Izimpawu eziningi zokulungiswa kobulili ezihlobene namacwecwe ziyancipha futhi azihlali njalo. Ikhanda (cishe 21% abasebenzisi), isicanucanu (cishe 17%), ukucasuka endaweni yokufaka isicwecwe (cishe 17%), ubuhlungu besifuba nokopha okungajwayelekile yizona ezivamile, futhi iningi liyancipha phakathi kwemijikelezo emibili kuya kwemithathu. Uhlu olufushane lwezimpawu, okubandakanya ukuvuvukala kwezinyawo nobuhlungu besifuba obungazelelwe, ludinga ukunakekelwa kosuku olufanayo.

ISIFINGOGO: Izinto Ezibalulekile

  • Ikhanda, isicanucanu, ubuhlungu besifuba, ukucasuka endaweni yesicwecwe nokopha yizikhalazo zokuqala ezilindelekile, futhi iningi liyazilahla phakathi kwemijikelezo emibili kuya kwemithathu.
  • Izimpawu zokulungiswa kobulili ezitholakala ezinakwecwe zokuqala ezibonwa kakhulu (ukopha, isicanucanu, isiyezi, umphetho wesicwecwe uphakama) kungabonisa isicwecwe esinganamatheli ngokuphelele kunokuba kube ama-hormone.
  • Ukuqala nganoma yiluphi usuku ngaphandle kosuku lokuqala lokuya esikhathini kusho izinsuku eziyisikhombisa zokuvimbela ukukhulelwa okungewona ama-hormone.
  • Ubuhlungu noma ukuvuvukala kwezinyawo, ubuhlungu besifuba, ikhanda elibukhali elingazelelwe noma ukulahlekelwa yimibono kusho ukunakekelwa okungajabule njalo, hhayi isonto lokulinda nokubona.
  • I-BMI, isisindo somzimba nesimo sokubhema siguqule ubungozi bempahla enenzuzo kakhulu kunokuthi ibinzana lokuqala linzima kangakanani.

Izimpawu ezivame kakhulu zokulungiswa kobulili ezilindelekile, futhi iningi liyancipha

Izimpawu ezivame kakhulu zokulungiswa kobulili ezihlobene namacwecwe yikhanda, isicanucanu, ubuhlungu besifuba, ukucasuka lapho isicwecwe sihlala khona, nokopha phakathi kokuya esikhathini. Ezivivinyweni zezinye izidakamizwa, ikhanda labikwa cishe kubasebenzisi abangu-21%, isicanucanu noma ukuhlanza cishe kubasebenzisi abangu-17%, nezingqinamba zendawo yokufaka cishe kubasebenzisi abangu-17%. Iningi lalezi ziyancipha phakathi kwemijikelezo emibili kuya kwemithathu.

Lezi zibalo zivela ku [imiyalelo yokusebenzisa i-Xulane egunyazwe yi-FDA] (eyabuyekezwa ngo-3/2022), ebala izimpendulo ezibikiwe ngabantu abangu-5% abasebenzisi: izimpawu zesifuba nokuzwela, isicanucanu nokuhlanza, ikhanda, kanye nokuphazamiseka kwendawo yokufaka. Ukopha noma ukuphuma kwegazi phakathi kokuya esikhathini kungena esigabeni esifanayo futhi [iyinto evamile kakhulu ekuvukeni kwezinyanga ezintathu zokuqala] zokusebenzisa. [I-Cleveland Clinic] iphinde ibeke ukuguquguquka kwemizwa nokuyenga njengezibikiwe njalo, ngesivinini esiphansi kunezinga eliphezulu.

Okujwayelekile akufani nokuthi akubanga monakalo. Uhlu olufushane lwezimpawu, olubekwe ngezansi, kusho ukukhipha isicwecwe nokubonwa ngalolo suku kunokulinda ukubona ukuthi izinto ziyazihlala yini.

Umbuzo omkhulu akuyona isicanucanu. Yibo i-BMI yakho, isisindo sakho nesimo sakho sokubhema

Abantu abaningi bahlola indlela entsha ngokuthi amasonto amabili okuqala azizwa kanjani. Lo mkhuba uyachazeka futhi awusizi kakhulu, ngoba izinto eziguqula ngempela ukuthi ngabe isicwecwe siyisiphakamiso esihle kuwena ziyalungiswa ngaphambi kokuba uzifake.

I-Xulane ayinconywa ku-BMI engu-30 kg/m2 noma ngaphezulu ngenxa yengozi eyandayo ye-venous thromboembolism. Ngokwehlukana, futhi lesi yisitatimende esihlukile esifanekayo, isicwecwe [kungase kube nokungasebenzi kahle ekunqandeni ukukhulelwa kwabesifazane abanesisindo esingu-198 lbs (90 kg) noma ngaphezulu]. Kuyaphambaniswa futhi kwabesifazane abaneminyaka engaphezu kwengu-35 ababhemayo, ngoba ukubhema ugwayi kanye nomuthi wokuvimbela ukukhulelwa ohlangene kwandisa ingozi yokuhlaselwa yinhliziyo, isifo sohlanga nomgogodla.

Nalu okunye okuningi okungakutshelwa: isicwecwe akusona inguqulo ethambile yepill. Sinikeza cishe u-60% ukudala i-ethinyl estradiol ngokweqile ngokuhamba kwesikhathi (AUC) kunepill evamile engu-35-mcg, noma ngabe iziqongo (Cmax) zitholakala ngama-25% ngaphansi. Ukudala okuhlukile, hhayi umthamo ongaphansi.

Ngakho-ke ukuzwa isicanucanu esontweni lesibili akuyona ubufakazi bokuthi isicwecwe siyahluleka noma ukuthi akusifanele wena. I-BMI, isisindo somzimba nesimo sokubhema yizona okufanele zilungiswe, ngaphambi kokuba uqale noma ngokushesha nje ngemva kwalokho. Akekho kulawa uyazikhipha okufanele uzisebenzise ekhaya. Bangemibuzo ongayibuza kudokotela ongayilinganisa nezinye izinto zomlando wakho.

Izimpawu ezimbalwa zesicwecwe kusho ukuyeka nokuthola usizo ngalolo suku

Cishe konke ezinyangeni zokuqala kungalinda ukuvakashelwa okujwayelekile. Lezi azikwazi.

Shayela u-911 noma uye egumbini lezimo eziphuthumayo manje uma:

  • Unokubomvu, ukuvuvukala, ukufudumala noma ubuhlungu kwenye inyawo.
  • Unobuhlungu besifuba obungazelelwe, ukuntula umoya, noma ukhwehlela igazi.
  • Unokhanda olubukhali olungazelelwe noma olungajwayelekile, ukudideka, ubunzima bokukhuluma, noma ubuthakathaka noma ukubizwa ohlangothini olulodwa lomzimba.
  • Ulahlekelwe umbono kungazelelwe, umbono ophindwe kabili, amehlo aphumayo noma ubuhlungu emehlweni.
  • Isikhumba sakho noma amehlo akho abephuzi, noma unesifo esibi sohlanga.
  • Ubuso bakho noma umphimbo wakho kuvuvukala, ulwelwe ukuhlikihla, noma umkhuhlane usabalale emzimbeni wakho.

Ingozi yomgogodla yiyona enze lolu hlu. Izidakamizwa ezihlanganisiwe ze-hormone ziphethe [isilinganiso esilinganiselwe se-venous thromboembolism samacala angu-3 kuye kwayi-12 ku-10,000 iminyaka yomuntu], nengozi ephakeme kakhulu engezansi yokuqala, nakuba isivumelwano esifanayo se-FDA sithi ukukhulelwa ngokwayo kunezengozi ezilinganayo noma ezinkulu. Lesivumelwano siphinde sikhulume ukuthi ukusebenzisa isicwecwe kufanele kuyekwe ngokushesha ngemuva komcimbi we-arterial noma we-venous thromboembolic, noma ngokulahleka kombono okungachazekile, amehlo aphumayo, umbono ophindwe kabili, ukuvuvukala kwe-optic disc noma izilonda zemithambo ye-retinal.

Bhukha ukuvakashelwa kungakapheli iviki elilandelayo uma:

  • Ukucasuka kwesikhumba endaweni yesicwecwe kuyaqhubeka noma kuyanda.
  • Ukuphuma kwegazi kusadabukisa ngemva kwenyanga yesithathu.
  • Amakhanda ayeneliseki noma ayanda, kodwa akukho kungazelelwe noma ubukhali.
  • Ukuguquguquka kwemizwa kuthinta impilo yakho yansuku zonke.
  • Isicwecwe sihluleka ukuqhubeka ngokuphindaphindiwe.

Akekho kulawa akuyona izimo eziphuthumayo. Akekho kulawa ufanele ukulinda imijikelezo emibili eyengeziwe futhi.

Khuluma nodokotela ngaphambi kokuba uqale uma:

  • I-BMI yakho ingu-30 kg/m2 noma ngaphezulu.
  • Unesisindo esingu-198 lbs (90 kg) noma ngaphezulu.
  • Uneminyaka engu-35 noma ngaphezulu futhi ubhema.
  • Unomlando wakho noma womndeni wakho we-blood clots, isifo sohlanga noma isifo senhliziyo.

I-Xulane iyona isicwecwe ongase ugqoke kuso

Izimpawu ze-Xulane, ngenhloso esebenza kakhulu, yizona izimpawu zokulungiswa kobulili ezichazwe kuleli khasi. I-Ortho Evra, isicwecwe sokuqala, ayisatholakali e-US, futhi i-Xulane kanye nama-generics ayo agunyaziwe (i-norelgestromin ne-ethinyl estradiol) yizo ezisetshenziswa eziningi ezitolo zemithi zase-US.

Kukhona isiphambuko esisodwa esibalulekile. [I-Twirla] (i-levonorgestrel ne-ethinyl estradiol) iyisicwecwe esihlukile, esine-estrogen ephansi, esagunyazwa yi-FDA ngoFebhuwari 2020. Kuyaphambaniswa futhi ku-BMI engu-30 kg/m2 noma ngaphezulu futhi kunezixwayiso zesifo senhliziyo kubabhemi abaneminyaka engu-35 nangaphezulu abane-BMI engaphezu kuka-30, okukubonisa ukuthi isisindo kanye nesixwayiso somgogodla siyisigaba esibanzi kunokuba yinto nje ye-Xulane. Hlola ibhokisi noma ilebuli yakho yomthengisi ukubona ukuthi yimuphi umkhiqizo owatholile ngempela. Lezi ezimbili azihambelani, futhi amaphesenti ezivivinyo ngenhla yizibalo ze-Xulane.

Isonto lokuqala liza nezinkinga ezimbili ezingekho kwezinye amasonto amathathu

Sesha "izimpawu zokulungiswa kobulili ezihlobene namacwecwe isonto lokuqala" futhi uthola uhlu lwezimpawu ezifanayo njalo nesonto, okukhohlisa izinto ezimbili ezenza isonto lokuqala lihlukile.

Okokuqala ukukhava kwezokuvimbela ukukhulelwa. Uma ubeka isicwecwe sakho sokuqala ngosuku lokuqala lokuya esikhathini, awudingi ukwesekwa. [Noma yikuphi ukuqala kamuva kudinga indlela yokuvimbela ukukhulelwa okungewona ama-hormone], njengama-condom, ezinsukwini eziyisikhombisa zokuqala.

Okwesibili ukungaphumeleli kokufaka. Ukopha nokuyenga ngokweqiniso kuvela kuqala futhi kulindelekile, ne-breakthrough bleeding evame kakhulu ekuvukeni kwezinyanga ezintathu. Kodwa ukuyenga, imiphetho yesicwecwe ephakanyisiwe, intuthu enamathiselayo noma ikhoneni elingahlangani ngokuphelele libonisa inkinga yokunamathela, hhayi inkinga ye-hormone, futhi isixazululo siyinjini. Hlola yonke imiphetho emine nsuku zonke, ikakhulukazi ngemuva kokugeza, ukubhukuda noma ukubila kakhulu. Yilokho okuhlukile okwenza ukuthi isinqumo esifanele esontweni lokuqala sicindezele noma senze.

Ngokwempela: isicwecwe esikhishwe isikhathi esingaphansi kwamahora angama-24 singabuyiselwa, noma siphathelwa esisha, sigcina usuku lwakho lokushintsha isicwecwe olujwayelekile futhi akudingeki ukwesekwa. Uma usukhishwe isikhathi esingaphezu kwamahora angama-24, noma isikhathi esingaziwa, kuvame kusho ukuqala umjikelezo omusha nesicwecwe esisha, usuku olusha lokushintsha isicwecwe kanye nezinsuku eziyisikhombisa zokuvimbela ukukhulelwa okwesekelwayo.

Uhlelo lokusebenza lomngane wezempilo olufana ne [August AI] lungakusiza ukuthi ukhanyise ukuthi yiluphi usuku isifo siqale ngalo nokuthi ngabe isicwecwe sahlala sinamathele ngokuphelele, okuyikho kanye nodokotela akuzobuzwa kuwe kuqala.

Umkhuhlane wesicwecwe uvame ukuba ngeendawo, hhayi nge-hormone

Umkhuhlane wesicwecwe wokulungiswa kobulili uvame ukuba yinkinga endaweni lapho isicwecwe sihlala khona kunokuba nento ekulo. Ukuphazamiseka kwendawo yokufaka kwavela cishe kubasebenzisi abangu-17% ezivivinyweni ze-Xulane, okwenza kube ngesinye sezinkinga ezintathu eziphezulu esivumelwaneni.

Ukuvimbela kubhalwe esivumelwaneni somkhiqizo futhi akubanga kuhle. Guqula phakathi kwezindawo zokufaka ezigunyaziwe (iqolo, isisu, ingalo engaphezulu yangaphandle kanye nesifuba esingaphezulu, hhayi izifuba), futhi ungaphinde usebenzise indawo efanayo ngokulandelana. Ungafaki i-lotion, uwoyela, ukhilimu noma impushana esikhunjeni lapho isicwecwe sizobeka khona, noma ngaphansi kwesicwecwe esesikhohlisiwe.

Uma umkhuhlane wesicwecwe wokulungiswa kobulili ubikwa phakathi nesonto, faka isicwecwe sokugcina endaweni ehlanzekile, eyomile, ehlukile, gcina usuku lwakho lokushintsha isicwecwe olujwayelekile, futhi uphathe ukukhava kwakho kwezokuvimbela ukukhulelwa njengengakaphazamiseki kuphela uma isicwecwe sikhishwe isikhathi esingaphansi kwamahora angama-24. Uma ukucasuka kuyaqhubeka noma kuyanda, [thintana nodokotela, ngoba indlela yokuvimbela ukukhulelwa ehlukile ingase idingeke]. Isikwele esinomkhawulo sesikhumba esicasukile yinkinga yendawo. Umkhuhlane osabalala emzimbeni wakho nge-facial noma ukuvuvukala komphimbo noma ubunzima bokuphefumula yisimo esiphuthumayo, futhi kungena ohlwini lokuqala olungenhla.

Ngomkhuhlane ongeyakuqhubeka, [ivisi eliku-inthanethi elibiza u-$39 lezimo eziphuthumayo] livumela udokotela ogunyazwe yi-US ukuthi abuyekeze indawo futhi axoxe ukuthi ngabe indlela ehlukile iyasiza yini. Udokotela unquma noma yisiphi isidakamizwa, futhi akukho ukuvakashelwa okungakubeka isiqinisekiso. Ukuvakashelwa kwe-telehealth akukwazi ukuhlola noma yikuphi okusolwa nge-blood clot; ukuvuvukala kwezinyawo noma ubuhlungu besifuba kufanele kubonwe mathupha, namuhla. Uma ulungisa ukuthi uzoya kuphi, kuyaphumelela ukuqonda [ukuthi ngabe i-urgent care inganikeza imithi yokuvimbela ukukhulelwa] ngaphambi kokuba ubhukhe.

Uma izimpawu zihlezi kwi nyanga yesithathu, azisazibuyelo

Zihlala isikhathi esingakanani izimpawu zokulungiswa kobulili ezihlobene namacwecwe? Kubantu abaningi, cishe izinyanga ezimbili kuya kwezintathu. [I-Cleveland Clinic ithi] ikhanda livame kakhulu ekuvukeni kwezinyanga zokuqala futhi liyathambisa, futhi izimpawu eziningi (ikhanda, isicanucanu, ukuphuma kwegazi okungajwayelekile, izifuba ezibuhlungu, ukuguquguquka kwemizwa, ukucasuka kwesikhumba) azihlali futhi ziyathuthuka ngemuva kwezinyanga ezimbili zokusebenzisa njalo. Ukuphuma kwegazi kulandela umugqa ofanayo, okugxilwe ekuvukeni kwezinyanga ezintathu.

Phatha leli iwindi njengesikhathi sokugcina kunokuba isiqinisekiso. Izimpawu ezisekhona, noma ezibuyayo, ngemuva komjikelezo wesithathu azisazibuyelo, futhi zifanele ingxoxo yendlela kunokuba zibe nesineke esengeziwe. Ukuguquguquka kwemizwa ikakhulukazi kuyisizathu esivamile nesingokwemvelo sokuthi abantu bashintshe, futhi kukhona [izinketho zokuvimbela ukukhulelwa ezithambekele ekuba lula engqondweni].

Ukushintsha kuyimiphumela ejwayelekile, hhayi ukuhluleka. Izinyathelo ezilandelayo ezifanelekile zihlanganisa iphilisi eline-estrogen ephansi, indlela ye-progestin-only, noma [i-hormonal IUD njengoKyleena], ekhethwe nodokotela owaziyo umlando wakho. Uhlelo lokusebenza lomngane wezempilo olufana ne [August AI] lungakusiza ukuthi ulandele izimpawu ngomjikelezo, ngakho-ke ukuhlolwa kwenyanga yesithathu kuyaqhubeka ngerekhodi kunokuba inkumbulo.

Imibuzo evame ukubuzwa

Ingabe isicwecwe sokulungiswa kobulili sibanga ukwanda kwesisindo?

Kuvame ukuba ngalokho. Akukho bufakazi obuqinile bokuthi i-contraception ye-hormone ehlanganisiwe ibangela ukukhula kwangempela kwesisindo, futhi ayifakwa ohlwini phakathi kwezimpendulo ezingajwayelekile ezivivinyweni ze-Xulane. Lokho abantu abavame ukukubona ukugcinwa koketshezi kanye nokugcwalisa kwesifuba ekuqaleni, okungashintsha indlela izingubo ezilingana ngayo ngaphandle kokushintsha amafutha omzimba. Uma isikali sihamba njalo ngenyanga, siyidlulisele kudokotela kunokuba ucabange ukuthi isicwecwe siyimbangela.

Ingabe isicwecwe sokulungiswa kobulili sivikela ezifweni ezidluliselwa ngokocansi?

Cha. Isicwecwe sivimbela ukukhulelwa kuphela. Asinikezi ngezinguquko ezivikelayo ezivela ku-chlamydia, i-gonorrhea, i-HIV, i-herpes, i-syphilis noma i-HPV. Uma udinga ukuvikelwa ezifweni ezidluliselwa ngokocansi, udinga futhi indlela yokuvimbela, nama-condom yikho okusebenzayo. Lokho kuphinde kufike ezingqeni zokuqala eziyisikhombisa esicwecweni, lapho udinga khona ukwesekwa kwezokuvimbela ukukhulelwa ngisho nokuvimbela ukukhulelwa.

Ingabe isicwecwe sokulungiswa kobulili siphephile ngenkathi uncelisa?

Kuvame ukuba ngalokho, okungenani ekuqaleni. Izindlela eziqukethe i-estrogen ngokuvamile ziyagwenywa ngokushesha ngemva kokubeletha ngenxa yethonya kusinye ubisi kanye nengozi yomgogodla eyanda kakhulu ngemuva kokubeletha. Izinketho ze-progestin-only zivame kakhulu kulokho. Isikhathi siyavela ngokuthi ungafelwa kanjani, kanjani ukuncelisa kuhamba, kanye nezinketho zakho zobungozi bomgogodla, ngakho-ke lesi yisinqumo sedokotela wakho kunokuba umthetho ojwayelekile.

Ingabe izimpawu ziyahamba ngemuva kokuyeka ukusebenzisa isicwecwe?

Yebo. Izimpawu ze-hormone njengokuyenga, ubuhlungu besifuba kanye nekhanda kuvame ukubuyela emuva ezingakapheli amasonto ambalwa ngemuva kokukhipha isicwecwe sokugcina, futhi ukuzala kuyabuya ngokushesha, okusho ukuthi udinga enye indlela ngokushesha uma ungazami ukukhulelwa. Ukucasuka kwesikhumba endaweni kuvame ukuqeda zingakapheli izinsuku. Noma yini eqhubeka isikhathi eside kunezinga lamaviki ambalwa ifanele ukubukwa okuhlukile, ngoba kungenzeka ingaba isicwecwe.

Ngingakwazi ukweqa isonto elingenasicwecwe ukuze ngigweme ukuya esikhathini?

Kwamuva. Ukusebenzisa njalo noma isikhathi eside kwenziwa empilweni, kodwa akubhalwanga esivumelwaneni isicwecwe futhi kudinga ukugunyazwa kukadokotela, ingxenye ngenxa yokuthi kusho ukudala i-estrogen eyengeziwe unyaka wonke. Ukuphuma kwegazi kuvame ukuvela kakhulu lapho ugwema isonto elingenasicwecwe, ikakhulukazi ezinyangeni zokuqala. Ungazenzeli wena komjikelezo wokuqala, lapho imodeli yakho yokuphuma kwegazi ingakabi khona.

Isiphetho

Nikeza izikhalazo ezijwayelekile, ikhanda, isicanucanu, ubuhlungu besifuba, ukucasuka kwesicwecwe nokopha, cishe izinyanga ezimbili kuya kwezintathu ukuthi zizolile, futhi uphathe noma yini esangaphesheya komjikelezo wesithathu njengesizathu sokukhuluma ngokushintsha. Ubuhlungu noma ukuvuvukala kwezinyawo, ubuhlungu besifuba, ikhanda elibukhali elingazelelwe, ubuthakathaka ohlangothini olulodwa, ukulahlekelwa yimibono noma i-jaundice kusho ukunakekelwa okungajabule ngalolo suku, ngaphandle kokulinda. Futhi kunokuhlola isicwecwe ngokuthi isonto lokuqala lizizwa kanjani, lungisa imibuzo ebalulekile nodokotela: i-BMI yakho, isisindo sakho, nokuthi uyabhema yini.

Ukuzihlangula: Lesi sihloko senzelwe izinjongo zolwazi kuphela futhi asinconywa njengeseluleko sezokwelapha. Njalo thintana nomhlinzeki wezempilo onekhono ukuze uthole izinqumo zokuxilongwa nokwelashwa. Uma ubhekene nesimo esiphuthumayo sezokwelapha, shayela u-911 noma uye esikhungweni esiseduze esiphuthumayo ngokushesha.