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თარიღი: 15 ივნისი, 2020

საუბრობს მედიცინის აკადემიური დოქტორი, ექიმი ენდოკრინოლოგ – რეპროდუქტოლოგი, მეან გინეკოლოგი ანი ჯინჯიხაძე

XXI საუკუნეში, ოჯახის დაგეგმარება ერთ ერთ ყველაზე აქტუალურ სოციალურ პრობლემას წარმოადგენს. ოჯახის დაგეგმარების არსი მდგომარეობს იმაში, რომ წყვილს ყავდეს სასურველი ბავშვი სასურველ დროს. და ეს პრობლემა გადაიჭრას რაც შეიძლება ნაკლებ მტკივნეულად და ნაკლებ საზიანოდ – ნაკლები  აბორტების  გზით. ამის ალტერნატივა კი არის სწორად შერჩეული კონტრაცეფციული მეთოდი. საქართველოში ჩატარებული კვლევების შედეგად დადგინდა, რომ კონტრაცეფციული მეთოდების მრავალფეროვნების მიუხედავად, გამოყენების მხრივ პირველ ადგილზეა. ე.წ კალენდარული მეთოდი და შეწყვეტილი სქესობრივი აქტი.

ცნობილია რომ, კალენდარული მეთოდის მიხედვით , რეგულარული ციკლის მქონე ქალების ოვულაციის პერიოდი ემთხვევა ციკლის შუა პერიოდს. ე.წ „ნაყოფიერი დღეები“. დანარჩენი დღეები კი „არანაყოფიერია“  და ჩასახვის შანსი ნაკლებია. თუმცა აქაც არ გვაქვს 100 % გარანტია. აქედან გამომდინარე დღესდღეობით უფრო და უფრო მეტ აქტუალობას იძენს ე.წ ავარიული ანუ ექსტრემალური კონტრაცეფცია. ამ მეთოდის არსებობის შესახებ ბევრმა არ იცის –არ არის ინფორმირებული. თვითონ  ტერმინი –   ექსტრემალური კონტრაცეფცია მიეკუთვნება, არასასურველი ორსულობისაგან დაცვის იმ მეთოდებს, რომლებიც გამოიყენება უშუალოდ დაუცველი სქესობრივი აქტის შემდგომ.  (მაგ: შეწყვეტილი სქესობრივი კონტაქტის არასრულფასოვნება, გაუპატიურება), ან გამოყენებული კონტრაცეფციული მეთოდის ეფექტურობისა და    საიმედოობის  ეჭვის დროს (მაგ: რეგულარული კონტრაცეპტივის  ტაბლეტის  მიღების გამოტოვება, პრეზერვატივის გახევა, კალენდარული მეთოდის გამოყენებისას ფერტილური (ნაყოფიერი) დღეების არასწორი გამოთვლა. 

 დღესდღეობით ფარმაცევტულ ბაზარზე არსებობს სულ რამოდენიმე პრეპარატი, რომელიც ექსტრემალური კონტრაცეფციის მიზნებს ემსახურება. ასეთებია მაგალითად ლევონორგესტრილის შემცველი პრეპარატები , რომელთა მოქმედება ნარჩუნდება, დაუცველი სქესობრივი აქტიდან, 72 საათის განმავლობაში, ისინი მოქმედების მექანიზმის მიხედვით თრგუნავენ  ოვულაციის პროცესს,  მოქმედებენ ციკლის პირველ ფაზაში  და  თუ მათი გამოყენება მოხდა ციკლის მეორე ფაზაში, ხასიათდებიან რიგი გვერდითი მოვლენებით (სისხლდენით).

ერთ ერთი , ახალი თაობის  პრეპარატი არის გინეპრისტონი – რომლის მოქმედ ნივთიერებას წარმოადგენს   მიფეპრისტონი , ანტიგესტაგენი, რომელიც მოქმედებს რეცეპტორულ დონეზე და თრგუნავს პროგესტერონულ რეცეპტორებს (პროგესტერონი – ე.წ ორსულობის ჰორმონი). თუ  გინეპრისტონის მიღება ხდება ციკლის პირველ ფაზაში ოვულაციამდე – ითრუნება კვერცხუჯრედის გამოთავისუფლება, შესაბამისად განაყოფიერება არ ხდება. ხოლო თუ გინეპრისტონის მიღების აუცილებლობა დგება ციკლის მეორე ნახევარში ანუ ოვულაციის შემდგომ, მიფეპრისტონი ხელს უშლის კვერცხუჯრედის მიმაგრებას საშვილოსნოს კედელზე – და  ორსულობა არ ვითარდება. გინეპრისტონი გამოირჩევა მაღალი უსაფრთხოებით, ეფექტურია მენსტრუალური ციკლის ნებისმიერ ფაზაში და არ ხასითდება   გართულებების განვითარებით. 

ამასთან თუ ძველი თაობის პრეპარატების  მოქმედება ნარჩუნდება  პირველი 72 საათის განმავლობაში.  ბოლო კვლევებზე დაყრდნობით პრეპარატ გინეპრისტონის  გამოყენება  ეფექტურია 120 სთ განმავლობაში.  აქვე მინდა ავღნიშნო , რომ  ექსტრემალური კონტრაცეფციის  პრეპარატის მიღების ეფექტურობა  უფრო მაღალია პირველ საათებში და კლებულობს შემდგომ პერიოდში. ანუ რაც უფრო სწრაფად მიიღებს ქალი ტაბლეტს დაუცველი სქესობრივი აქტიდან , მით უფრო მაღალია ეფექტი. თუმცა  როგორც უკვე ავღნიშნე, კვლევებზე დაყრდნობით,  გინეპრისტონი  ეფექტურია   პირველი 120  საათის განმავლობაში. (ჰტტპს://წწწ.ნცბი.ნლმ.ნიჰ.გოვ/პუბმედ/17559015)

დღესდღეობით ექსტრემალური კონტრაცეფცია წარმოადგენს, დაუცველი სქესობრივი აქტის შემდგომ, არასასურველი ორსულობისაგან დაცვის ერთ ერთ ყველაზე უსაფრთხო , მაგრამ არა სისტემატიური სახით გამოსაყენებელ  მეთოდს. ყველა ქალს უნდა ახსოვდეს რომ ექსტრემალური კონტრაცეფცია არ არის უკვე არსებული ორსულობის შეწყვეტის საშუალება. ასევე , ექსტრემალური კონტრაცეფციის მეთოდი არ არის  რეგულარული გეგმიური კონტრაცეფციის ალტერნატივა  (სახელწოდებაც ცხადყოფს) – ის გამოიყენება მკაცრად ექსტრემალურ,  „ავარიულ“ პირობებში.  აუცილებელია ქალმა გაიაროს კონსულტირება თავის ექიმ გინეკოლოგთან ან მიმართოს დეტალური ინფორმაციის  მისაღებად  გამოცდილ ფარმაცევტს.

მედიცინის აკადემიური დოქტორი, ექიმი ენდოკრინოლოგ – რეპროდუქტოლოგი, მეან გინეკოლოგი: ანი ჯინჯიხაძე