Ukwelapha Ngokubuyisela Iestrogen—Ingabe Kukulungele?

UMA ungowesifazane odidekile futhi okhathazekile ngokusebenzisa iestrogen ngemva kokunqamuka kokuya esikhathini, awuwedwa. IERT (estrogen replacement therapy [ukwelapha ngokubuyisela iestrogen]) idida abantu abaningi namuhla, ngisho nodokotela. Ngakolunye uhlangothi, kungenzeka uye wezwa ukuthi iestrogen isiza ekuvimbeleni izifo zenhliziyo futhi ivikela ukudleka kwamathambo okungase kuholele ekwephukeni kwawo okwesabekayo. Ngakolunye uhlangothi, kungenzeka uye wezwa ukuthi iestrogen ihlanganiswa nomdlavuza wesibeletho futhi ngokunokwenzeka ngisho nomdlavuza wamabele.

Kungenzeka uye watshelwa ukuthi ingozi yomdlavuza incishiswa ngokusebenzisa ihormone yesibili yowesifazane ekhiqizwa amaovary, iprogesterone, noma eyokwenziwa efana nayo, iprogestin. Kodwa kungenzeka futhi ukuthi uye wezwa ukuthi iprogesterone ibangela ukopha kokuya esikhathini nyanga zonke futhi ingase iqede izinzuzo ze-estrogen enhliziyweni.

Okwenezela kulokhu kudideka, ukuthi odokotela abaningi basekela noma bamelane ngokunamandla ne-ERT. Omunye udokotela uyabhala kuyiAmerican Journal of Obstetrics and Gynecology: “Ngokuvamile manje sicabanga ukuthi izinzuzo zokwelapha ngokubuyisela iestrogen zizedlula kakhulu izingozi zako. Ukuze bagweme izinkinga zokuntuleka kwe-estrogen, [cishe bonke] abesifazane kufanele baqalise inkambo yesikhathi eside yokwelashwa ngokubuyisela iestrogen lapho ukuya esikhathini sekuzonqamuka.”

Eveza umbono ohlukile, udokotela waseBrithani onokuhlangenwe nakho kweminyaka engu-50 kokucwaninga ngomdlavuza wathi: “Uma uphazamisa amahormone, kunokwenzeka kakhulu ukuthi kube nokulimala okungathi sína. Ioestrogen ikhulisa izicubu futhi isicubu esikhulayo sizwela kakhulu ezintweni ezibangela umdlavuza. Cishe akunakwenzeka ukusebenza ngamahormone ngokuphephile, ngakho kungcono ukukukhohlwa.”

Ukunqamuka Kokuya Esikhathini Ne-ERT

Lapho amantombazane ethomba, cishe ebudaleni beminyaka engu-11, amaovary awo aqala ukukhiqiza iestrogen, ihormone efeza ingxenye enkulu ekwakhekeni kwezici zowesifazane nasekulawuleni umjikelezo wokuya esikhathini. Cishe eminyakeni engu-40 kamuva, ngokwesilinganiso, lapho ukuya esikhathini kunqamuka, ukukhiqizwa kwe-estrogen kusuke sekwehle kangangokuthi akube kusakusekela ukukhiqizwa kwamaqanda nokuya esikhathini. Ekugcineni amaovary ayeka ngokuphelele ukukhiqiza iestrogen. Lokhu kungase kuqalise isikhathi semithwalo yemfanelo enciphile, kuvule umnyango wemisebenzi emisha namathuba amasha nesikhathi sokufunda nokwenza izinto ezintsha.

Kodwa futhi yisikhathi lapho ukuntuleka kwe-estrogen kungase kubangele kokubili izinkinga zesikhashana nezesikhathi eside. Ukuze banqobe lezinkinga, odokotela baqala ukutusa iestrogen yokwenziwa ngawo-1940. Ngo-1975 yayisetshenziswa abesifazane abayizigidi eziyisithupha. Khona-ke kwezwakala ukuthi abasebenzisa iestrogen babesengozini yokungenwa umdlavuza wesibeletho ngokuphindwe kahlanu kunabangayisebenzisi. Kwakhulunywa futhi nangokuthi iestrogen yayihlangene nomdlavuza wamabele. Ukushisekela iERT kwaphela ngokushesha. Kodwa abacwaningi basebenza kanzima ukuze banciphise izingozi, futhi ekuqaleni kwawo-1980, ukwenezelwa kwamaprogestin kwabonakala kuyiqeda ingozi yomdlavuza. Khona-ke iERT yabuye yasetshenziswa futhi emhlabeni kabanzi.

Yini ebangela ukuba ithandwe? Ukuqedwa kobuhlungu besikhumba obunyazimayo, ukuqhubeka kuba nobuhlobo bobulili, nokuncishiswa kwengozi yokukhumuzeka kwamathambo nesifo senhliziyo.

Ubuhlungu Besikhumba Obunyazimayo, Ezinye Izinkinga

Ubuhlungu besikhumba obunyazimayo (noma ukushintsha umbala), obuwuphawu lokunqamuka kokuya esikhathini, buwumphumela oqondile wokuntuleka kwe-estrogen. Uhlobo oluvamile lobuhlungu besikhumba obunyazimayo luqala ngokuba bomvu okungazelelwe kwesikhumba ekhanda, entanyeni, nasesifubeni. Lokhu kuhambisana nokuzwa ukushisa okukhulu komzimba, ngezinye izikhathi okulandelwa ukujuluka kakhulu. Iningi labesifazane asebedlulile ekunqamukeni kokuya esikhathini liyahlangabezana nalokhu. Kwabanye kuba yinto esesilinganisweni. Kwabanye kuba kubi kakhulu futhi kugoge, kubangele izingubo namashidi okumanziswe umjuluko futhi kubangele izimo eziphoxayo emphakathini nokuqwasha ebusuku.

Omunye umphumela wokwehla kokukhiqizwa kwe-estrogen ukoma nokuncipha komgudu wesitho sobulili sowesifazane. Ngokuhamba kwesikhathi ukuhlangana ngokobulili kuba okungajabulisi, okubuhlungu, noma ngisho nokungenzeki. Abanye abesifazane bamukela lezinguquko njengeziwumphumela ongenakubalekelwa wokuguga futhi bacabange ukuthi abasenakuqhubeka beba nobuhlobo bobulili. Nokho, ukushintsha kwesitho sobulili ngokuvamile kungavinjelwa noma kulungiswe ngokushesha nge-ERT.

Enye yezinkinga zempilo ezivame kakhulu ethinta abesifazane abadala ukukhumuzeka kwamathambo, isimo lapho amathambo eba nezimbotshana eziningi, anciphe, futhi abe buthakathaka ngenxa yokulahlekelwa icalcium neprotheni. Lokhu kuholela emathanjeni aphukile, nezinqulu eziphukile. Lapho ukukhumuzeka kwamathambo sekusezingeni elibi kakhulu, owesifazane angase ephuke ingalo lapho ekhipha ipani kuhhavini. Angase ephuke ngisho nobambo lapho ethimula! Wonke umuntu uhlangabezana nokudleka kwamathambo njengoba ekhula, kodwa kwabesifazane asebedlulile ekunqamukeni kokuya esikhathini lenqubo ishesha kakhulu ngenxa yokuntuleka kwe-estrogen.a Abesifazane ababhema ugwayi nabaphuza uphuzo oludakayo njalo basengozini enkulu yokuba nalenkinga kunabanye.

Ngokuvamile ukukhumuzeka kwamathambo kuvela ngaphandle kwezimpawu ezixwayisayo, futhi abantu basuke bengazi ukuthi basenkingeni kuze kube yilapho bephuka ithambo. Ngokuvamile ngalesosikhathi kusuke sekwephuze kakhulu ukwelapha lesosimo. Kuthiwani ngokusebenzisa icalcium eningi? Ngaphandle kwe-estrogen ayenzi lutho ekunciphiseni ukudleka kwamathambo. Icalcium ibalulekile; yingakho odokotela betusa ukuba abesifazane bayisebenzise ne-estrogen. Iestrogen isiza umzimba ukuba umunce icalcium.

Isifo Senhliziyo

EYurophu naseUnited States, imbangela enkulu yokufa kwabesifazane asebedlulile ekunqamukeni kokuya esikhathini iyisifo senhliziyo. Ingabe iERT iyawanciphisa amathuba okungenwa yiso? Kunobufakazi obunamandla bokuthi iyawanciphisa. Kubonakala sengathi iestrogen yandisa izinga lalokho okubizwa ngokuthi icholesterol enhle, iHDL, emithanjeni yegazi futhi inciphise izinga lalokho okubizwa ngokuthi icholesterol embi, iLDL. UkuHlola Kwezempilo Kwabahlengikazi kwalandelela irekhodi lezempilo labesifazane abangu-121 700 kusukela ngo-1976 kuya ku-1982. Imininingwane yabonisa ukuncipha okungamaphesenti angu-70 kwengozi yokungenwa yisifo senhliziyo kwababesebenzisa iestrogen ngalesosikhathi uma kuqhathaniswa nababengayisebenzisi.

Imiphumela enjalo ivumelana ngokunamandla ne-ERT, kodwa kuze kube manje siye sacabangela uhlangothi lwezinzuzo kuphela. Ngaphambi kokuba uphuthume kudokotela wakho uyocela imvume, cabangela izingozi.

Umdlavuza Neprogesterone

Iestrogen, uma isetshenziswa iyodwa, ithuthukisa ukwakheka kwamangqamuzana olwelwesini lwesibeletho. Ngokuhamba kwesikhathi kungase kube nomdlavuza. Ngokwesilinganiso, oyedwa kwabesifazane abangu-⁠1 000 asebedlulile ekunqamukeni kokuya esikhathini ungenwa umdlavuza wesibeletho unyaka ngamunye. Ngalabo abasebenzisa iestrogen, isibalo sabangenwe umdlavuza wesibeletho siphakama ngokushesha sisuka kwabane siya kwabangu-⁠8 kubantu abangu-⁠1 000. Kwabasebenzisa iestrogen eningi isikhathi eside, isibalo singabangu-10 kwabangu-⁠1 000 unyaka ngamunye. Abanye odokotela bacabanga ukuthi iestrogen ihlangene futhi nezinye izinkinga zezifo zabesifazane.

Ukuze banqobe lezizingozi, odokotela batusa, naphezu kwe-estrogen, iprogestin. Ngenxa yokuthi ivimbela ukwakheka kwamangqamuzana esibelethweni, iprogestin inciphisa kokubili izinkinga eziphathelene nomdlavuza nezingaphathelene nawo ezihlangene nokusebenzisa iestrogen iyodwa. UDkt. Lila Nachtigall noJoan Heilman, encwadini yabo ekhuluma nge-estrogen, bayaxwayisa: “Uma unesibeletho, ungalokothi uyeke ukusebenzisa iprogesterone ngaphandle kokuba uyeke ukusebenzisa ne-estrogen ngokufanayo. Iprogesterone iyona eyenza iERT iphephe kangaka namuhla.”

Kodwa ukwenezela iprogestin kunezako izinkinga. Ukukhononda okukhulu okokuthi inhlanganisela ye-estrogen neprogestin ibangela ukubuya kokuya esikhathini. Inkinga engathi sína kakhulu ngokwengeziwe ngeprogestin iwukuthi ingase iyenze ize imiphumela ezuzisayo ye-estrogen enhliziyweni. Esinye isici ekuhloleni izingozi nezinzuzo siwumphumela, uma ukhona, we-ERT emathubeni okuthola umdlavuza wamabele.

Kusukela ngo-1974, abacwaningi baye benza okungenani ukuhlola okungu-30 ukuze babone ukuthi kukhona yini ukuhlangana phakathi kokusetshenziswa kwe-ERT kwesikhashana nomdlavuza wamabele. Ukuhlola akubonisanga ukuhlangana phakathi kokusetshenziswa isikhashana kwe-ERT nomdlavuza wamabele. Ukusetshenziswa kwayo isikhathi eside kwakwehlukile. Ukuhlola eUnited States kwabonisa ingozi enkudlwana engenzeka engamaphesenti angu-50 ngemva kokusebenzisa iERT iminyaka engu-15 noma ngaphezulu. Ukuhlola kwaseYurophu kwasikisela ingozi ephakeme ngisho nangokwengeziwe yokusebenzisa iERT isikhathi eside. Nokho, okunye ukuhlola okwenziwa ngokucophelela akubonisanga ukuhlangana phakathi kokusebenzisa iestrogen isikhathi eside nomdlavuza wamabele.

Ingabe IERT Ikulungele?

“Okwamanje akunakwenzeka ukubhala iqoqo lemithetho elula ngokuqondene nokubuyisela iestrogen,” kusho uDkt. Isaac Schiff waseSikoleni Sezokwelapha saseHarvard. “Isinqumo kufanele kube esomuntu siqu, esisekelwe engxoxweni ehlanganisa konke, enengqondo, nengagwegwesi ephakathi kukadokotela nesiguli.”

Esikhundleni se-ERT, abanye bakhetha ukuzelapha ngokubona kwabo noma amakhambi emvelo. Ngokwesibonelo, abanye besifazane bathola ukuthi ivitamin E yenza izimanga ekunciphiseni ubukhulu nokuvama kobuhlungu besikhumba obunyazimayo. Futhi kungakhathaliseki ukuthi uyayisebenzisa iERT noma cha, ukudla okuhle nokuvivinya umzimba njalo kungabangane abaqinisekisiwe ekumelaneni kokubili nesifo senhliziyo nokukhumuzeka kwamathambo.

Yebo, ukubuyisela iestrogen nanoma yikuphi okunye ukwelapha ngeke kukwenze ube musha noma kuvimbe inqubo yokuguga. Lezi izinto eziyofezwa kuphela uMbuso kaNkulunkulu. (Mathewu 6:​10) Okwamanje, iERT isiza abanye ukuba badambise imiphumela emibi yokuphila ngemva kokunqamuka kokuya esikhathini.

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Ngaphambi kokuba wamukele ukwelashwa nge-ERT, buza udokotela wakho ukuthi yiziphi izingozi ezingaba khona