Phantse isiqingatha sabo konke ukukhulelwa okungalindelekanga kubangelwa ngabasetyhini abalisa ukusetyenziswa kwemithi ngexesha lokukhulelwa kwabo. Uphando lubonise ubudlelwane phakathi kweepilisi zokulawula ukuzalwa kunye nesisindo - ukuba ubunzima besifazana bungafaka isandla ekuphumeleleni komlomo. Ukukhulelwa okungenakulungiswa kunye nokukhuluphala kukumela izifo zengxaki ezithintekayo eUnited States. Abasetyhini bafanele baqonde ukuba ukukhuluphala nobunzima kunokunciphisa ukuphumelela kwipilisi yokulawula ukuzalwa.
Nangona iipilisi zolawulo lokuzalwa ziba yindlela eyaziwayo kakhulu yokuthintela ukukhulelwa, ukuphumelela kwabo kunokuthi bancitshiswe kunabesifazane abakhulu.
Ubume bangoku
Ukunyuka kwamatyala kuye kwanda kwiminyaka engama-25 edlulileyo. Enyanisweni, ngokwesiZiko seSizwe seMpilo yeeNtsholongwane, ukunyamezela kuyaqhubeka kuyinkxalabo yezempilo kawonkewonke eMelika nasehlabathini lonke. Ngo-2005 ukuya ku-2006, abantu abangaphezu kweyesithathu kwabase-US (abantu abangaphezu kwezigidi ezingama-72) babalwa njengobunzima. Olu pho nonongo luye lwabonisa ukuba i-35.3% yabasetyhini bahluthe ukunyanya. Ngomxholo ofanayo, malunga no-34% wabantu abadala base-US (27.4% yabesifazane) babeza kuthathwa njengongaphezulu komzimba. Ubutyebi buchazwa njenge-index mass mass (BMI) engama-30 okanye ngaphezulu kodwa umntu ogqithise ngokweqile une-BMI ye-25 ukuya ku-29.9. I-BMI ibalwa ukusuka kwisisindo somntu kunye nokuphakama kwayo kwaye inikezela isalathisi esilungeleyo sokunyusa umzimba kunye neemeko zesisindo ezinokubangela iingxaki zempilo.
Imvelaphi
Ngaphambi kweHolt et al. ukufundisisa, kwakukholelwa ukuba ubunzima bomzimba abuzange bube nempembelelo ekusebenzeni kwepilisi yokusebenza. Esi sigqibo sisekelwe ngokusisiseko kwisifundo se-Oxford Family Planning Association esashicilelwe ngo-2001. Abaphandi abafumananga ubudlelwane phakathi kobunzima bomzimba kunye namazinga okuhluleka kokukhulelwa komlomo (emva kokulungelelanisa iminyaka kunye nobunye).
Nangona kunjalo, i-75% yabasetyhini kulesi sifundo babesebenzisa iipilisi zokulawula ukuzalwa eziqulethe ngaphezu kokulingana no-50 mcg we-estrogen. Iziphumo ezivela kulesi sifundo akunakusetyenziswa kwixesha langoku lokusetyenziswa komlomo ngomlomo ngenxa yokuba (ngaphandle kweempawu zepilisi ezincinci), ininzi yezihlanganisi zokulawula iipilisi ziqulethe i-30 ukuya kwi-35 mcg ye-estrogen kunye ne-esterogen ephantsi (20 mcg) iintlobo ziyafumaneka.
Uphando olutsha
Holt et al. iqhube isifundo esiphezulu kwimeko yokufunda ngoku, ukuhlola ukudibanisa phakathi kobunzima kunye nokuhluleka kokukhulelwa komlomo . Baphetha ukuba abafazi abasebenzisa iipilisi zokulawula ukuzalwa (xa kuthelekiswa nabasetyhini besisindo esiphantsi), abo banesisindo esiphezulu bangama-60% amathuba okukhulelwa ngelixa abo banama-70% banakho amathuba okufumana ukungaphumeleli kokukhulelwa. Ngokukodwa, ukuxhamla phakathi kwamapounds angaphezulu kunye neepilisi ukuhluleka kokuqala kubonakala phakathi kwabafazi abangaphezu kwamandla amaninzi anama-BMI angama-27.3 okanye ngaphezulu (oku kuya kufana ne-5-foot-foot, 4-intshikazikazi olinganisa iipounds ezili-160 okanye ngaphezulu). Ngaloo ndlela, abasetyhini abasebenzisa ngokuqhubekayo izithintelo zokukhulelwa komlomo kunye ne-BMI yabo enkulu kunama-27.3 ayenamaxesha angama-1.58 mngcipheko wokukhulelwa xa kuthelekiswa nabasebenzisi abasebenzisayo abane-BMI abangaphantsi kwe-27.3.
Kwakhona, owesifazane ogqithiseleyo kunokwenzeka ukuba angakwazi ukufumana ukungaphumeleli kokukhulelwa komzimba xa ephuthelwa ipilisi yakhe yansuku zonke. Kubalulekile ukuqaphela, nangona kunjalo, izinto ezibandakanya ukuphakama, ubunzima, ukubambelela kwishedyuli yolawulo lokuzalwa, kunye nokuphindaphindiwe kwesondo ngokobulili bezinto ezizibiweyo kulolu cwaningo. Oku kuthetha ukuba iziphumo ezingachanekiyo zinokwenzeka ngenxa yokunika ingxelo engafanelekanga.
Ucwaningo olwenziwa ngo-2007 olwenziwa nguBrunner, uHuber, kunye neToth lubonisa ubuthathaka, nangona kungabalulekanga, ubudlelwane phakathi kokukhuluphala nokulahla kwepilisi. Iziphumo zabonisa ukuba abafazi abagqithisileyo (BMI ≥ 30) banomngcipheko ophezulu wokukhulelwa.
Sekunjalo, emva kokuba abaphandi bahlengahlengele ixesha, ubuhlanga / ubuhlanga, kunye nobufazi besifazane, baqukumbela ukuba akukho mhlangano phakathi kobunzima kunye nokungaphumeleli komlomo. Abaphandi bacebisa ukuba isifundo sabo singenokuba neziphumo eziphosakeleyo kuba kunokuba kunzima ukulinganisa nokulinganisa uphando kuthatha inxaxheba, iziphumo zisekelwe kwi-self-report of women's height and weight. Ngenxa yokuba abafazi bathambekele ngokugqithiseleyo-babike ukuphakama kwabo kwaye bangaphantsi kwengxelo yabo ubunzima ngamapounds ambalwa, i-BMI ingenakulungile. Ekugqibeleni, abaphandi babengenalo ulwazi ngobudlelwane besondo okanye nokuba ngaba abafazi bebengathathi rhoqo iipilisi zabo; Ukungabikho kokubandakanywa kwezi zinto kunokubaluleka ngokucacileyo iziphumo zolu cwaningo, kwaye abaphandi banokugqiba ukuba kukho iimfuno ezikhulu, ezibanzi kunokuba zifumane impendulo ecacileyo malunga nokuba ukunyamezela kunendima ebalulekileyo ekusebenzeni komlomo ngomlomo.
Kutheni iPilisi ingasebenzi kakuhle
Ngelishwa, isizathu esona sizathu sokuthi kutheni ukugqithisa ngokweqile kunye / okanye ukugqithisa kwabasetyhini banomngcipheko omkhulu wokungaphumeleli ngomlomo akungaziwa ngokupheleleyo. Nangona kunjalo, iingcamango ezininzi ezicetywayo zibhekiselele kwizinto eziphilayo ezinokuthi zilandele ingozi enkulu:
- Amanqanaba eHormone: Iipilisi zokulawulwa kokuzalwa kwamhlanje ziqukethe ama- hormone aphantsi (xa kuthelekiswa nalawo aqalayo eminyaka eminyaka edlulileyo). Abavelisi bokukhulelwa ngomlomo baye bancipha amazinga e-hormone kwisilingo sokunciphisa imiphumo engafunekiyo engafanelekiyo, njengengozi yamacandelo egazi, inzuzo yesisindo, kunye neentloko. Ukuze kusebenze, ama-hormone epilisi kufuneka ajikeleze ngegazi lomfazi. Ukuba ibhinqa inomzimba omkhulu, kunokuba kunzima ukuhambisa ukujikeleza okwaneleyo ukuba kwenzeke, ngokukodwa kunikwe izinga elingaphantsi kwamahomoni atholakala kwiipilisi ezininzi namhlanje.
- I-Metabolism: Ngokuqhelekileyo, abafazi abanzima kakhulu baneemetabolism eziphezulu, ngoko i-hormone yeepilisi ingasetyenziswa ngokukhawuleza. Ngoko ke, ngokugqithiseleyo umfazi ulinganisa, iphakamileyo yesilinganiselo sesisombululo; oku kunganciphisa ixesha lokusebenza kweepilisi.
- Ama- Enzyme ye- Liver: Abafazi abangaphezu kwamandla amaninzi banokufumana umgaqo-miselo wesibindi semetabolism; ezi nqanaba eziphezulu ze-enzymes zinokukunceda ukuphula ii-hormone kwi-contraceptive ngomlomo. Abafazi abanzima kunokuba banomlinganiselo omkhulu wegazi kunye nomzimba. Ngenxa yokuba kunezicubu ezininzi apho igazi kufuneka lijikeleze kwaye amathuba okuba ama-enzyme aya kuphuhla ama-hormone ngokukhawuleza, amanqanaba e-hormone ajikelezayo angancipha.
- Ukugcinwa kweHormone: Amahomoni, i- estrogen kunye neprogesin , etholakala kwiipilisi zokulawula ukuzalwa zigcinwa ngamafutha omzimba. Ngaloo ndlela, iiseli ezinamafutha amaninzi, i-hormone yeepilisi inamathuba amaninzi athatyathwa ngamanqatha endaweni yokuhamba ngegazi lakhe.
Kuthetha Kanjani Oku Konke?
Ngaba kufuneka sichaze uphando ukuba uthethe ukuba abafazi abagqithisileyo kufuneka baphephe ukusetyenziswa kweepilisi zokulawula ukuzalwa? Oku akumele kube yimpendulo. Enyanisweni, ukusetyenziswa kokusetyenziswa komlomo okanye ukukhulelwa komlomo (nakwindoda ekhuselekileyo kakhulu) kuya kuhlala kuphakamileyo. Phakathi kwabangama-100 abafazi abathatha i-contraceptive ngomlomo omnye ngonyaka, uvavanyo lukaHolt et al (2005) lubonisa ukuba abesetyhini abongezelelekileyo babini baya kukhulelwa ngenxa yokugqithisa okanye ukugqithisa. Nangona kunjalo, lo mngcipheko wokukhulelwa unokulingana nenani eliphakamileyo leengxaki zokukhulelwa, ezinokubandakanya isifo sikashukela, ukunyamezela kwegazi kunye nokunikezelwa kwe-Caesarea.
Apho ibeka khona
Abanikezeli abaninzi bezempilo bayakhetha ukuchasana nokunciphisa ukuphumelela kweepilisi ngokubeka abafazi abangaphezu komzimba kunye nabagqithisileyo kwiipilisi zokulawula ukuzalwa kokuzalisa i-dose kunokuba i-brand ye-dose ephantsi ukwenzela ukuqinisekisa ukuba kukho i-hormone eyaneleyo yokuvimba ukuvutha.
Ukuba uzifumanisa kule meko, kubalulekile ukuxoxa ngazo zonke iinketho zakho kunye nemeko yobungozi kunye nogqirha wakho. Ekubeni abafazi abangaphezu kwesisindo sinokuthi banakho amathuba okuba nesifo sengqondo somngcipheko kunokuba besetyhini abaqhelekileyo, umthamo ophezulu wokukhulelwa komlomo ungakhuthaza le mngcipheko womoya. Ngokomzekelo, uphando lubonakaliswe khona ukuba kubekho ingozi ye-thromboembolism ye-venous (i-blood clots) phakathi kwabasetyhini abagqithisileyo abasebenzisa iipilisi zokulawula ukuzalwa. Ngako oko, ugqirha unokufuna ukugcina umfazi ogqithiseleyo kwiipilisi zokulawula ukuzala ngokuqhelekileyo kunye nemiyalelo yokusebenzisa indlela yokulondoloza yokulawula ukuzalwa ukuqinisekisa ukukhusela ukhuseleko lokukhulelwa. Kule meko, iindlela zokukhawulela ezinjengamakhondom esilisa okanye amabhinqa , isiponji , okanye i- spermicide ingasetyenziswa ngokubambisana nepilisi. Ekugqibeleni, ukuba owesifazane ogqithiseleyo uye wagqiba ekubeni akafuni ukuba nabantwana, isimo esingasigxina sokukhulelwa kwezilwanyana ezifana ne- tubal ligation okanye i-hysteroscopic ( non-surgical ) inzalo, njenge- Essure .
Ngaphantsi
Njengoko kunxibelelwano oluncinane phakathi kobunzima obuphezulu kunye nolawulo lokulawula umzali , kubalulekile ukuxoxa ngale nkonzo kunye nomboneleli wakho wezempilo. Kwakhona, ukususela ekuqaleni kokumiselwa kwepilisi, ukuba uyaphawula ukuba ubunzima bakho buye benyuka phezulu (mhlawumbi, mhlawumbi ubuncinane ubunxibe beengubo ezimbini), qinisekisa ukwazisa umboneleli wakho wezempilo ukuze aqiniseke ukuba le ndlela isona sisona esona sisebenze ngokukhuselekileyo kwaye sikhuselekileyo inketho yokukhulelwa kwakho.
> Imithombo:
> Brunner Huber, uLR & Toth, JL (2007). Ukunyaniseka kunye nokungaphumeleli komlomo komlomo: Iziphumo ezivela kwiNgxelo yeSizwe yoKhula kwe-2002. I-American Journal ye-Epidemiology, 166 (11), 1306-1311.
> Holt et al. (2005). I-Index Mass Mass, Isisindo, kunye nokungaphumeleli komlomo. Abagqithisi kunye neGynecology, 105 (1), 46-52.
> Ogden, CL, uCarroll, MD, McDowell, MA, kunye noMthetho, uKM (2007). Ubuthakathaka phakathi kwabantu abadala eUnited States - Akukho shicilelo oluphawulekayo ukususela ngo-2003-2004 .
> Vessey, M (2001). Ukungaphumeleli komlomo kunye nokuPhathwa komzimba: Iziphumo kwiSifundo esiPhakamileyo samaqela. Umbhalo woCwangciso loNtsapho kunye noNonophelo lwezeMpilo yoBubele, 27 (2), 90-91.