I-Patch Yokulawula Ukuzalwa Ngokuphambene Nepilisi: Ukusebenza, Ukuthola I-Estrogen, Nokuthi Ungakhetha Kanjani

Ukusetshenziswa kahle kungafanana, cishe ukukhulelwa okungu-7 kubasebenzisi abayi-100 ngonyaka nganoma iyiphi indlela bese cishe u-0.3% ngokusebenzisa ngokuphelele. Umehluko wangempela wokulawula ukuzalwa kwe-patch ngokuphambene nepilisi uthola i-estrogen: i-patch iletha cishe u-60% we-estrogen ephelele, futhi iyayeka ukusebenza ngokuthembekile ngaphezu kwamakhilogremu angu-198.

TL;DR: Izinto ezibalulekile okufanele uzikhumbule

• Ukwehluleka kokusetshenziswa okuvamile kungaba cishe okungu-7 kubasebenzisi abayi-100 ngonyaka kokubili; ukusetshenziswa ngokuphelele kungaba cishe u-0.3% kokubili.
• I-patch akuyona indlela ye-hormone ephansi. Iletha cishe u-60% we-ethinyl estradiol ephelele kune-pill evamile engu-35 mcg.
• I-venous thromboembolism iqala cishe ku-3 kuye ku-12 kubantu abayi-10,000 abesifazane abangonyaka kunoma iyiphi indlela ehlanganisiwe, uma kuqhathaniswa no-1 kuye ku-5 kubasebenzisi abangasebenzisi.
• I-patch ingase yehluleke ngaphezu kwamakhilogremu angu-198 futhi ayivunyelwe ku-BMI engu-30 noma ngaphezulu. Ipilisi ayinayo imikhawulo enjalo.
• Shintsha ngaphandle kokuphumula kwe-hormone futhi awudingi i-backup. Noma yikuphi ukuphumula kusho izinsuku eziyisikhombisa zamakhondomu.

I-patch yokulawula ukuzalwa ngokuphambene nepilisi: iyasebenza ngokufanayo, kodwa iyahluleka ngezindlela ezahlukene

Zombili ziyizilawuli zokukhulelwa ze-hormone ehlanganisiwe ezinomkhawulo wokwehluleka wangempela okufakwe yi-FDA: cishe ukukhulelwa okungu-7 kubasebenzisi abayi-100 ngonyaka ngokusebenzisa okuvamile, cishe u-0.3% ngokusebenzisa ngokuphelele. Ukusebenza kwe-patch yokulawula ukuzalwa kufanana nepilisi ngoba zombili zivimbela ukukhululwa kweqanda kusetshenziswa i-estrogen ne-progestin. Okuhlanganisiwe yisikhathi sokudosi, inani eliphelele le-estrogen, nomkhawulo wesisindo osebenza kuphela ku-patch.

Into eyodwa ithebula elingenakukhombisa: zombili izindlela zithwele uhlu olufanayo olunzima lwezingozi i-FDA eziqamba ngalo ezilawulweni zamahomoni ezihlanganisiwe, kufaka phakathi amahlule egazi, isifo senhliziyo, isifo sohlangothi, nomfutho wegazi ophezulu. I-patch ayishintshi iprofayili yengozi eyodwa ngeyokupholisa eyengeziwe.

I-patch akuyona indlela ye-hormone ephansi: iletha cishe u-60% we-estrogen owengeziwe

Ingozi ye-blood clot ye-patch yokulawula ukuzalwa yikho lapho izindlela ezimbili zihlukanisana khona ngempela, futhi hhayi ngendlela abantu abaningi abacabanga ngayo. Ngokwemiyalelo ye- FDA ye-Xulane, i-patch ifaka cishe u-60% we-ethinyl estradiol ephelele egazini (elilinganiselwe njenge-area under the curve) kune-pill evamile engu-35 mcg ye-estrogen, noma ngabe isikhathi esiphezulu siphansi. Okuqhubekayo kuhamba ngesivinini. Okuqhubekayo kusho nokuthi okwengeziwe.

Izinombolo ziyenza le nto ibe nesisindo. I-venous thromboembolism yenzeka kumacala acatshangwa ukuthi angu-3 kuye ku-12 ku-10,000 abesifazane abangonyaka phakathi kwabasebenzisi banoma iyiphi i-contraceptive ye-hormone ehlanganisiwe, i-pill, i-patch, noma i-ring, uma kuqhathaniswa no-1 kuye ku-5 ku-10,000 abesifazane abangonyaka kubantu abangakhulelwe abangasebenzisi ama-hormone. Lelo sono liphakeme kakhulu ekuqaleni konyaka wokuqala, futhi liyaphinda noma nini indlela ehlanganisiwe ibuyiselwa emsebenzini ngemuva kokuphumula okungamasonto amane noma ngaphezulu.

Nansi into ezindabeni eziningi ezingeke ikutshele yona: i-FDA yasho ukuthi u-60% wokuthola ubunzima esazisweni sokuphepha sango-2005 yengeza i-epidemiology embhalweni we-patch ngo-2008 iphakamisa ukuthi abasebenzisi be-patch babhekane nezingozi eziphakeme kakhulu ze-clot kunabasebenzisi be-pill, kodwa izifundo zokuqhathanisa azikaze zivumelane ngokuphelele. Umkhuba kusukela lapho uhlanganiswe. Isibuyekezo sokulawula ukuzalwa esisekelwe ebufakazini sango-2020 sifaka izinyathelo ezifanayo kokubili, okusho ukuthi akukho ama-hormone ahlanganisiwe anomlando womuntu siqu we-VTE noma ngaphambi kokuhlinzwa okukhulu okungahambisani nokuhamba.

Ngakho-ke khetha ngokusekelwe ekufaneleleni kwakho nengozi yakho yokuphuma kwegazi ne-BMI. Hhayi ngokucabanga ukuthi i-patch iyathambisa kunephilisi elimunyiwe.

Ukusebenza kwehlisa ngaphezu kwamakhilogremu angu-198, umkhawulo i-pill engenawo

Ukusebenza kwe-patch yokulawula ukuzalwa kunomkhawulo i-pill engenawo: isexwayiso esifakwe esihlokweni sithi i-patch ingase ingasebenzi kahle kwabesifazane abayisinkulungwane eyi-198 lb (90 kg) noma ngaphezulu, futhi ayivunyelwe ku-BMI engu-30 kg/m² noma ngaphezulu ngenxa yokwenyuka kwezingozi zokuphuma kwegazi. Ukuthi i-patch yokulawula ukuzalwa isebenza kanjani ngaphezu kwalokho akuyona into umbhalo owuqinisekisa, okuyikho ngokwako kuyimpendulo.

Uma omunye wemikhawulo isebenza kuwe, isinyathelo akusona ukuzama kanzima nge-patch. Buza ngepilisi ehlanganisiwe, engenawo umkhawulo wesisindo ekubhalweni kwayo, noma ngendlela yokuthi ukusebenza kwayo kungathembeli nesisindo somzimba nhlobo, njenge-IUD noma i-implant.

Imikhiqizo futhi ayishintshani. I-Xulane, i-Twirla, ne-Zafemy zinezilimi ezihlukene ze-BMI nezesisindo, ngakho-ke funda umbhalo womkhiqizo othize kunokucabangela "i-patch" njengomkhiqizo owodwa.

Impikiswano ye-patch yezibalo. Amathuba angama-52 ngonyaka okuzobambezeleka, uma kuqhathaniswa nama-365. Uma uye waphuthelwa izipilisi ezimbili noma ngaphezulu ezinyangeni ezintathu ezedlule, i-patch ingase idlule i-pill empilweni yakho yangempela noma ngabe zombili zilingana esivivinyweni. Uhlelo lokusebenza lomngane wezempilo njengo-August AI lungakusiza ukuthi ubhale izinsuku zokushintsha kwe-patch noma izipilisi eziphuthelwe ukubona ukuthi yiluphi uhlelo olugcina luyimpumelelo.

Into eyodwa encane yokukhumbula, kodwa u-1 kubasebenzisi abayi-5 bathola ukucasuka kwesikhumba

Ukubheka izinzuzo nezingozi zokulawula ukuzalwa kwe-patch ngobuqotho kuqala esikhunjeni. Ukucasuka endaweni yesicelo kuthinta cishe u-20% wabasebenzisi be-patch, kodwa u-3% kuphela abayeka le ndlela ngenxa yayo, okusho ukuthi izimpendulo eziningi ziyacasula kunokuba zivinjelwe.

I-patch iyabonakala, futhi ukuhlala ibambelela kuhloliwe ukushisa, ukufinyelela umswakama, ukujuluka kakhulu, ukubhukuda, namatiyubhu ashisayo. Guqula izindawo, faka esikhunjeni esihlanzekile esomile, futhi ugcine ukhilimu namafutha kude nendawo. Izindawo zesikhumba ezicashiwe eziphindelelwe zifanele ukuphakanyiswa kunokuba uzifakele indawo ngokuthula. Ukuphumelela okukodwa kwe-patch yangempela: ukumunca akubangwa yilungiso noma yikulula, okuyimodi yokwehluleka yangempela yepilisi elinengi ngesikhathi sesifo sesisu.

Izinzuzo ze-pill zithule futhi zihlala njalo. Ayibonakali, iza ngezindlela eziningi nemithamo ye-estrogen, futhi kukhona inguqulo ye-progestin-kuphela yabantu abangakwazi ukuthatha i-estrogen. I-patch ayinawo umsebenzi we-progestin-kuphela. Uma ugcwalisa iphrofayela yezimpawu ezingezinhle, kufaka phakathi ukuthi iyiphi indlela yokulawula ukuzalwa engcono kakhulu ekuzinziseni komoya, i-pill ikunikeza amathuluzi amaningi. Uhlelo lokusebenza lomngane wezempilo njengo-August AI lungakusiza ukuthi ubhale ukubopha, izinhlungu zekhanda, noma izimpawu zesikhumba phakathi nezinyanga ezintathu zokuqala, ukuze umelaphi abone iphethini esikhundleni sokukhumbula.

Ukushintsha izindlela kudala ukuphumula kwezinsuku eziyi-7 abantu abaningi abangayihleli

Ukushintsha kusuka nepilisi yokulawula ukuzalwa kuye ku-patch yilapho ukuhlanganiswa kucwilisa buthule. Umthetho ulula: faka i-patch yakho yokuqala ngosuku obuyobe uqale ngalo iphakethe lakho elisebenzayo le-pill, ngaphandle kokuphumula okungenayo-hormone, futhi akukho i-backup edingekayo. Uma kukhona ukuphumula, sebenzisa amakhondomu noma enye indlela yokusekelayo izinsuku eziyisikhombisa. Okufanayo kusebenza kusuka ku-patch kuya ku-pill.

Ungaphindwa kokubili izindlela ukuze ugcwalise isikhala ngaphandle kokuba umelaphi akutshele ukuba wenze kanjalo. Futhi uma uyekile isikhathi esingamasonto amane noma ngaphezulu esikhundleni sokushintsha ngqo, ukuqala kabusha kubuyisela ngaphezulu ingozi ye-clot yokuqala yonyaka.

Leli yiphuzu elilodwa kuleli khasi lapho ukuvakashelwa kuyisinyathelo esilandelayo ngempela. Ukuvakashela okungaxhunyiwe ku-inthanethi ngo-R39 nomelaphi onelayisense ase-US angahlanganisa umlando wakho futhi anikeze umuthi lapho kufanele khona. Umelaphi uyinquma, futhi akufanele kuqinisekiswe umuthi. Ukuvakashela okubonakalayo futhi akukwazi ukuhlola umfutho wakho wegazi noma wenze izivivinyo, okuthi abanye abantu badinge ngaphambi kokuqala indlela ehlanganisiwe. Uma ubheka izinketho zokuhamba, siye sahlanganisa ukuthi i-urgent care inganikela yini imithi yokulawula ukuzalwa ngokwehlukana.

Lapho izimpawu ze-patch noma i-pill kusho ukuyeka nokubona udokotela

Lezi zimpawu ezibomvu ziyafana kuzo zombili izindlela. Indlela yokulethwa ayishintshi ukuthi isimo esiphuthumayo sibukeka kanjani.

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

• Ukwelashwa okungazelelwe kwesifuba somoya noma ukungaphefumuli
• Izinhlungu ezinkulu ezingazelelwe ezingafani nezinhlungu zakho ezijwayelekile, noma ukuguquka kombono okuzumayo noma ukulahlekelwa umbono
• Ubuthakathaka obuzumayo, ukubambezeleka, noma ubunzima bokukhuluma ohlangothini olulodwa lomzimba
• Izinhlungu ezizumayo nokuvuvukala kwenye yomlenze
• Izinhlungu ezinkulu zesisu noma isisu nokubambezeleka
• Ukuphuzi kwesikhumba noma amehlo anomchamo omnyama nokulahlekelwa isifiso sokudla

Bhukha ukuvakashelwa phakathi nesonto elilandelayo uma:

• Uthola ibhubhu elisha lesifuba
• Ukopha esithweni sangasese kunokujwayelekile futhi kuhlala isikhathi esingaphezu kwezinsuku eziyi-7, ngokuya kwesiqondiso se-MedlinePlus ngokuphatha kwe-hormone ehlanganisiwe
• Indawo ye-patch ihlala ibomvu, ivulekile, noma iyazinzinyiswa phakathi kwezinguquko
• Ama-patch ayaqhubeka ukuwa
• Uphuthelwa izipilisi njalo

Khuluma nodokotela ngaphambi kokuba uqale uma:

• Uyasuta futhi ungaphezu kweminyaka engu-35
• I-BMI yakho ingu-30 noma ngaphezulu, noma unesisindo esingama-198 lb noma ngaphezulu
• Wena noma umalume wakho wokuqala uke waba nokuphuma kwegazi, i-DVT, noma i-pulmonary embolism
• Uthola i-migraine ene-aura
• Umfutho wakho wegazi awulawulwa
• Uke wahlaliswa okuhlinzwa okukhulu noma ukuvalwa isikhathi eside muva nje
• Uthatha i-rifampin, izidakamizwa ezithile zokuvikela ukudlikiza, noma i-St. John's wort

Imibuzo ejwayelekile

Uma i-patch yami iwa, ngisavikelwe?

Ngezinye izikhathi. Ukuthi i-patch yokulawula ukuzalwa isebenza kanjani ngemuva kokuba iwele phansi kuncike ngokuphelele ewashini. Uma ibingasekho isikhathi esingaphansi kwamahora angu-48, faka kabusha i-patch efanayo noma faka entsha bese ugcina usuku lwakho lwangempela lokushintsha, ngaphandle kwe-backup edingekayo. Ngamashumi amabili nane noma ngaphezulu, qala i-patch entsha, sebenzisa i-backup izinsuku eziyisikhombisa, bese ubuza nge-emergency contraception uma ube nobulili ngaleso sikhathi. Imiphetho eyenziweyo ibala njengokuwa.

Ingabe i-patch yokulawula ukuzalwa ibangela ukukhuluphala kakhulu kune-pill?

Cha. Kwi-patch yokulawula ukuzalwa ngokuphambene nokukhuluphala kwe-pill, ubufakazi be-Cochrane review obuwufanele i-contraceptives ye-hormone ehlanganisiwe bathola cishe u-0.4 kg (ngaphansi kwekhilogremu eyodwa) unyaka, ngaphandle umehluko omkhulu phakathi kwezindlela ezimbili. Lobu ubufakazi obubuyekeziweyo kunokuba isibalo se-FDA, futhi busondele ngokwanele ekushintsheni kwesisindo okujwayelekile kwaminyaka yonke ukuthi abantu abaningi abakwazi ukubuhlukanisa nakho konke okunye okwenzekayo.

Ngingakwazi ukweqa isonto elingenayo-patch ukuze ngiyeke ukuya esikhathini sami?

Yebo. Ukufaka i-patch entsha esikhundleni sokuthatha isonto elingenayo-patch kuyindlela eyenziwe yaba yindlela yokusetshenziswa okwandisiwe noma eqhubekayo, esetshenziswa ngokungekho emthethweni ngendlela efanayo abantu abasebenzisa iphakethe le-pill ngokuqhubekayo. Lindela ukuphuma kwegazi, ikakhulukazi ezinyangeni zokuqala, futhi lindela ukuthi kungazinzile. Qinisekisa uhlelo nodokotela kuqala, ngoba luguqula ukuthi ubale kanjani izinsuku zakho zokushintsha.

Ingabe izibulala-magciwane ziyayeka i-patch noma i-pill ukuthi ingasebenzi?

Ngokuvamile cha. Izibulala-magciwane ezijwayelekile njenge-amoxicillin ne-doxycycline azikunciphisi ukusebenza kunoma iyiphi indlela, naphezu kokuqina kwaleso sixwayiso. Izinto zangempela zokusebenzisana yi-rifampin ne-rifabutin, izidakamizwa ezithile zokuvikela ukudlikiza, ne-St. John's wort, ezisheshisa ukubola kwama-hormone. Tshela noma ngubani onikeza izibulala-magciwane ukuthi usebenzisa i-contraceptive ye-hormone bese ubuza ukuthi ngabe i-backup iyadingeka yini ngalokho lidakamizwa.

Ngingathola i-patch noma iphilisi le-prescription online ngaphandle kokuhlola komzimba?

Yebo. Akukho ukuhlolwa kwangasese noma i-Pap test okudingekayo ukuze kuqale i-contraception ehlanganisiwe. Okudinga umelaphi ukufundwa okufanele komfutho wegazi wakho nesimo sokuphuma kwegazi, i-migraine, nomlando wokubhema. Uma umfutho wakho wegazi ungaziwa noma umlando wakho uyinkinga, lindela ukucelwa ukuba uze noma uthole ukufundwa ngaphambi kokuba kunikezwe noma yini.

Isiphetho

Kwi-patch yokulawula ukuzalwa ngokuphambene nepilisi, ukusebenza kungumaka, ngakho-ke isinqumo sigxile kwezinye izinto. I-patch yokulawula ukuzalwa, izinzuzo nezingozi ziyayihlonipha uma uye wabhekana nobunzima nokudosi yansuku zonke futhi i-BMI yakho ingaphansi kuka-30 futhi unesisindo esingaphansi kwamakhilogremu angu-198. I-pill iyawina ngokuphuma kwe-estrogen, ukukhetha imikhiqizo, ukungabonakali, nokutholakala kwendlela ye-progestin-kuphela. Noma ngabe ukhetha ini, shintsha ngaphandle kokuphumula okungenayo-hormone, futhi wazi izimpawu eziyisithupha eziphuthumayo ngaphambi komthamo wakho wokuqala.

Isitatimende: Lesi sihloko singezimfuno zolwazi kuphela futhi akusona iseluleko sezokwelapha. Hlala uthintana nomhlinzeki wezempilo ofanelekile ukuze uthole izinqumo zokuxilonga nokwelashwa. Uma ubhekene nesimo esiphuthumayo sezokwelapha, shayela u-911 noma uye egumbini lezimo eziphuthumayo eliseduze ngokushesha.