Izithiyo ezedlule eziza kuqala ezizimele
I-US Preventive Services Task Force-igunya likaNdunankulu wesizwe emisebenzini yokuvimbela emitholampilo-liqinisekisile isiphetho sayo sangaphambili mayelana nokwelashwa kwe-hormone esikhundleni sokumisa esikhathini sokuvimbela isifo esingelapheki. Ngokuphinda futhi, i-Task Force ikhishwe leli qhinga ibanga le-"D," elibonisa ukuthi kunconywa ngokumelene nobufakazi obukhona.
Ukusebenzisa amazinga alobufakazi obucacile futhi obuphakeme, futhi ukubhekana nombuzo wokuthi ngabe i-hormone substlacement (HR) ingabuyekezwa yini "ngokujwayelekile" kubo bonke abesifazane besilisa ekuvimbeleni ukuvimbela isifo senhliziyo, umdlavuza, isifo sikashukela, ukuwohloka komqondo, futhi ingozi yokufa ngaphambi kwesikhathi ihlobene nanoma yiyiphi yalezi, uMbutho Wezemisebenzi ngokuqinisekile ulungile. Impendulo yalowo mbuzo ebufakazini obukhona yiyo: cha. Kunezinzuzo eziningi ezingase zibe khona ze-hormone esikhundleni, kodwa eziningi ezinobungozi ezingase zibe khona kanye, futhi jikelele, idatha evela ezivivinyweni ezinkulu kunazo zonke ezilandelwayo ezibangelwa kude nenzuzo enenzuzo.
Kodwa ngenkathi impendulo ye-Task Force ingahle ingabonakali, umbuzo wabo ungenye indaba. Ingabe isiphetho sifike mayelana nokushintshwa kwe-hormone ngesikhathi sokuya esikhathini sokuya esikhathini esijwayelekile, kubo bonke abesifazane ngokujwayelekile, ngokuthembeka ukuhumusha iseluleko esihle kunoma yimuphi wesifazane othile? Ngombono wami, akunjalo. Futhi, ngenkathi isiphetho se-Task Force ilandela ngokulandelako ngokubufakazi ehlangene namazinga awo aphakeme, umkhawulo walokho ubufakazi ungase uphenywe.
Ukucabangela okuningi okubalulekile kungakapheli, kungafundiwe, noma kunganakwa nje olwandle idatha.
Izibhamu ezine
Ngenhlonipho efanele yoMsebenzi Wezemisebenzi kanye nesiphetho sabo, ngakho-ke, ngibelana ngombono wabalingani bokuthi kukhona okungaba yingozi ekuchazeni isahlulelo ngokumelene ne-hormone esikhundleni. Ngokuqondile, ngicabanga ukuthi ukunconywa kweMisebenzi yeBasebenzi kuncike emigodini emine:
1) Ukulahla Okungafani Nokuphambana
Noma nini lapho ehumusha idatha emayelana nenani labantu, kunezingozi ezingenakugwemeka ezikhombini ezimbili eziphikisanayo: ukuqhuma nokuhlukaniswa. Ukulahla kungukuthi amalunga ahlukene kakhulu eqenjini elikhulu aphathwa ngendlela efanayo. Ukukhahlela kungukuthi isabelo senzelwe ukubaluleka kokuhlukahluka ngaphakathi kweqembu, ngokujwayelekile ngokuhlaziywa kweqembu eliphansi.
Ngenxa yokuthi umsebenzi we-Task Force ukukhipha isincumo esibhekisela kubantu abaningi, noma ingxenye enkulu yayo, bajwayele izikweletu zokwehla.
Iziphi izikweletu? Isiphetho sabo ngokususwa kwe-hormone sisekelwe ikakhulu esilingo esisodwa esikhulu kunazo zonke esihlolwe kulowo sihloko, i- Women's Health Initiative . Kodwa leso sivivinyo sabhalisa kokubili abesifazane asebekhulile nabancane; abesifazane abaqala i-HR ngemuva kokuya esikhathini sokuya esikhathini, nalabo abayiqalile eminyakeni eyishumi kamuva; abesifazane abaye bathola i-hysterectomy futhi, ngakho-ke, bakwazi ukuthatha i-estrogen yedwa; kanye nabesifazane abanesibindi esilungile esidinga ukuhlanganisa i-estrogen ne-progesterone.
Ingabe bonke laba besifazane abahlukile babe nemiphumela efanayo na-HR? Ngaphandle kwalo. Ozakwethu nami nganyathelisa ukuhlaziywa ngo-2013 ku- American Journal of Public Health , esekelwe emininingwaneni evela ku-Women's Health Initiative, kodwa igxile emiphumeleni yesikhathi eside kwabesifazane abaye babhekana ne-hysterectomy futhi bethatha i-estrogen yedwa.
Lapho laba besifazane beqala ukwelashwa kwe-estrogen nxazonke noma ngaphambi kweminyaka yobudala engama-50, isikhathi sokuqala sokuqala kokuya esikhathini sesikhathi esiphakathi, sabhekana nokunciphisa okukhulu kuzo zonke izimbangela zokufa kwabantu. Ukuchazwa kwethu ukuthi leli qembu labesifazane, elibalwe ngamashumi ezinkulungwane e-United States, ukwehluleka ukusebenzisa indawo yesterngen kubangela amashumi ezinkulungwane zokufa ngaphambi kwesikhathi njalo eminyakeni eyishumi. Ngakho-ke, kunjalo, yizingozi zokwehla.
2) Of Baby and Bathwater
Umgogodla ohlobene kakhulu ukuhluleka ukwahlukanisa amanzi namanzi okugeza endleleni eya kwesigwebo somshwana. Idatha evela ekuvivinyweni lapho iKomidi leMisebenzi elisekelwe khona ligcizelela ukubaluleka kweminyaka yobudala lapho kusetshenziswa khona ama-hormone, isikhathi sokuqala kokuya esikhathini, nokuthi ngabe isrogen ne-progesterone kumele ihlanganiswe noma cha.
Nakuba isincomo kubo bonke abesifazane ukuba basebenzise i-HR behluleka ukususa amanzi okugeza, iseluleko esijwayelekile ngokumelene nokuhluleka ukusindisa ingane.
3) Umthetho wesithathu kaNewton
Umthetho odumile wesithathu wokunyakaza ngu: kuzo zonke izenzo, ukusabela okulinganayo nokuphambene . Phakathi nekhulu leminyaka elidlulile, siye sahlukana ngokubambisana mayelana ne-hormone substlacement, ukusabalalisa kabanzi ngesisekelo sokuhlola okubukwayo, emuva kokubukeka okunamandla ngesisekelo sezilingo ezihleliwe. Ngesikhathi u-swing ngamunye we-pendulum ekwaziswa ngolwazi lwamanje kanye nedatha, futhi, ngokwengxenye, ukusabela ku-swing ngaphambi kwesinye isikhathi. Umbono wezesayensi kungenzeka ukuthi awuhambisani nalo mthetho olula wokunyakaza njengebhokisi le-flotsam, kodwa umbono wami awukwenzeki ngokuphelele kuwo, noma.
4) Ukungabikho kobufakazi obuhambisana nobufakazi bokungabikho
Izindinganiso eziphezulu zocwaningo ezicatshangwa yi-Task Force isiqiniseko sokuthi ubufakazi obuyisebenzisayo buyoba kuhle. Kodwa yiziphi iziqinisekiso ezinikezwa ngokungabikho kobufakazi obubalulekile kwisinqumo esinqunyiwe ngokugcwele? Akukho, ngempela. Ngokuqinisekile, uMbutho Wezinkampani kufanele uthathe isinqumo sokuthi ubufakazi obukhona buyanele yini ukusekela isiphetho esicacile, futhi banamabanga amabhuku ukuze akhombise uma kungenjalo. Kodwa nokho, inqubo yokubukeza ubufakazi ivele iphikise ukungabi khona kobufakazi bokufakaza kokungabikho.
Lokho okusho kulo mongo othize ukuthi cishe yonke idatha yokuhlolwa okungahleliwe ebizwa ngokuthi "i-hormone substlacement" ngokujwayelekile, iwukuthi iyingqikithi eyodwa, eqondile ye-hormone esikhundleni: ukusetshenziswa kwe-Premarin (uhlobo lwe-estrogen kusuka kumahhashi, hhayi abantu), kanye noPravera (i-medroxyprogesterone acetate, i-progesterone esebenzayo kanye ne-high-potency). Ukuhlanganiswa kwalokhu kwaziwa ngokuthi "Prem / Pro." Ingabe lokho esikuziyo ngalezi hormone ezithile kusitshela ngokugcwele mayelana nabanye? Cha, akusikho-lapho ubufakazi obungekho khona. I-Task Force iye yaphatha ukuthi "ubufakazi obungekho" njengokungathi singaqiniseka ukuthi kufanelana nombono wokuthi kukhona ubufakazi obunokwethenjelwa bezinzuzo ezingekho kwi-hormone substlacement, ngisho nalapho kwenziwa amalungiselelo angcono. Iqiniso liwukuthi, asazi ngempela.
Ukunquma Okulungile Kuwe
Njengamaphutha angenhla, kubonakala sengathi isincomo seMisebenzi Yehluleka ukunikeza ukunakekelwa okudingekayo ezintweni ezintathu ezibaluleke kakhulu-izinto ezibalulekile ezingakwazi ukwazisa ezakhe, ukwenza izinqumo:
1) Kanjani?
Ochwepheshe abaningi bayavuma ukuthi amalungiselelo e-hormone ahluke kakhulu emiphumeleni yawo. Idatha yokuhlola engahleliwe ayitholakali kakhulu emalungiselelweni anjalo abachwepheshe abanconyayo. Ngenkathi singakwazi ngokuqinisekile ukuthi amanye amalungiselelo anciphisa isifo esibucayi lapho i-Prem / Pro ingenjalo, ukuhlolwa kwe-Prem / Pro akukwazi ukukhipha leyo nzuzo noma. Ngisho nedatha etholakalayo, imiphumela ye-estrogen ne-progesterone, ngokumelene ne-estrogen yedwa, ihluke kakhulu.
2) Ncamashi nini?
Imiphumela ye-hormone replacement ihluke ngokuphawulekayo ngekhathi. Ukusetshenziswa kwabesifazane abasebasha, eduze nesikhathi sokuya esikhathini, kunika inzuzo eningi nangencishwana encane kunokusebenzisa kamuva. Ukuhlolwa okukhulu okungahleliwe kwakufake ukubandakanya ukusetshenziswa okusezingeni eliphezulu, ngenkathi kuqeda idatha kusuka kula maqembu ndawonye.
3) Ngubani ngempela?
Abesifazane abaye bathola i-hysterectomy bangathatha i-estrogen ngaphandle kwe-progesterone. Ekuqaleni kokuqala kokuya esikhathini, okubonakala kunenzuzo okumele ikwazi ukusizwa nge-hormone esikhundleni. Umphumela wenetha engozini yomuntu siqu kungenzeka uhluka ngomlando womndeni womuntu kanye nesiphrofayli sezinhlekelele. Ngenkathi i-Task Force iphoqelekile ukuhlinzeka isiqondiso sezinga labantu, lokhu kuyinkinga lapho indlela engcono kakhulu yokuvimbela isetshenziswa kakhulu. Yilokho okuphethwe yizinhlangano ezihola ezinikezwe impilo yabesifazane, nombuzo othize wezingozi ezihlobene nokuya esikhathini.
Okokugcina, i-HR ivame ukusetshenziselwa ukuphatha izimpawu, kunokunciphisa ingozi engapheli. Izincomo eziphezulu kakhulu mayelana nokusetshenziswa kwe-HR komunye zingase zingabonakali, futhi zingalungile, zikhulume kokubili abesifazane nabodokotela bazo ekusebenziseni kwawo omunye. Ngenkathi u-HR enganciphisi ngokuthembela ingozi yesifo esingapheli kwabesifazane jikelele, akwenyusisi okuningi; kungcono nje "ukugeza." Ezinye izingozi zikhuphuka, ezinye zehla. Ukusebenzisa isikhathi esifushane kwe-HR ekunciphiseni izimpawu ze-menopausal kuyinto enhle kakhulu, eqondakalayo futhi ephansi kakhulu engozini.
Ukuthatha konke lokhu yilokho ngenkathi i-Task Force ikhiphe impendulo enokwethenjelwa, esekelwe ebufakazini yombuzo onikeziwe mayelana nabesifazane ngokujwayelekile, lowo mbuzo kungenzeka ukuthi awungalungile kunoma yikuphi owesifazane ngokukhethekile. Ukuthembela endleleni yokuphila yokunciphisa ingozi yezifo ezingapheli kunconywa kubo bonke, kepha u-HR angase anconywe kwabanye. Indlela engcono kakhulu yokwandisa impendulo yomuntu oyedwa ukubuza udokotela wakho ngalokho okwenzayo kungabi ngabantu, kodwa kuwe.