Ukukhulelwa okuqakathekileko ngukuthi umntwana uqala ukukhombisa iimpawu zokuthomba ngaphambi kokubheka njengokujwayelekile. Kwabafana, izimpawu zokukhulelwa ngaphambi kweminyaka engu-9 zivame ukubhekwa njengento engenangqondo. Kumantombazane, izibonakaliso zobusana ngaphambi kweminyaka eyi-8 zibhekwa njengezinkinga. Kodwa-ke, amanye amantombazane amancane athola izimpawu zokukhulelwa kuphela zokukhula kwesifuba noma ukuthuthukiswa kwezinwele ze-pubic.
Ukukhula kwezinwele zakuqala ze-pubic kuvame kakhulu kumantombazane amnyama amnyama. Lezi zibonakaliso zodwa azibhekwa njengobushakama obunempilo.
Kubalulekile ukuphawula ukuthi ubufakazi bubonisa ukuthi ukukhulelwa kuyenzeka eminyakeni yobudala nangaphansi kwesikhathi. Kunezizathu eziningi zokuthi kungani lokhu kungase kwenzeke. Ukuqala ukukhulelwa kungaxhunyaniswa nokudla okunomsoco ebuntwaneni. Kungase kuhlotshaniswe nemvamisa ekhulayo yokukhuluphala kwengane. Ngakolunye uhlangothi, kunobunye ubufakazi bokuthi bungabhekiswa nezinguquko emvelweni. Ososayensi baye babhekisela kukho konke kusukela ekucindezelekeni kuya ekushintsheni komjikelezo wokukhanya ekungcoleni kwamakhemikhali njengokungathi kunomthelela ekutheni iqiniso liwukuthi, akekho owaziyo ngempela.
Kubalulekile, Nokho, ukubheka umehluko phakathi kokukhulelwa kwangaphambi kokuqala nokuthambekela kokukhulelwa ukuba kube khona ekuqaleni komphakathi wonke. Ubushakama obusanda kuqhathaniswa nobushakathaka okwenzeka ngokushesha kusenokwenzeka ukuthi kungabangela izinkinga zomphakathi noma zezokwelapha kumuntu omusha otholayo.
Ingabe Zikhona Izinkinga Ezihlobene Nokuguga Kwangaphambi Kokuqala?
Izimo eziningana ezahlukahlukene zihlotshaniswa nokukhulelwa kwangaphambili. Noma kunjalo, ubufakazi bezinye zezimo zikhulu kunabanye. Kukhona, isibonelo, ubufakazi obunamandla bokuthi izingane ezithola ubushakathaka obunempilo zizokhula kancane kodwa ziphelele ekuphakameni kwabantu abade kunabangane babo.
Isiqu esifushane ikakhulu inkinga kubantwana abaqala ukukhulelwa ngesikhathi esencane kakhulu. Kwenzeka ngoba amathambo abo avuthiwe futhi ayeka ukukhula ngokushesha. Lesi yisimo esisodwa esingathinteka kahle ngokubambisana nabasakhulayo.
Ubufakazi bezinye izinkinga ezihlobene nobushakama obunempilo buxube kakhulu. Ucwaningo oluthile lubonisa ukuthi ukukhulelwa kwangaphambilini kungaholela ekuziphatheni okubi ngokocansi. Ucwaningo luye lwathola, ngokungahambisani nalokho, ukuthi ukukhulelwa kwangaphambi kwesikhathi kuhlobene nezinkinga zokuziphatha namakhono omphakathi omphakathi. Kukhona nobufakazi bokuthi ukukhulelwa okungahambi kahle kungabangela izinkinga ezingokomzwelo ezigcina zibe ngabantu abadala. Kodwa-ke, eminye imiphumela emibi yezenhlalakahle nezomzwelo ehambisana nokucindezeleka kokukhulelwa kwasekuqaleni inganciphisa ukusekelwa okuhle kwabazali kanye nemfundo.
Kunobunye ubufakazi bokuthi ukukhulelwa kwasekuqaleni kungase kuhlotshaniswe nezinye izingozi zempilo yesikhathi eside. Kungase kube nengozi encane yesifo sikashukela, isifo senhliziyo noma isifo sohlangothi. Kodwa-ke, lezi zingozi zihlazeka yiqiniso lokuthi ukukhuluphala kuhlotshaniswa kokubili kokuthomba kanye nazo zonke izimo zempilo ezintathu. Kungase kube nomngcipheko omncane kakhulu wesifo somdlavuza webele esifundeni sabesifazane abasebasha abanesikhathi sabo sokuqala eminyakeni engaphambili.
Yini Ebangela Ukukhulelwa Okungakaqali?
Kunezici eziningi ezihlukahlukene eziye zahlotshaniswa nokukhulelwa kwangaphambili, nakuba imbangela eqondile isalokhu imfihlakalo.
Ukuvimbela ingane yokubeletha kusetshenziselwa ukwelapha lokho okuyaziwa njengenkathi ebusheni bokuqala ebusweni . Ubushakathaka obukhulu obungakapheliyo kwenzeka lapho ubuchopho buqala ukuthumela izimpawu zokukhulelwa ukuze ziqale.
Ezinye izinto ezihlotshaniswa nokukhulelwa okuphambene nendawo zihlanganisa:
- izakhi zofuzo
- izinkinga zokudla okunempilo zakudala ezilandelwa ukukhuluphala
- ubuchopho kanye nokulimala kwesimiso sezinzwa
Ngeshwa, amacala amaningi okuba embhedeni wangaphambilini ayengama-idiopathic. Lokhu kusho ukuthi odokotela abazi ukuthi kungani kwenzeka.
Kukhona isigaba sesibili sokukhulelwa kwangaphambili okubizwa ngokuthi i- peripheral yobushakama obunempilo noma ubusuku bokuzimela obuyimpumelelo . Lezi zimo zibangelwa ukukhiqizwa kwe-hormone okungavamile okuqala ngaphandle kobuchopho.
Kuyini Ukuvimbela Ukukhulelwa? Benza Kanjani Ukuguga Kwangaphambi Kokuqala?
Abakhi bezingane zokubeletha bavame ukubizwa ngokuthi i-GnRH efanayo noma i- GnRH agonists . Zibizwa nangokuthi ukwelashwa kwe-GnRHa . Lezi zidakamizwa ziphazamisa izimpawu ukuthi ubuchopho buveza umzimba ukuthi uqale ukukhiqiza ama-hormone ahlobene nokukhulelwa kubafana namantombazane. Ngaphambi kokukhulelwa, izingane zinenani elincane kuphela lehomoni elibizwa nge-GnRH-gonadotropin ekhulula i-hormone. I-hormone ikhishwa ngokungapheli nangamanani aphansi. Lapho usuqala ukukhulelwa, umzimba uqala ukwenza i-GnRH eyengeziwe futhi uyikhulule kaningi. Ukwelashwa kwe-GnRHa kuguqula leyo signal ngaphambi kokuba odokotela neziguli bekulungele ukukhulelwa ukuqala.
Ukubeletha kuvame ukuqala ezinyangeni ezingu-6 ukuya ngonyaka ngemuva kokuyeka ukwelashwa kwe-GnRHa. Ososayensi baye bathola njalo ukuthi abantu abasha abathola ukwelashwa kwe-GnRHa yokukhulelwa okungakaqhathanisi bafinyelela ezindaweni eziphakeme kakhulu kunabangaphathwa. Lokhu kuyiqiniso ikakhulu kulabo abathola ukukhulelwa kusukela ngaphambi kweminyaka eyisithupha.
Ukucwaninga kusikisela ukuthi abantu abasha abathola ukwelashwa bangabhekana nokucindezeleka okunciphise kanye nokuhlambalaza ezindleleni lapho ubushakama obunokuqala bubenza bahluke kontanga yabo. Kodwa-ke, kudingwa izifundo eziningi ngaphambi kokuba ososayensi babe nokuqonda kwangempela imiphumela yengqondo yokunakekelwa kokukhulelwa kwangaphambili.
Zombili izinhlobo ezimfushane zokwenza futhi zesikhathi eside zokuvimbela ukukhulelwa ziyatholakala. Amafomu asebenza isikhathi eside angadlulela iminyaka engaba ngu-2 ngaphandle kwesidingo sokwelashwa okuphindaphindiwe. Lawa angathatha uhlobo lwemijovo yesikhathi eside noma implants. Ukwelapha okukhethekile kubandakanya ukufakelwa kwe-histrelin kanye ne-depot leuprolide acetate injection.
Ingabe Abakhubazekile Abakhubazekile?
Ukuvimbela izingane zokubeletha sekusetshenziselwe iminyaka engaphezu kwamashumi amathathu ukuphatha ubushakama obunempilo. Ngokuvamile zibhekwa njengeziphephile futhi zisebenza kahle. Ucwaningo lubonisa ukuthi abantu abasha abaye baqala ukukhulelwa banomsebenzi wokuzala ovamile ngemva kokuba bayeke ukuwathatha, nakuba abesifazane abasha bangase babe nengozi ye- PCOS . Idatha iphinde ikhombise ukuthi abavimbeli besikhathi sokukhulelwa abanemiphumela yesikhathi eside emathanjeni noma emzimbeni. Kodwa-ke, ososayensi abathile bayosathanda ukubona ukucwaninga ngemiphumela emide yokuphila yalezi zindlela zokwelapha ngaphambi kokumemezela ukuthi ziphephile ngempela.
Inothi, enye yezinto ezibalulekile kubantu abasha ekunakekeleni kwe-GnRHa kugcina ukulawula isisindo. Lezi zidakamizwa zingahlanganiswa nokuzuza kwesisindo nokukhuluphala. Njengoba ukukhuluphala kuhloswe futhi kuhlotshaniswa nokukhulelwa kwangaphambili, kubalulekile ukulalela ukudla nokuzivocavoca nezinye izinto ezingasiza umuntu omusha ukuba alondoloze isisindo esinempilo. Kodwa-ke, izindaba ezinhle ukuthi ucwaningo lubonisa ukuthi esikhathini eside, ukwelashwa kwe-GnRHa kuhlotshaniswa nokufezwa kwesisindo esinempilo, okungenani ngamantombazane. Ngakho-ke, akufanele kube yisici esikhulu ekunqumeni ukuthi noma cha ukuqala ukwelashwa noma cha.
Imithombo:
I-Fuqua JS. Ukwelashwa nemiphumela yobushakama obunokuqala: isibuyekezo. J Clin Endocrinol Metab. 2013 Jun; 98 (6): 2198-207. i-doi: 10.1210 / jc.2013-1024.
Kim EY. Imiphumela yesikhathi eside ye-gonadotropin-ekhulula ama-hormone analogs emantombazaneni aphakathi kwentsha ebusweni. I-Korean J Pediatr. 2015 Jan; 58 (1): 1-7. doi: 10.3345 / kjp.2015.58.1.1.
U-Pienkowski C, u-Tauber M. Gonadotropin-Ukukhulula I-Hormone Ukwelashwa Kwe-Agonist Ekuqapheni Ngokwezocansi. I-Endocr Dev. 2016; 29: 214-29. i-doi: 10.1159 / 000438893.
Thornton P, Silverman LA, Geffner ME, Neely EK, Gould E, Danoff TM. Ukubukeza kwemiphumela ngemuva kokuphela kwe-gonadotropin-ukukhipha ukwelashwa kwe-hormonone ye-agonist yamantombazane enenkathi yobushakathaka obunempilo. I-Pediatr Endocrinol Rev. 2014 Mar; 11 (3): 306-17.
Yoo JH. Imiphumela yezinyanga zokuqala ezinkingeni zempilo nezengqondo ezinganeni namantombazane asekhulile. I-Korean J Pediatr. 2016 Sep; 59 (9): 355-361.