Cishe isigamu sabo konke ukukhulelwa okungalindelekile kubangelwa abesifazane ababika ukusetshenziswa kokukhulelwa phakathi nenyanga abakhulelwa ngayo. Ucwaningo lubonise ubuhlobo phakathi kwamaphilisi okulawula ukubeletha nesisindo - ukuthi isisindo sesifazane singabangela ukuhluleka kokubeletha ngomlomo. Ukukhulelwa okungahleliwe nokukhuluphala kubhekisela ku-epidemics evulekayo e-United States. Abesifazane kufanele baqonde ukuthi ukukhuluphala nesisindo kunganciphisa ukusebenza kwepilisi yokulawula ukuzalwa.
Nakuba amaphilisi okulawula ukubeletha evame ukuba enye yezindlela ezidume kakhulu zokuvimbela ukukhulelwa, ukusebenza kwabo kungase kukhishwe emantombazaneni anzima kakhulu.
Isimo samanje
Ukukhula ngokweqile kwamanani kule minyaka engama-25 edlule. Eqinisweni, ngokusho kweNational Center for Health Statistics, ukukhuluphala kuqhubeka nokukhathazeka kwezempilo emphakathini e-United States nasezweni lonke. Ngo-2005 kuya ku-2006, abantu abangaphezu kweyodwa kwabangu-3 base-US (abantu abangaphezu kwezigidi ezingu-72) babekwa njengabantu abakhuluphele kakhulu. Lolu cwaningo lubuye lwaveza ukuthi ama-35.3% abesifazane abhekana nokukhuluphala. Ngomqondo ofanayo, cishe ama-34% wabantu abadala ase-US (27,4% wabesifazane) bazobhekwa njengokwedlulele ngokweqile. Ukukhuluphala ngokweqile kuchazwa njenge-mass mass Index (BMI) engama-30 noma ngaphezulu kanti umuntu onamandla ngokweqile une-BMI ka-25 kuya ku-29.9. I-BMI ibalwa kusukela ngesisindo somuntu nokuphakama kwayo futhi inikeza isibonakaliso esizwakalayo sokudla komzimba nesigaba somzimba esingabangela izinkinga zempilo.
Ingemuva
Ngaphambi kweHolt et al. ukutadisha, kwakucatshangwa ukuthi isisindo somzimba asizange sibe nomthelela ekusebenzeni kwamaphilisi okulawula ukuzalwa. Lesi siphetho sasihloselwe ngokuyinhloko isifundo seqembu le-Oxford Family Planning Association esanyatheliswa ngo-2001. Laba baphandi bathola ukuhlangana phakathi kwesisindo somzimba kanye namazinga okuhluleka kokuvimbela ukukhulelwa komzimba (emva kokulungiswa iminyaka yobudala nobunye).
Kodwa-ke, abesifazane abangama-75 kuleso sifundo basebenzisa amaphilisi okulawula ukubeletha aqukethe noma alingana no-50 mcg we-estrogen. Imiphumela evela kulolu cwaningo ingase ingasebenzi kulolu suku olusetshenziswayo lokukhulelwa komlomo ngoba (ngaphandle kwamatshe amancane amaphilisi), iningi lamaphilisi okulawula ukubeletha linama-30 kuya ku-35 mcg we-estrogen, kanti eziningana-estrogen ezincane (20 izinhlobo ze-mcg) nazo ziyatholakala.
Ucwaningo Lwakamuva
Holt et al. okwenziwe ucwaningo oluphakeme kakhulu lwezocwaningo kuze kube manje, ukuhlola ukuxhumana phakathi kwesisindo nokuhluleka kokubeletha komlomo . Baphetha ngokuthi kulabo abasebenzisa amaphilisi okulawula ukubeletha (uma kuqhathaniswa nabesifazane abanesisindo esiphansi), labo abakhuluphele ngokweqile bangama-60% amathuba okukhulelwa kanti labo abakhuluphele bangama-70% amathuba okuthola ukuhluleka kokukhulelwa. Ngokuqondile, ukuxhuma phakathi kwamaphilisi engeziwe kanye nokuhluleka kwamaphilisi kuqala kwaqala phakathi kwabesifazane abakhuluphele ngokweqile abakwa-BMI abangu-27.3 noma ngaphezulu (lokhu kungalingana nowesifazane onamamitha angu-5, ama-4 intshi olinganisa amapremu angu-160 noma ngaphezulu). Ngakho-ke, abesifazane abasebenzisa njalo izisu zokubeletha ngomlomo kanye no-BMI wabo omkhulu kunama-27.3 izikhathi ezingu-1.58 zengozini yokukhulelwa uma kuqhathaniswa nabasebenzisi abahlala njalo abane-BMI abangaphansi kuka-27.3.
Futhi, owesifazane oweqile ngokweqile cishe uthola ukwehluleka kokukhulelwa uma ephuthelwa ipilisi yakhe yansuku zonke. Kubalulekile ukuqaphela, noma kunjalo, izici ezibandakanya ukuphakama, isisindo, ukunamathela esimweni sokulawula ukuzalwa, kanye nokuvama kocansi kwakuzibikezela kulolu cwaningo. Lokhu kusho ukuthi imiphumela engalungile kungenzeka kungenzeka ngenxa yokubika okungalungile.
Ucwaningo olwenziwa ngo-2007 olwenziwa nguBrunner, Huber noToth lwembula ubuhlobo obunobuthakathaka, nakuba bungabonakali, obuphakathi kokukhuluphala nokuhluleka kokulawula iphilisi. Imiphumela yabonisa ukuthi abesifazane abakhuluphele (BMI ≥ 30) babe nenengozi enkulu yokukhulelwa.
Kodwa-ke, ngemva kokuba abacwaningi bahlelwe ngokuvumelana nobudala, ubuhlanga / ubuhlanga, nobungcweti besifazane, baphetha ngokuthi kwakungekho ukuhlangana phakathi kwesisindo nokuhluleka kokubeletha ngomlomo. Abacwaningi bacebisa ukuthi ukutadisha kwabo kungahle kube nemiphumela engalungile ngoba kunokuba ukulinganisa nokulinganisa ucwaningo kuthatha iqhaza, imiphumela isekelwe ekuzikhulumeni kwabesifazane ngokuphakama nesisindo sabo. Njengoba kunikezwa ukuthi abesifazane bavame ukubikezela ukuphakama kwabo futhi baphinde babike isisindo sabo ngamakhilogremu ambalwa, i-BMI kungenzeka ukuthi yayingalungile. Okokugcina, abacwaningi babengenalo ulwazi ngesilinganiso sobulili noma ngabe abesifazane besithatha njalo amaphilisi abo noma cha; ukungabi khona kokufakwa kwalezi zici kungase kubangele kakhulu imiphumela yalolu cwaningo, futhi abacwaningi baze baphetha ngokuthi kudingekile ukuthi kudingeke ukuthi kube nezifundo ezinkulu, ezengeziwe ukuze kube nempendulo eqondile yokuthi ngabe ukukhuluphala kudlala indima ebalulekile ekusebenzeni komlomo ngomlomo.
Isizathu Sokuba Iphilisi Lingafezi Ngempumelelo
Ngeshwa, isizathu esicacile sokuthi kungani abesifazane ngokweqile kanye / noma abakhuluphele besengozini enkulu yokuhluleka kokubeletha ngomlomo akukwaziwa ngokuphelele. Kodwa-ke, izinkomba eziningana ezihlongozwayo zikhomba izinto eziphilayo ezingase zilandele ingozi eyengeziwe:
- Izinga leHormone: Amaphilisi okulawula ukubeletha kwezinsuku zanamuhla aqukethe amazinga e-hormone aphansi (uma kuqhathaniswa nalawo asetshenziswe eminyakeni emashumi edlule). Abakhiqizi bokubeletha ngomlomo baye banciphisa amazinga e-hormone ngomzamo wokunciphisa imiphumela engathandeki yocala, njengengozi yezindwangu zegazi, inzuzo yesisindo, kanye nezinsizwa. Ukuze iphumelele, ama-hormone epilisi adinga ukujikeleza ngegazi lomfazi. Uma owesifazane enesisindo esikhulu somzimba, kungaba nzima kakhulu ukuhambisa okwanele okwenzekayo, ikakhulukazi unikezwa izinga eliphansi lama-hormone elitholakala eziningi zamaphilisi anamuhla.
- I-Metabolism: Ngokujwayelekile, abesifazane abakhulu kunomzimba ophezulu, ngakho-ke ama-hormone ephilisi angase asebenze ngokushesha. Ngakho-ke, uma owesifazane ekhulula kakhulu, izinga eliphakeme lomzimba wakhe liphakeme; lokhu kunganciphisa isikhathi sokusebenza kwamaphilisi.
- Ama-enzyme enesibindi: Abesifazane abakhuluphele ngokweqile bangase babe nesimiso esiphezulu se-metabolism yesibindi; la mazinga aphezulu ama-enzyme angasiza ukudiliza ama-hormone emithonjeni yokukhulelwa ngomlomo. Abesifazane abakhulu kunesidingo esikhulu sokujikeleza kwegazi nomzimba. Njengoba kunikezwe izicubu eziningi lapho igazi kufanele lijikeleze futhi amathuba okuthi ama-enzyme azokwephula ama-hormone ngokushesha, amazinga e-hormone ajikelezayo angase anciphise.
- Isitoreji seHormone: Amahomoni, i- estrogen ne- progestin , etholakala emaphilisi okulawula ukubeletha agcinwa emaqenjini omzimba. Ngakho-ke, ama cell fat more owesifazane, amathuba akhe amaningi ama-hormone ephilisi abanjwe ngamafutha esikhundleni sokugeleza ngegazi lakhe.
Lokho Okushiwo Konke?
Ingabe kufanele sichaze ucwaningo lokusho ukuthi abesifazane abakhuluphele kufanele bagweme ukusetshenziswa kwamaphilisi okulawula ukuzalwa? Lokhu kungase kungabi yimpendulo. Eqinisweni, ukuphumelela kokusetshenziswa kwezidakamizwa zokubeletha ngomlomo (ngisho nakwabesifazane abakhuluphele ngokweqile) bekuzohlala kusezingeni eliphezulu. Phakathi kwabesifazane abangu-100 abasebenzisa izisu zokubeletha ngomlomo ngonyaka owodwa, ucwaningo lukaHolt et al. (2005) lubonisa ukuthi abesifazane ababili kuya kwabangu-4 bazokhulelwa ngenxa yokuqhathanisa noma ukugqwala. Kodwa-ke, lokhu kwanda ingozi yokukhulelwa kungafanisa nenani eliphakeme lezinkinga zokukhulelwa ezihlobene nokukhuluphala, okungafaka phakathi isifo sikashukela sokuphefumula, ukucindezelwa kwegazi eliphezulu kanye nokulethwa kwe-Caesarea.
Lapho Uqala khona
Abanikezeli abaningi bezempilo bakhetha ukulwa nokunciphisa ukuphumelela kwamaphilisi ngokubeka abesifazane abakhuluphele ngokweqile futhi abakhuluphele ekupileni okulawulwa kokuzalwa kokubeletha kunokuba kube nomkhiqizo ophansi wokudosa ukusiza ukuqinisekisa ukuthi kukhona amahomoni okwanele okuvimbela ukuvuthwa.
Uma uzithola ulesi simo, kubalulekile ukuxoxa ngazo zonke izinketho zakho kanye nezici eziyingozi nge nodokotela wakho. Njengoba abesifazane abakhuluphele ngokweqile bangase babe namathuba okusengozini yengqondo kunabesifazane abanesisindo esivamile, izinga eliphakeme lokubeletha ngomlomo lingakhuphuka nakakhulu lezi zingozi zenhliziyo. Isibonelo, ucwaningo lukhonjiswe lapha ukuthi lube yingozi enkulu ye-thromboembolism ye-venous (i-blood clots) phakathi kwabesifazane abakhuluphele abasebenzisa amaphilisi okulawula ukubeletha. Ngakho-ke, udokotela angase afise ukugcina owesifazane okhuluphele ngokweqile ephasilini lokulawula ukuzalwa kokubeletha kanye nemiyalelo yokusebenzisa indlela yokusekelayo yokulawula ukuzalwa ukusiza ukukhulisa ukuvikelwa kokukhulelwa. Kulokhu, izindlela zokuvimbela amakhondomu abesilisa noma abesifazane , isiponji noma i- spermicide ingasetshenziswa ngokuhlanganyela nephilisi. Okokugcina, uma owesifazane oweqile ngokweqile uye wanquma ukuthi akasasafuni ukuthi abe nezinye izingane, uhlobo oluhlala njalo lokuvimbela ukukhulelwa njenge- tubal ligation noma inzalo ye-hysteroscopic (no-surgical), njenge- Essure .
Okubalulekile
Njengoba kunikezwe uxhumano oluncane phakathi kwesisindo esiphakeme kanye nokulawulwa kwepilisi lokusebenza kahle , kubalulekile ukuxoxa ngalokhu nomhlinzeki wakho wezempilo. Futhi, kusukela kokuqala ukushiwo iphilisi, uma ubona ukuthi isisindo sakho senyuke ngokuphawulekayo (mhlawumbe, mhlawumbe okungenani ubuncane bomgqobo obuncane), qinisekisa ukwazisa umhlinzeki wakho wezempilo ukuze aqiniseke ukuthi le ndlela isasebenza kakhulu futhi iphephile kakhulu inketho yokukhulelwa kuwe.
> Imithombo:
> Brunner Huber, i-LR ne-Toth, i-JL (2007). Ukwehla komzimba kanye nokuhluleka kokukhulelwa komlomo: Okutholakele Kusukela ku-2002 Ucwaningo lukazwelonke lwezokukhula komndeni. I-American Journal of Epidemiology, 166 (11), 1306-1311.
> Holt et al. (2005). I-Mass Mass Index, Isisindo, kanye Nengozi Yokuhluleka Ukukhulelwa Ngomlomo. Izidakamizwa kanye namaGynecology, 105 (1), 46-52.
> Ogden, CL, uCarroll, MD, McDowell, MA, & Flegal, KM (2007). Ukukhuluphala Phakathi Kwabantu Abadala E-United States - Akukho Ukushintshwa Okuphawulekayo Kwezinguquko Kusukela ngo-2003 kuya ku-2004 .
> Vessey, M (2001). Ukwehluleka kokukhulelwa komlomo kanye nesisindo somzimba: Okufundwayo esifundweni esikhulu seqembu. I-Journal Yokuhlela Komndeni Nokunakekelwa Kwezempilo Kwezokubeletha, 27 (2), 90-91.