Kkontracepciis bunebrivi meTodebi

swavleba grZeldeba didi xnis manZilze, rac moiTxovs treneris(konsultantis, eqimis) sakmaod did dros; qalisTvis momabezrebelia fertilobis niSnebis yoveldRiurimeTvalyureoba; sqesobrivi abstinenciis xangrZlivi periodi wyvilebs xSiraduqmnis sirTules da fiziologiur stress; araregularuli menstrualuri ciklis mqone qalebisaTvis meTodisgamoyeneba rTulia; fertilobis simptomebis dadgena rTulia meZuZuri qalebisTvis.Cvenebebikontracepciis bunebriv meTodebs iyeneben is wyvilebi, romelTac ar surTkontracepciis sxva meTodebis gamoyeneba, vinaidan: eSiniaT gverdiTi movlenebis ganviTareba; religiuri an tradiciuli mizniT; kontracepciis sxva meTodebi araxelmisawvdomia.mdgomareobebi, romlebic moiTxoven gansakuTrebul yuradRebas:zogierTi garemoeba moiTxovs gansakuTrebul yuradRebas kontracepciisbunebrivi meTodis konsultirebisas: maRalefeqturi dacva orsulobisgan (rodesac qalis janmrTelobasafrTxis qveSaa) abstinenciis SeuZlebloba.gansakuTrebuli garemoebebikontracepciis bunebrivi meTodebis gamoyenebisas aucilebeliagansakuTrebuli midgoma momxmarebelTa garkveul jgufebSi.mozardebimozard gogonebsa da qalebSi xSiria anovulatoruli ciklebi, rackontracepciis aRniSnuli meTodis gamoyenebis sirTules qmnis. garda amisa,axalgazrdebs uWirT saTanado periodSi TavSekaveba.2

eqimebs.reproduqtologs, mean-ginekologs, ojaxis eqims, pirveladi jandacviskalendaruli anu ritmuli (ogino-knausis) meTodiganmartebakontracepciis bunebriv meTodebs Soris yvelaze farTod gamoiyenebakalendaruli meTodi. meTodi emyareba menstrualuri ciklis drosfertiluri dReebis dadgenas. meTods gaaCnia sakmaod didi warumateblobismaCvenebeli (4, xarisxi A).Cvenebebi:qalebi, romelTac aqvT regularuli menstrualuri cikli, vinaidan esmeTodi ar saWiroebs fertilobis niSnebze yovedRiur meTvalyureobas.mdgomareobebi, romlebic aucileblad unda iqnas gaTvaliswinebuli: araregularuli cikli; ZuZuTi kveba (2, 4, xarisxi A).konsultireba da informirebaimisaTvis rom miRebuli iqnas srulyofili informacia, gaanalizebuli undaiqnas 6 menstrualuri ciklis maCveneblebi, am informaciis damuSavebis Semdegqals SeuZlia gamoyenos arahormonaluri kontracepcia (kontracepciishormonalurma meTodebma SesaZloa gavlena iqonios qalis menstrualuriciklze) (1, 2, 4, xarisxi A)instruqcia klientebisTvisklienti (momxmarebeli) informirebuli unda iyos, rom: 6 Tvis ganmavlobaSi unda aRiniSnos menstrualuri ciklis pirvelidRe; 6 Tvis ganmavlobaSi dadgenili unda iqnas yvelaze xangrZlivi daxanmokle menstrualuri cikli (eqimTan mimarTvamde an eqimTankonsultaciis Semdeg) pirveli fertiluri dRis dadgenisaTvis yvelaze moklemenstrualur cikls akldeba 184

pirveli fertiluri dRe= xanmokle menstrualuri cikls gamovakloT18 bolo fertiluri dRis gamosaTvlelad xangrZliv menstrualurcikls akldeba 11bolo fertiluri dRe=xangrZliv menstrualur cikls gamovakloT 11 sqesobrivi kontaqtisgan TavSekaveba saWiroa fertiluri fazisdros. magaliTad, Tu bolo eqvsi menstrualuri ciklisxangrZlivoba iyo Semdegi: 28, 26, 29, 27, 29 da 27.fertiluri fazis pirveli dRe=26 - 18=8fertiluri fazis bolo dRe= 29-11=18amdenad, zemoaRniSnuli monacemebis mixedviT, sqesobrivi kontaqtisganTavSekaveba saWiroa menstrualuri ciklis 8-18 dReebis CaTvliT (1, 2, 4, xarisxiA).bazaluri temperaturis meTodiganmartebabazaluri temperaturis meTodi emyareba sxeulis temperaturis matebasovulaciis periodSi, rac ganpirobebulia yviTeli sxeulis mierprogesteronis sekreciiT.ovulaciis Semdeg sxeulis temperatura matulobs 0,5 0 C da SenarCundebaSemdegi menstruaciis dawyebamde. infertiluri periodi iwyeba mas Semdeg, ractemperatura moimatebs 3 dRe gadabmulad wina 6 dResTan SedarebiT (1, 2, 4,xarisxi A).Cvenebebibazaluri temperaturis meTodi misaRebia im wyvilTaTvis, rodesac: qalisTvis miuRebelia cervikaluri lorwos (bilingsis) meTodi; wyvilebs SeuZliaT Tavi Seikavon sqesobrivi kavSirisgan garkveuliperiodis ganmavlobaSi; Tu qals aqvs araregularuli menstrualuri cikli da Tavs aridebskalendaruli meTodis gamoyenebas.instruqcia klntebisTvistemperaturis gazomva5

klients aucileblad ganumarteT Semdegi: Termometri unda idos sawolTan axlos, ise rom xeliT adviladSeZlos misi aReba; dawolamde vercxliswylis maCvenebeli unda iyos 35 0 C. diliT,temperaturis gazomvamde kargad unda Semowmdes, rom maCvenebeliiyos 35 0 C. winaaRmdeg SemTxvevaSi Termometri sasurvelmaCveneblamde unda miiyvanos qalis partniorma an sxva pirma,vinaidan zedmeti moZraobis Sedegad SesaZloa miRebuli iqnas cruCveneba ; temperatura gazomili unda iqnas gaRviZebisTanave, loginidanaudgomlad da civi an cxeli sasmelis miRebamde. Tu qalimuSaobis Ramis ganmavlobaSi, maSin SesaZloa dRis manZilze ansaRamos, aucileblad 3 saaTis mosvenebis Semdeg; temperatura unda gaizomos erTsa da imave dros; temperatura SeiZleba gaizomos oraluri, vaginaluri anreqtaluri gziT. ufro mosaxerxebelia reqtaluri da vaginaluri.- oraluri gazomvisas Termometris Tavi moTavsebuli undaiqnas enis qveS 5 wuTis ganmavlobaSi;- reqtaluri gazomvisas: gamoyenebul unda iqnas reqtaluriTermometri, romlis bolozec wasmuli unda iqnas vazelinismalamo, qali unda iwves gverdze, muxlebSi moxrili,Termometri swor nawlavSi unda Sevides 2,5sm siRrmeze 3wuTis ganmavlobaSi.- vaginaluri gazomvisas: Termometri saSoSi unda moTavsdes4,5sm siRrmeze 3 wuTis ganmavlobaSi. yovelTvis gamoyenebuli unda iqnas temperaturis gazomvis erTida igive gza; daafiqsirebuli unda iqnas Termometris maCvenebeli; Termometri unda gaiwmindos grili wyliT.ovulatorul cikls axasiaTebs orfaziani temperatura. sxeulisbazaluri temperatura dabalia ovulaciamde, matulobs ovulaciis Semdeg 0,2-0,4 0 C –iT an ufro metiT da SenarCundeba Semdegi menstrualuri ciklisdasawyisamde (1,4, xarisxi A).6

sqesobrivi kavSiris periodebisqesobrivi kontaqtisgan TavSekavebaa saWiro menstrualuri ciklispirveli dRidan sxeulis bazaluri temperaturis momatebamde gadabmulad 3dRis manZilze. amis Semdgomi periodi menstruaciis dasawyisamde iTvlebausafrTxod (1, 2, 4, xarisxi A).faqtorebi, romlebic moqmedeben sxeulis bazalur temperaturazearsebobs ramodenime garemoeba, romelic ganapirobebs sxeulistemperaturis matebas: temperatura gazomilia drois sxva monakveTSi; temperaturis gazomvisas ar aris daculi pirobebi; sxvadasxva avadmyofoba; mSofTvare Zili; garemos temperaturis cvlileba; emociuri stresi; alkoholi.saSvilosnos yelis lorwos (bilingsis) meTodiganmartebasaSvilosnos yelis lorwos meTodi dafuZnebulia cervikaluri lorwosciklur cvlilebebze, rac ganpirobebulia estrogenebis sekreciis cikluricvlilebebiT.menstrualuri ciklis ganmavlobaSi saSvilosnos yelis lorwo ganicdiscvlilebas. wyvilebs, romlebic iyeneben bunebrivi kontracepciis am meTods,sqesobrivi kontaqti SeuZliaT hqondaT, rogorc pre- ise postovulatorulfazebSi, vinaidan mudmivad mimdinareobs dakvirveba cervikaluri lorwoscvlilebis xasiaTze (4, 8, xarisxi A).preovulatoruli faza menstrualuri periodis Semdgom iwyeba mSrali dReebi, am droscervikaluri lorwo sqelia da webovani an warmoqmnis sacobs, rac7

ablokirebs cervikalur arxs, am dros qals aqvs saSos simSralisSegrZneba da cervikaluri lorwo ar vizualizdeba; estrogenebis sekreciis matebasTan erTad, lorwo matulobs saSoSi,Tavdapirvelad is mwiri raodenobiTaa da qals aqvs sisvelis an vulviswebvadobis SegrZneba. lorwo aris sqeli, webvadi, mRvrie an bundovanida ar aris elastiuri; estrogenebis sekreciis matebasTan erTad dgeba ovulaciis faza,lorwos raodenoba xdeba Warbi da vulvis midamoSi sisvelisSegrZnebaa. lorwo aris Txeli, TeTri, gamWvirvale da Zalianelastiuri. Zalian hgavs mouxarSavi kvercxis cilas. cervikalurilorwos aseTi cvlileba miuTiTebs fertiluri fazis dadgomas; sveli lorwos bolo dRes uwodeben lorwos piks.postovulatoruli faza sisvelis SegrZneba qreba da isev iwyeba mSrali periodebi.Cvenebebicervikaluri lorwos meTodi misaRebia im wyvilebisaTvis, romlebsacsurT kontracepciis bunebrivi meTodis gamoyeneba, magram ver iyenebensxeulis bazaluri temperaturis meTods. (cervikaluri lorwos xasiaTisdasadgenad qali unda Seexos genitaliebs) (4, xarisxi A).mdgomareobebi, romlebic aucileblad unda iqnas gaTvaliswinebuli saSos an saSvilosnos yelis sxavadasxva infeqciebi; ZuZuTi kveba, romelic amcirebs da cvlis cervikaluri lorwos xarisxsda raodenobas.instruqcia klientebisTviscervikaluri lorwos xasiaTze dakvirveba: yuradReba eqceva SegrZnebas: simSrale, sinotive, sisvele. lorwosxasiaTi unda Semowmdes minimum dReSi orjer, diliT da saRamos; SeamowmeT saSoSi lorwos arseboba qaRaldis an TiTis saSualebiT; SeagroveT lorwo qaRaldze;8

aRniSneT maxasiaTeblebi: TeTri feri, mRvrie an sufTa, fizikurimaxasiaTeblebi: webvadoba, sisqe; elastiuroba unda Semowmdes qaRaldiT an TiTiT, Tu lorwo elastiuriaTu iweleba qaRaldis or furcels an or TiTs Soris, gawyvetis gareSe. lorwos xasiaTis cvlilebis dafiqsireba unda moxdes yoveldRiurad; aRniSneT elastiuri da sriala lorwos bolo dRe, rac iTvlebalorwos pikad da Semdgomi 3 dRe. lorwos pikis dadgena xdebaretrospeqtulad, rodesac lorwo aRar iqneba iseTi elastiuri, rogorcwina dReebSi (4,5 xarisxi ).sqesobrivi kontaqtis drosqesobrivi kontaqti nebadarTulia menstruaciis Semdeg cervikaluri lorwos pirvel niSnebamde; pikis Semdeg meoTxe saRamodan menstruaciis mosvlamde.rekomendirebulia sqesobrivi kontaqtisgan TavSekaveba cervikalurilorwos fazamdec, vinaidan zogjer sqesobrivma aqtivobam SesaZloagaarTulos cervikaluri lorwos mdgomareobis interpretireba (4, 5, xarisxiA).sqesobrivi kontaqti ar aris nebadarTuli: menstruaciis Semdeg cervikaluri lorwos gaCenidan pikis meoTxedRemde; nebismieri SemTxvevaSi, rodesac garTulebulia cervikalurilorwos xasiaTis dadgena.faqtorebi, romlebic moqmedeben cervikaluri lorwos xasiaTze vaginaluri an cervikaluri infeqcia; vaginaluri sekrecia, sqesobrivi stimulaciis CaTvliT; gaciebis da sinusitis samkurnalo preparatebi, romlebic iwvevencervikaluri lorwos simSrales; fizikuri da emociuri stresi; ZuZuTi kveba.9

simptoTermaluri meTodies meTodi aerTianebs bazaluri temperaturis, bilingsis da kalendarulmeTodebs (1, 2, xarisxi A).Sewyvetili sqesobrivi aqtimoqmedebs meqanizmi: sperma ar xvdeba saSoSi da ami gamo ar xdeba ganayofiereba;Sewyvetili sqesobrivi aqtis meTodis gamoyenebisas unda moxdes saSodanasos gamoReba eakulaciamde. am meTodis kontracepciuli efeqturoba Seadgens4-18 orsulobas 100 qalze weliwadSi (1, xarisxi A; 2, xarisxi A).Sewyvetili sqesobrivi aqtis kontracepciuli da arakontracepciuliupiratesobebi: efeqturia dauyovnebliv; SeiZleba gamoyenebuli iyos, rogorc damatebiTi kontracepciismeTodi kontracepciis sxva meTodis gamoyenebis wesebisdarRvevisas; ar saWiroebs maragis Sevsebas; ar axdens gavlenas qalis organizmze; ar saWiroebs finansur danaxarjebs; xels uwyobs ojaxis dagegmvaSi mamakacis monawileobas.Sewyvetili sqeobrivi aqtis naklovanebebi: efeqturoba damokidebulia wyvilis survilze gamoiyenon meTodiyvela sqesobrivi aqtis dros (4-18 orsuloba 100 qalze weliwadSigamoyenebis pirveli wlis ganmavlobaSi); efeqturoba SesaZlebelia ufro Semcirdes boloMeakulaciisSemdeg (< 24 sT) ureTraSi darCenili spermis gamo; SeiZleba Semcirdes seqsualuri dakmayofileba;10

ar icavs sqesobrivi gziT gadamdebi infeqciebisa dadaavadebebisagan (virusuli hepatiti B, aiv/Sidsi) (2, xarisxi A; 8,xarisxi A).literatura:1. reproduqciuli janmrTeloba, praqtikuli saxelmZRvanelo, prof. aA.xomasuriZis redaqciiT, Tbilisi, 2002 (xarisxi A )2. cercvaZe g., praqtikuli saxelmZRvanelo kontracepciaSi, Tbilisi, 2005(xarisxi A )3. Association of Professors of Gynecology and Obstetrics. APGO Women’s Healthcare EducationResource Network. Available at http://www.apgo.org/resourcenetwork/. (xarisxi A)4. International Planned Parenthood Federation, Medical and Service Delivery Guidelines for Sexualand Reproductive Healthcare Services, Third Edition, 2004. Available online: www.ippf.org(xarisxi A )5. Royal College of Obstetricians &Gynecologists, Faculty of Family Planning and ReproductiveHealth Care, UK Medical Eligibility Criteria for Contraceptive Use (UKMEC 2005/2006), 2006.Available at : www.fffprhc.org.uk (xarisxi A)6. Stanford J.B., Lemaire J.C. and Thurman P.B., Women’s interest in natural family planning, Journalof Family Practice 46(1):65-71, 1998 (xarisxi B)7. Upadhyay U.D. New Contraceptive Choices, Population Reports, Series M, No 19. Baltimore, JohnHopkins Bloomberg School of Public Health, The INFO Project, April 2005. Available online:http://www. populationreports.org. (xarisxi B)8. World Health Organization (WHO). Improving access to quality care in family planning: Medicaleligibility criteria for contraceptive use. 3d ed. Geneva, WHO, 2004 (xarisxi A)avtorebi: med. doqtori g. cercvaZe, med. doqtori m. WipaSvili,med. doqtori n. marsagiSvili11

protokoli “kontracepciis bunebrivi meTodebi”(gankuTvnilia reproduqtologebisTvis, mean-ginekologebisTvis,ojaxis eqimebisTvis)Ggamoyenebuli Semoklebebi:kal- kalendaruli meTodi: kalendaruli anu riTmuli meTodibt – bazaluri temperaturis meTodibil - bilingsis meTodig- gamoiyeneba - rodesac ar arsebobs winaaRmdegCveneba kontracepciisbunebrivi meTodis gamoyenebis mimarTs- sifrTxile, rodesac kontracepciis bunebrivi meTodis gamoyeneba saWiroebsgansakuTrebul sifrTxiles da konsultirebas konkretul garemoebaSi meTodissworad gamoyenebis mizniT.ag- ar gamoiyeneba kontracepciis bunebrivi meTodebi12

kategoriakomentarebiMdgomareobakal bt bilreproduqciuli sistemis funqcionirebis sxvadasxva etapiOrsuloba ag kontracepciis bunebrivi meTodi argamoiyenebacxovrebisperiodebia) menarxes Semdgomb) perimenopauzassssssmenarxes Semdgom da perimenopauzalurperiodSi menstrualuri cikliararegularulia, am dros saWiroagansakuTrebuli sifrTxilekontracepciis bunebrivi meTodebisgamoyenebisas.ZuZuTi kvebaa) < 6 kviramSobiarobidanb) > 6 kviramSobiarobidanagsagsagsZuZuTi kvebis periodSi amenoreisa dasakvercxeebis arasrulfasovanifunqcionirebis gamo, fertilobisniSnebi da normaluri hormonaluriparametrebis aRdgena SeiniSnebamSobiarobidan mxolod 6 Tvis Semdeg.fertilobis niSnebis aRdgenis albaTobaizrdeba mas Semdeg rac xdeba bavSvisxelovnur kvebaze gadayvana.g) menstrualuriciklis aRdgenisSemdegmSobiarobis Semdeg(Tu qali ZuZus arawovebs)a) < 4 kvira s g sssgfertilobis niSnebis aRdgenis(gansakuTrebiT cervikaluri sekreciis)Semdeg SesaZloa gamoyenebuli iqnassimptomuri meTodi. mSobiarobis Semdeg 3menstrualuri ciklis ganmavlobaSigamoyenebuli unda iqnas kontracepciisbarieruli meTodebi, mxolod amisSemdeg aris SesaZlebebli kontracepciisbunebrivi meTodebis, maT Soriskalendaruli meTodis gamoyeneba.kontracepciis bunebrivi meTodebinakleb efeqturia ZuZuTi kvebisperiodSi, sxva periodTan SedarebiT.Tu qali ZuZus ar awovebs, massakvercxeebis arasrulfasovanifunqcionirebis gamo fertilobisniSnebi da normaluri hormonaluriparametrebis aRdgena SeiniSnebamSobiarobidan mxolod 4 kviris Semdeg.13

vinaidan am periodSi orsulobis riskidabalia, gamoyenebuli unda iqnasmSobiarobis Semdgomi periodisTvismisaRebi meTodi.MdgomareobamSobiarobis Semdegkategoriasim bt bilkomentarebi> 4 kvira g ag g am periodisaTvis aRdgeba sakvercxeebisnormaluri funqcionireba, SesaZlebeliafertilobis niSnebis da/an normalaurihormonaluri parametrebis aRdgena.mSobiarobis Semdeg 3 menstrualuriciklis ganmavlobaSi gamoyenebuli undaiqnas kontracepciis Sesabamisi meTodi,mxolod amis Semdeg aris SesaZlebelikontracepciis bunebrivi meTodebisgamoyeneba.abortis Semdgomiperiodis ag s abortis Semdgom periodSi sakvercxeebinormalurad funqcionirebs daSesabamisad fertilobis niSnebisgamovlena SesaZlebelia, Tumcakontracepciis bunebrivi meTodebigamoyenebuli unda iqnas mxolodabortis Semdgom 3 menstrualuriciklis Semdeg.reproduqciuli sistemis infeqciebi da daavadebebiararegularulivaginalurisisxldenas s s am SemTxvevaSi kontracepciisbunebrivi meTodis gamoyenebamizanSewonili araris, mdgomareobis gaumjobesebamdegamoyenebuli unda iqnas barierulimeTodi.saSodan gamonadeni s gsvinaidan saSodan gamonadenisarsebobisas SeuZlebeliacervikalurisekreciis dadgena, saWiroa Sesabamisimkurnaloba da Semdgom kontracepciisim meTodebis gamoyeneba, romelic14

efuZneba cervikaluri lorwosgansazRvras.Mdgomareobasxvakategoriasim bt bilkomentarebipreparatebisgamoyeneba,romlebicmoqmedeben ciklisregulaciaze,hormonebissekreciaze da/anfertilur niSnebzes s s iseTma preparatebma, rogorebicaa:liTiumi, tricikluriantidepresantebi, zogierTiantibiotiki da anTebissawinaaRmdegopreparati, SesaZloa gavlena iqoniosciklis regulirebaze da fertilobisniSnebze. aRniSnuli preparatebiTmkurnalobisas gamoyenebuli undaiqnas kontracepciis barierulimeTodebi.daavadebebi,romlebicmimdinareobssxeulistemperaturismatebiTa) qronikulidaavadebebib) mwvave daavadebebiagsggggsxeulis temperaturis matebamSesaZloa gaarTulos sxeulisbazaluri temperaturisinterpretireba, Tumca ar axdensgavlenas cervikalur sekreciaze.amdenad, temperaturis maCveneblebzedamokidebuli meTodebis gamoyenebamdgomareobis gaumjobesebamde araris mizanSewonili. mniSvnelovaniaaRiniSnos, rom zogierTi qronikulidaavadeba moqmedebs menstrualuriciklis regularobaze, amdenad amSemTxvevebSi kalendaruli meTodisgamoyeneba araefeqturia.15

protokolikalendaruli anu ritmuli (ogino-knausis meTodi) 6 Tvis ganmavlobaSi unda aRiniSnos menstrualuri ciklis pirvelidRe; 6 Tvis ganmavlobaSi dadgenili unda iqnas yvelaze xangrZlivi daxanmokle menstrualuri cikli (eqimTan mimarTvamde an eqimTankonsultaciis Semdeg) pirveli fertiluri dRis dadgenisaTvis yvelaze moklemenstrualur cikls akldeba 18pirveli fertiluri dRe= xanmokle menstrualuri cikls gamovakloT18 bolo fertiluri dRis gamosaTvlelad xangrZliv menstrualurcikls akldeba 11bolo fertiluri dRe=xangrZliv menstrualur cikls gamovakloT 11 sqesobrivi kontaqtisgan TavSekaveba saWiroa fertiluri fazisdros. magaliTad, Tu bolo eqvsi menstrualuri ciklisxangrZlivoba iyo Semdegi: 28, 26, 29, 27, 29 da 27.fertiluri fazis pirveli dRe=26 - 18=8fertiluri fazis bolo dRe= 29-11=18amdenad, zemoaRniSnuli monacemebis mixedviT, sqesobrivi kontaqtisganTavSekaveba saWiroa menstrualuri ciklis 8-18 dReebis CaTvliT.16