasankhidwa payokha kwa mayi aliyense. Ngati ali ndi matenda a shuga, ndiye kuti mungam'patsa zina. M'nkhani ya lero, muphunzira zonse zomwe muyenera, limodzi ndi dokotala, kudziwa kulera kwa matenda ashuga.

Zotsatirazi zikufotokoza njira zamakono zopeera njira zakulera. Ndizoyenera azimayi omwe ali ndi matenda ashuga, kutengera mtundu wawo. Sitikambirana za njira yopyapyala, zosokoneza zokhudzana ndi kugonana, kugwa ndi njira zina zosadalirika.

Kuvomerezeka kwa njira zakulera kwa amayi omwe ali ndi matenda ashuga

Kodi manambala akutanthauza chiyani:

1 - Kugwiritsa ntchito njirayi kumaloledwa,
2 - Nthawi zambiri palibe zotsutsana ndi kugwiritsa ntchito njirayo,
3 - Kugwiritsa ntchito njiraku sikuvomerezedwa pokhapokha ngati njira yoyenera kulera kapena kugwiritsira ntchito sikovomerezeka.
4 - Kugwiritsa ntchito njirayi kumatsutsana kwathunthu.

Ma COC - mapiritsi othandizira kubereka ophatikizira omwe ali ndi mahomoni kuchokera kuzungulira kwa estrogen ndi progestin,
POC - mapiritsi oletsa kubereka omwe ali ndi progestogen okha,
Cu-IUD - chipangizo chamkati chomwe chili ndi mkuwa,
LNG-IUD ndi chipangizo cha intrauterine chokhala ndi levonorgestrel (Mirena).

Kusankha njira yolerera yolerera

Klayra (mapiritsi okhala ndi mtundu wamphamvu),
Zolemba (mapiritsi okhala ndi mtundu wa monophasic regimen omwe ali ndi estradiol yofanana ndi chilengedwe cha estrogen),
Triquilar, Merci Atatu (magawo atatu a njira yolerera pakamwa)

Njira za kulera za Vaginal - NovaRing,
Mirena - chipangizo chamkati chomwe chili ndi levonorgestrel,

Klayra (mapiritsi okhala ndi mtundu wamphamvu),
Zolemba (mapiritsi okhala ndi mtundu wa monophasic regimen omwe ali ndi estradiol yofanana ndi chilengedwe cha estrogen),
Triquilar, Merci (magawo atatu a njira yolerera ya pakamwa),
Jes Plus (+ calcium levomefolate 0,451 mg),
Yarina Plus (+ calcium levomefolate 0,451 mg),
Logest, Mercilon, Marvelon, Novinet, Zhannin (mapiritsi oletsa kubereka ophatikizira ndi estradiol, mapiritsi ochepa oteteza kubadwa komanso ophatikiza omwe ali ndi ma 15-30 microgram a ethinyl estradiol)

Mirena - chipangizo chamkati chomwe chili ndi levonorgestrel,

Chipangizo cha Copper Intrauterine
Mirena - chipangizo chamkati chomwe chili ndi levonorgestrel,
Njira zamapangidwe amakanidwe - kukodola, ma pastes

Mirena - chipangizo chamkati chomwe chili ndi levonorgestrel,
Kudzifunira Opaleshoni Yothandiza

Source: Chidziwitso cha zipatala "Ma algorithms a chithandizo chapadera cha odwala omwe ali ndi matenda a shuga", okonzedwa ndi II. Dedova, M.V. Shestakova, kope 6, 2013.

Ngati mayi yemwe ali ndi matenda ashuga ali ndi zotsutsana zokwanira kuchipatala, ndiye kuti ayenera kuchitidwa opaleshoni yodzifunira. Zomwezo ngati "mwathetsa kale ntchito zanu zoberekera."

Njira zophatikiza zakulera za pakamwa (COCs) ndi mapiritsi oteteza kubala omwe ali ndi mitundu iwiri ya mahomoni: estrogens ndi progestins. Estrogen m'mapiritsi oteteza kubala amakwanira kuperewera kwa estradiol, kapangidwe kazachilengedwe komwe kumapanikizidwa m'thupi. Chifukwa chake, kuwongolera kwa kusamba kumapitilizidwa. Ndipo progestin (progestogen) imaperekanso njira zolerera za ma COC.

Musanagwiritse ntchito njira yolerera ya mahomoni, kaonaneni ndi dokotala ndikukuwunika. Awa ndi mayeso am magazi a ntchito ya platelet, AT III, factor VII ndi ena. Ngati mayeserowa atakhala oyipa - njira yoletsa kubereka siyabwino kwa inu, chifukwa pali chiopsezo cha venous thrombosis.

Pakadali pano, njira zakulera zophatikizira pakamwa ndizodziwika kwambiri padziko lonse lapansi, komanso mwa azimayi omwe ali ndi matenda ashuga. Zifukwa zake:

Ma COC amateteza modziteteza ku mimba zosafunikira,
Nthawi zambiri amaloledwa ndi akazi,
atayimitsa mapiritsi, azimayi ambiri amatenga pakati pakatha miyezi 1 mpaka 12,
kumwa mapiritsi ndikosavuta kuposa kumangowerenga kumene, kupanga jakisoni, ndi zina zambiri,
njira yolerera yothandizira imakhala ndi zowonjezera zowonjezera zowonjezera komanso prophylactic.

Contraindative kugwiritsa ntchito limodzi pakamwa kulera azimayi omwe ali ndi matenda ashuga:

Matenda a shuga salipidwa, i.e. shuga amawonjezereka,
kuthamanga kwa magazi pamtunda wa 160/100 mm RT. Art.
dongosolo lotsekemera limaphwanyidwa (kutulutsa magazi kwambiri kapena kuchuluka kwa magazi),
zovuta zamatenda a shuga atapangidwa kale - proliferative retinopathy (2 zimayambira), matenda a shuga a nephropathy pa gawo la microalbuminuria,
wodwala alibe luso lokwanira kudziletsa.

Zotsatira za kutenga ma estrojeni ngati gawo limodzi la njira zakulera zapakamlomo:

chiopsezo chowopsa cha magazi ndi kufinya kwa mitsempha yamagazi (pimani mayeso ndikufufuza!),
wapeza matenda amisala,
matenda a chiwindi (hepatitis, Rotor, Dabin-Johnson, Gilbert syndromes, cirrhosis, matenda ena omwe amakhala ndi matenda a chiwindi).
kutulutsa magazi kumiseche, zomwe sizimveketsa bwino,
zotupa zodalira mahomoni.

Zinthu zomwe zimawonjezera chiopsezo cha mavuto a estrogen:

kusuta
ochepa matenda oopsa,
zaka zopitilira 35
kunenepa kwambiri kuposa madigiri 2,
cholowa chovuta mu matenda a mtima, i.e.banja panali zochitika za matenda a mtima kapena sitiroko, makamaka osakwana zaka 50,
mkaka wa m'mawere (yoyamwitsa).

Kwa amayi omwe ali ndi matenda ashuga, njira yotsika ndi yokhala ndi kachulukidwe kakang'ono kamakhala koyenera.

Ma COC ochepera - okhala ndi zochepa za 35 μg za estrogen. Izi zikuphatikiza:

monophasic: "Marvelon", "Femoden", "Regulon", "Belara", "Jeanine", "Yarina", "Chloe",
Gawo lachitatu: "Tri-Regol", "atatu-Merci", "Trikvilar", "Milan".

Ma COC osakanizidwa - amakhala ndi 20 mcg kapena kuchepera kwa gawo la estrogen. Izi zikuphatikiza kukonzekera monophasic "Lindinet", "Logest", "Novinet", "Mercilon", "Mirell", "Jacks" ndi ena.

Kwa amayi omwe ali ndi matenda ashuga, njira yatsopano kwambiri yolerera kubereka ndi KOK, yomwe ili ndi estradiol valerate ndi dienogest, yokhala ndi mtundu wamphamvu wa "Klayra").

Njira zonse zophatikizira zakulera pakamwa zimakulitsa milingo ya triglyceride m'magazi. Koma ichi ndi chiopsezo chokhacho kwa azimayi omwe kale anali ndi hypertriglyceridemia asanamwe mapiritsi. Ngati mayi ali ndi dyslipidemia wolimbitsa thupi (kuchepa kwamafuta metabolism), ndiye kuti ma COC amakhala otetezeka. Koma pakudya kwawo, muyenera kumayesa magazi pafupipafupi kwa triglycerides.

Njira yachikazi yogwiritsira ntchito mahomoni a steroid yoletsa kubereka, pazifukwa zambiri, ndibwino kuposa kumwa mapiritsi. Kutulutsa kwa mahomoni m'mwazi kumakhala kosasunthika. Zinthu zomwe sizikuchita zimawonekera padera kudzera m'chiwindi, monga m'mapiritsi. Chifukwa chake, mukamagwiritsa ntchito njira zakulera zamkati za amayi, kuchuluka kwa mahomoni tsiku ndi tsiku kumatha kuchepetsedwa.

Mphete yam'mimba ya NovaRing imakhala yoletsa kubereka mwa mawonekedwe a mphete yowonekera, masentimita 54 mm ndi mainchesi 4 mm pamagawo a mtanda.Kuchokera pamenepa, ma microgram 15 a ethinyl estradiol ndi ma microphs a etonogestrel amatulutsidwa mu nyini tsiku lililonse, iyi ndi metabolite yogwira ya desogestrel.

Mzimayimayala payekhapayekha amaloza mphete yoletsa kubereka kudzera mu nyini, mopanda kuchitapo kanthu. Iyenera kuvalidwa masiku 21, ndiye yopuma masiku 7. Njira yolerera yolerera imakhudza kwambiri kagayidwe kazakudya zamafuta ndi mafuta, ofanana ndi microdosed ophatikizana am'kamwa.

Mphete yam'mimba ya NovaRing imasonyezedwa makamaka kuti imagwiritsidwa ntchito ndi azimayi omwe shuga imaphatikizidwa ndi kunenepa kwambiri, magazi okwera a triglycerides kapena matenda a chiwindi. Malinga ndi kafukufuku wakunja, zikuwonetsa zaumoyo wamkati sizimasintha pamenepa.

Zikhala zothandiza kukumbukira kuti azimayi omwe ali ndi kunenepa kwambiri komanso / kapena shuga wambiri chifukwa cha matenda ashuga amakonda kwambiri candidiasis vulvovaginitis. Izi zikutanthauza kuti ngati muli ndi thrush, ndiye kuti siyosavuta kugwiritsa ntchito njira yakulera ya NovaRing, koma yafika pazifukwa zina.

Njira zakulera za intrauterine zimagwiritsidwa ntchito ndi azimayi 20% omwe ali ndi matenda ashuga. Chifukwa njira yolerera yodalirika ndi nthawi yomweyo imateteza motsutsana ndi pakati posakonzekera. Amayi amakhala omasuka kwambiri kuti safunikira kuyang'aniridwa mosamala tsiku lililonse, monga kumwa mapiritsi a kulera.

Zowonjezera za njira zakulera za intrauterine za matenda ashuga:

siziwonjezera chakudya ndi mafuta kagayidwe,
Musachulukitse mwayi wamagazi ndikutseka magazi.

Zoyipa zamtundu uwu wa kulera:

azimayi nthawi zambiri amakhala ndi kusamba kwa msambo (hyperpolymenorrhea ndi dysmenorrhea)
chiopsezo chowonjezereka cha ectopic mimba
Nthawi zambiri matenda opatsirana a m'chiberekero amapezeka, makamaka ngati ali ndi shuga m'magazi a shuga amakhala wambiri.

Amayi osabereka samalimbikitsidwa kuti azigwiritsa ntchito njira zakulera za intrauterine.

Chifukwa chake, mwaphunzira zifukwa zomwe mungasankhire njira imodzi kapena ina yoletsera kulera. Mkazi wazaka zobereka azitha kusankha yekha njira yoyenera, onetsetsani kuti mukugwira ntchito ndi dokotala. Nthawi yomweyo khalani okonzeka kuyesa njira zingapo mpaka mutasankha njira yabwino kwambiri.

Njira zakulera za matenda a shuga 1: A mpaka Z

Mbiri ya kulera kwa akazi ndi amuna idayamba zaka masauzande ambiri. Njira zambiri zamakono zakulera zinali ndi machitidwe awo zaka mazana angapo zapitazo. Tikukhala munthawi yomwe kugonana pakati pa mwamuna ndi mkazi ndi kotheka popanda kutenga pakati. Pakadali pano, pali kusankha kwakukulu kwa njira zakulera, kutengera zofuna zanu, moyo wanu ndi kusowa kwa zotsutsana.

Komabe, vuto la kulera pakati pa matenda ashuga 1 sikuti limangophikidwa ndi madokotala omwe amapezekapo, ndipo pali zambiri zambiri zotsutsana pa intaneti. Pali mafunso ambiri omwe simumapeza mayankho nthawi zonse. Kodi njira zakulera ndizothandiza bwanji? Njira iti yothandiza kwambiri? Kodi amaloledwa kukhala ndi matenda ashuga? Kodi zingayambitse kuwonongeka kwa milingo ya shuga, kumayambiriro kapena kukula kwa zovuta za matenda ashuga? Kodi "kuvulaza" ndikugwiritsa ntchito bwanji mankhwala a mahomoni? Momwe mungasankhire njira yoyenera ine? Kodi zitha kunditeteza bwanji? Ndi mafunso ena ambiri. Munkhaniyi tiyesera kuyankha ambiri a iwo.

Kulera (kuchokera ku novolat. "Contraceptio" - makalata. - kupatula) - kuletsa kutenga pakati ndi makina, mankhwala ndi njira zina zakulera.

Kusankha njira yolerera, tiyenera kupeza bwino pakati pa kugwiriridwa kwa njirayo, kuopsa kwake ndi zotsatirapo zake, malingaliro okonzekera kutenga pakati ndi zomwe amakonda.

Amayi onse amisinkhu yokhala ndi matenda a shuga kapena opanda matenda a shuga amawagawa m'magulu awiri: omwe akufuna kukhala ndi pakati komanso omwe safuna kukhala ndi pakati. Kwa amayi omwe akukonzekera kukhala ndi pakati, ndikofunikira kuti akonzekere moyenera pamodzi ndi endocrinologist ndi dokotala wazachipatala. Kumbukirani kuti kutenga pakati kumachitika ndi kuchuluka kwa hemoglobin yayikulu komanso kusowa kwa chipukutiro cha matenda ashuga, kuopsa kwa kusiyana kwa kubereka kwa ana, zovuta za pakati komanso kubereka kumawonjezeka. Chifukwa chake, ndikofunikira kukonzekera pakati ndipo nthawi yakukonzekera gwiritsani ntchito njira yoyenera yolerera kwa inu. Kwa amayi omwe sakukonzekera kutenga pakati, nkhani yoletsa kulera ndiyofunikanso kupewa mimba yosafunikira.

Palibe njira zakulera zomwe zimaphatikizidwa kwathunthu mu shuga. Popeza kuchuluka kowopsa kwa mwana wosabadwayo ndi mayi panthawi yapakati yosakonzekera, njira zomwe zimagwira bwino ntchito kwambiri zimasankhidwa. Chofunikira kwambiri chachipatala chomwe chimasankha kusankha njira zolerera ndi kukhalapo kwa zovuta zamatenda a mtima. Pazifukwa izi, muyenera kuyesedwa ndi dokotala musanasankhe njira yodzitetezera. Palibe chifukwa chomwe mungayambire kutenga njira za kulera nokha.

Mukamasankha njira yodzitetezera, ndikofunika kuti muziiganizira za chitetezo chake komanso chitetezo chake. Kuti muwone kuyendetsera bwino kwake, cholozera chimagwiritsidwa ntchito chomwe chikuwonetsa kuti ndi azimayi angati mwa zana omwe adakhala ndi pakati pogwiritsa ntchito njira imodzi kapena ina yolerera kudzera chaka chimodzi. Palibe njira imodzi yomwe ilipo 100% yothandiza. Kumbukirani kuti posatengera kulera mwa amayi 100, opitilira 80 amakhala ndi pakati chaka chimodzi. Kudalirika kwa njira zambiri zotetezera kumatengera kulondola kwa kugwiritsidwa ntchito kwawo.

Muyenera kudzisankhira nokha nthawi yomwe mayi sangathe kukhala ndi pakati - mwezi, chaka, zaka 10, kapena simukonzekera ana konse. Pali njira zakulera zazifupi komanso zazifupi.

Kuti kulera kwa nthawi yayitali kuphatikiza zida za intrauterine ndi zodulira zam'mimba. Njira zakulera izi sizitanthauza kuti mukhale nawo pachiwonetsero ndipo ndinu otetezeka, kuphatikizapo matenda ashuga amtundu 1. Kukhazikitsa kwawo kumatenga mphindi zingapo, kupereka njira yodalirika yolerera.