{"id":10650,"date":"2021-04-15T12:17:37","date_gmt":"2021-04-15T10:17:37","guid":{"rendered":"https:\/\/www.cidsr.md\/?post_type=news&#038;p=6441"},"modified":"2023-12-08T18:12:01","modified_gmt":"2023-12-08T15:12:01","slug":"noua-informatie-despre-endometrioza-publicata-de-oms","status":"publish","type":"news","link":"https:\/\/cidsr.md\/en\/news\/noua-informatie-despre-endometrioza-publicata-de-oms\/","title":{"rendered":"New WHO Factsheet on Endometriosis[:]","raw":"New WHO Factsheet on Endometriosis[:]"},"content":{"rendered":"<p><span style=\"font-size: 14pt;\"><strong>Endometriosis<\/strong><\/span><\/p>\n<p><span style=\"font-size: 10pt;\">31 March 2021<\/span><\/p>\n<p><strong>Key facts<\/strong><\/p>\n<ul>\n<li><strong>Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and\/or infertility (1).<\/strong><\/li>\n<li><strong>Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally (2).<\/strong><\/li>\n<li><strong>It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and\/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.<\/strong><\/li>\n<li><strong>The variable and broad symptoms of endometriosis mean that healthcare workers do not easily diagnose it and many individuals suffering from it have limited awareness of the condition. This can cause a lengthy delay between onset of symptoms and diagnosis (3).<\/strong><\/li>\n<li><strong>At present, there is no known cure for endometriosis, and treatment is usually aimed at controlling symptoms (4).<\/strong><\/li>\n<li><strong>Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many settings, including in low- and middle-income countries.<\/strong><\/li>\n<li><strong>There is a need for more research and awareness raising around the world to ensure effective prevention, early diagnosis, and improved management of the disease (2,5).<\/strong><\/li>\n<\/ul>\n<p><strong>Introduction and definition<\/strong><br \/>\nEndometriosis is a disease characterized by the presence of tissue resembling endometrium (the lining of the uterus) outside the uterus (1). It causes a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. Several lesion types have been described (1,6):<\/p>\n<ul>\n<li>superficial endometriosis found mainly on the pelvic peritoneum<\/li>\n<li>cystic ovarian endometriosis (endometrioma) found in the ovaries<\/li>\n<li>deep endometriosis found in the recto-vaginal septum, bladder, and bowel<\/li>\n<li>in rare cases, endometriosis has also been found outside the pelvis<\/li>\n<\/ul>\n<p>Symptoms associated with endometriosis vary, and include a combination of:<\/p>\n<ul>\n<li>painful periods<\/li>\n<li>chronic pelvic pain<\/li>\n<li>pain during and\/or after sexual intercourse<\/li>\n<li>painful bowel movements<\/li>\n<li>painful urination<\/li>\n<li>fatigue<\/li>\n<li>depression or anxiety<\/li>\n<li>abdominal bloating and nausea<\/li>\n<\/ul>\n<p>In addition to the above, endometriosis can cause infertility. Infertility occurs due to the probable effects of endometriosis on the pelvic cavity, ovaries, fallopian tubes or uterus. There is little correlation between the extent of endometrial lesions and severity or duration of symptoms: some individuals with visibly large lesions have mild symptoms, and others with few lesions have severe symptoms. Symptoms often improve after menopause, but in some cases painful symptoms can persist. Chronic pain may be due to pain centres in the brain becoming hyper-responsive over time (central sensitisation), which can occur at any point throughout the life course of endometriosis, including treated, insufficiently treated, and untreated endometriosis, and may persist even when endometriosis lesions are no longer visible. In some cases, endometriosis can be asymptomatic.<\/p>\n<p><strong>What is the cause of endometriosis?<\/strong><br \/>\nEndometriosis is a complex disease that affects some women globally, from the onset of their first period (menarche) through menopause regardless of ethnic origin or social status. The exact origins of endometriosis are thought to be multifactorial, meaning that many different factors contribute to its development. Several hypotheses have been proposed to explain origins of endometriosis. At present endometriosis is thought to arise due to:<\/p>\n<ul>\n<li>Retrograde menstruation, which is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity at the time that blood is flowing out of the body through the cervix and vagina during periods. Retrograde menstruation can result in endometrial-like cells being deposited outside the uterus where they can implant and grow.<\/li>\n<li>Cellular metaplasia, which is when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and start to grow.<\/li>\n<li>Stem cells giving rise to the disease, which then spreads through the body via blood and lymphatic vessels.<\/li>\n<\/ul>\n<p>Other factors may also contribute to the growth or persistence of ectopic endometrial tissue. For example, endometriosis is known to be dependent on estrogen, which facilitates the inflammation, growth, and pain associated with the disease. However, the relationship between estrogen and endometriosis is complex since the absence of estrogen does not always preclude the presence of endometriosis. Several other factors are thought to promote the development, growth, and maintenance of endometriosis lesions. These include altered or impaired immunity, localized complex hormonal influences, genetics and potentially, environmental contaminants (2,7).<\/p>\n<p><strong>Health, social and economic benefits of addressing endometriosis<\/strong><br \/>\nEndometriosis has significant social, public health and economic implications. It can decrease quality of life due to severe pain, fatigue, depression, anxiety, and infertility. Some individuals with endometriosis experience debilitating endometriosis-associated pain that prevents them from going to work or school (8,9). In these situations, addressing endometriosis can reduce absence from school or increase an individual\u2019s ability to contribute to the labour force. Painful sex due to endometriosis can lead to interruption or avoidance of intercourse and affect the sexual health of affected individuals and\/or their partners (9). Addressing endometriosis will empower those affected by it, by supporting their human right to the highest standard of sexual and reproductive health, quality of life, and overall well-being.<\/p>\n<p><strong>Prevention<\/strong><br \/>\nAt present, there is no known way to prevent endometriosis. Enhanced awareness, followed by early diagnosis and management may slow or halt the natural progression of the disease and reduce the long-term burden of its symptoms, including possibly the risk of central nervous system pain sensitisation, but currently there is no cure.<\/p>\n<p><strong>Diagnosis<\/strong><br \/>\nA careful history of menstrual symptoms and chronic pelvic pain provides the basis for suspecting endometriosis. Although several screening tools and tests have been proposed and tested, none are currently validated to accurately identify or predict individuals or populations that are most likely to have the disease. Early suspicion of endometriosis is a key factor for early diagnosis, as endometriosis can often present symptoms that mimic other conditions and contribute to a diagnostic delay. In addition to medical history, referral from the primary health care level to secondary centers where additional investigations are available may be needed. For instance, ovarian endometrioma, adhesions and deep nodular forms of disease often require ultrasonography or magnetic resonance imaging (MRI) to detect. Histologic verification, usually following surgical\/laparoscopic visualization, can be useful in confirming diagnosis, particularly for the most common superficial lesions (1,2). The need for histologic\/laparoscopic confirmation should not prevent the commencement of empirical medical treatment.<\/p>\n<p><strong>Treatment<\/strong><br \/>\nTreatment can be with medications and\/or surgery depending on symptoms, lesions, desired outcome, and patient choice (4). Contraceptive steroids, non-steroidal anti-inflammatory medications, and analgesics (painkillers) are common therapies. All must be carefully prescribed and monitored to avoid potentially problematic side effects. Medical treatments for endometriosis focus on either lowering estrogen or increasing progesterone in order to alter hormonal environments that promote endometriosis. These medical therapies include the combined oral contraceptive pill, progestins, and GnRH-analogues. However, none of these treatments eradicates the disease, they are associated with side effects, and endometriosis-related symptoms can sometimes &#8211; but not always &#8211; reappear after therapy discontinuation. The choice of treatment depends on effectiveness in the individual, adverse side effects, long-term safety, costs, and availability. Most current hormonal management is not suitable for persons suffering from endometriosis who wish to get pregnant, since they affect ovulation.<\/p>\n<p>Surgery can remove endometriosis lesions, adhesions, and scar tissue. However, success in reducing pain symptoms and increasing pregnancy rates are often dependent on the extent of disease. In addition, lesions may recur even after successful eradication, and pelvic floor muscle abnormalities can contribute to chronic pelvic pain. Secondary changes of the pelvis, including the pelvic floor, and central sensitisation may benefit from physiotherapy and complementary treatments in some patients. Treatment options for infertility due to endometriosis include laparoscopic surgical removal of endometriosis, ovarian stimulation with intrauterine insemination (IUI), and in vitro fertilization (IVF), but success rates vary (4).\u00a0 Other comorbidities may occur alongside endometriosis, requiring diagnosis and management. Multidisciplinary treatment addressing different symptoms and overall health should involve different specialists, such as pain specialists, pelvic physiotherapists, complementary and alternative medicine specialists, general practitioners, and psychologists, in addition to gynaecologists, to be most effective (2,10).<\/p>\n<p><strong>Read the full document <a href=\"https:\/\/drive.google.com\/file\/d\/1FuAsvVWfIqgkFRjmwzksIU6iKXoTQatQ\/view?usp=sharing\" target=\"_blank\" rel=\"noopener\">here<\/a><\/strong>[:][:]\n","protected":false,"raw":"\n\n<span style=\"font-size: 14pt;\"><strong>Endometriosis<\/strong><\/span>\n\n<span style=\"font-size: 10pt;\">31 March 2021<\/span>\n\n<strong>Key facts<\/strong>\n<ul>\n \t<li><strong>Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and\/or infertility (1).<\/strong><\/li>\n \t<li><strong>Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally (2).<\/strong><\/li>\n \t<li><strong>It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and\/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.<\/strong><\/li>\n \t<li><strong>The variable and broad symptoms of endometriosis mean that healthcare workers do not easily diagnose it and many individuals suffering from it have limited awareness of the condition. This can cause a lengthy delay between onset of symptoms and diagnosis (3).<\/strong><\/li>\n \t<li><strong>At present, there is no known cure for endometriosis, and treatment is usually aimed at controlling symptoms (4).<\/strong><\/li>\n \t<li><strong>Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many settings, including in low- and middle-income countries.<\/strong><\/li>\n \t<li><strong>There is a need for more research and awareness raising around the world to ensure effective prevention, early diagnosis, and improved management of the disease (2,5).<\/strong><\/li>\n<\/ul>\n<strong>Introduction and definition<\/strong>\nEndometriosis is a disease characterized by the presence of tissue resembling endometrium (the lining of the uterus) outside the uterus (1). It causes a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. Several lesion types have been described (1,6):\n<ul>\n \t<li>superficial endometriosis found mainly on the pelvic peritoneum<\/li>\n \t<li>cystic ovarian endometriosis (endometrioma) found in the ovaries<\/li>\n \t<li>deep endometriosis found in the recto-vaginal septum, bladder, and bowel<\/li>\n \t<li>in rare cases, endometriosis has also been found outside the pelvis<\/li>\n<\/ul>\nSymptoms associated with endometriosis vary, and include a combination of:\n<ul>\n \t<li>painful periods<\/li>\n \t<li>chronic pelvic pain<\/li>\n \t<li>pain during and\/or after sexual intercourse<\/li>\n \t<li>painful bowel movements<\/li>\n \t<li>painful urination<\/li>\n \t<li>fatigue<\/li>\n \t<li>depression or anxiety<\/li>\n \t<li>abdominal bloating and nausea<\/li>\n<\/ul>\nIn addition to the above, endometriosis can cause infertility. Infertility occurs due to the probable effects of endometriosis on the pelvic cavity, ovaries, fallopian tubes or uterus. There is little correlation between the extent of endometrial lesions and severity or duration of symptoms: some individuals with visibly large lesions have mild symptoms, and others with few lesions have severe symptoms. Symptoms often improve after menopause, but in some cases painful symptoms can persist. Chronic pain may be due to pain centres in the brain becoming hyper-responsive over time (central sensitisation), which can occur at any point throughout the life course of endometriosis, including treated, insufficiently treated, and untreated endometriosis, and may persist even when endometriosis lesions are no longer visible. In some cases, endometriosis can be asymptomatic.\n\n<strong>What is the cause of endometriosis?<\/strong>\nEndometriosis is a complex disease that affects some women globally, from the onset of their first period (menarche) through menopause regardless of ethnic origin or social status. The exact origins of endometriosis are thought to be multifactorial, meaning that many different factors contribute to its development. Several hypotheses have been proposed to explain origins of endometriosis. At present endometriosis is thought to arise due to:\n<ul>\n \t<li>Retrograde menstruation, which is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity at the time that blood is flowing out of the body through the cervix and vagina during periods. Retrograde menstruation can result in endometrial-like cells being deposited outside the uterus where they can implant and grow.<\/li>\n \t<li>Cellular metaplasia, which is when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and start to grow.<\/li>\n \t<li>Stem cells giving rise to the disease, which then spreads through the body via blood and lymphatic vessels.<\/li>\n<\/ul>\nOther factors may also contribute to the growth or persistence of ectopic endometrial tissue. For example, endometriosis is known to be dependent on estrogen, which facilitates the inflammation, growth, and pain associated with the disease. However, the relationship between estrogen and endometriosis is complex since the absence of estrogen does not always preclude the presence of endometriosis. Several other factors are thought to promote the development, growth, and maintenance of endometriosis lesions. These include altered or impaired immunity, localized complex hormonal influences, genetics and potentially, environmental contaminants (2,7).\n\n<strong>Health, social and economic benefits of addressing endometriosis<\/strong>\nEndometriosis has significant social, public health and economic implications. It can decrease quality of life due to severe pain, fatigue, depression, anxiety, and infertility. Some individuals with endometriosis experience debilitating endometriosis-associated pain that prevents them from going to work or school (8,9). In these situations, addressing endometriosis can reduce absence from school or increase an individual\u2019s ability to contribute to the labour force. Painful sex due to endometriosis can lead to interruption or avoidance of intercourse and affect the sexual health of affected individuals and\/or their partners (9). Addressing endometriosis will empower those affected by it, by supporting their human right to the highest standard of sexual and reproductive health, quality of life, and overall well-being.\n\n<strong>Prevention<\/strong>\nAt present, there is no known way to prevent endometriosis. Enhanced awareness, followed by early diagnosis and management may slow or halt the natural progression of the disease and reduce the long-term burden of its symptoms, including possibly the risk of central nervous system pain sensitisation, but currently there is no cure.\n\n<strong>Diagnosis<\/strong>\nA careful history of menstrual symptoms and chronic pelvic pain provides the basis for suspecting endometriosis. Although several screening tools and tests have been proposed and tested, none are currently validated to accurately identify or predict individuals or populations that are most likely to have the disease. Early suspicion of endometriosis is a key factor for early diagnosis, as endometriosis can often present symptoms that mimic other conditions and contribute to a diagnostic delay. In addition to medical history, referral from the primary health care level to secondary centers where additional investigations are available may be needed. For instance, ovarian endometrioma, adhesions and deep nodular forms of disease often require ultrasonography or magnetic resonance imaging (MRI) to detect. Histologic verification, usually following surgical\/laparoscopic visualization, can be useful in confirming diagnosis, particularly for the most common superficial lesions (1,2). The need for histologic\/laparoscopic confirmation should not prevent the commencement of empirical medical treatment.\n\n<strong>Treatment<\/strong>\nTreatment can be with medications and\/or surgery depending on symptoms, lesions, desired outcome, and patient choice (4). Contraceptive steroids, non-steroidal anti-inflammatory medications, and analgesics (painkillers) are common therapies. All must be carefully prescribed and monitored to avoid potentially problematic side effects. Medical treatments for endometriosis focus on either lowering estrogen or increasing progesterone in order to alter hormonal environments that promote endometriosis. These medical therapies include the combined oral contraceptive pill, progestins, and GnRH-analogues. However, none of these treatments eradicates the disease, they are associated with side effects, and endometriosis-related symptoms can sometimes - but not always - reappear after therapy discontinuation. The choice of treatment depends on effectiveness in the individual, adverse side effects, long-term safety, costs, and availability. Most current hormonal management is not suitable for persons suffering from endometriosis who wish to get pregnant, since they affect ovulation.\n\nSurgery can remove endometriosis lesions, adhesions, and scar tissue. However, success in reducing pain symptoms and increasing pregnancy rates are often dependent on the extent of disease. In addition, lesions may recur even after successful eradication, and pelvic floor muscle abnormalities can contribute to chronic pelvic pain. Secondary changes of the pelvis, including the pelvic floor, and central sensitisation may benefit from physiotherapy and complementary treatments in some patients. Treatment options for infertility due to endometriosis include laparoscopic surgical removal of endometriosis, ovarian stimulation with intrauterine insemination (IUI), and in vitro fertilization (IVF), but success rates vary (4).\u00a0 Other comorbidities may occur alongside endometriosis, requiring diagnosis and management. Multidisciplinary treatment addressing different symptoms and overall health should involve different specialists, such as pain specialists, pelvic physiotherapists, complementary and alternative medicine specialists, general practitioners, and psychologists, in addition to gynaecologists, to be most effective (2,10).\n\n<strong>Read the full document <a href=\"https:\/\/drive.google.com\/file\/d\/1FuAsvVWfIqgkFRjmwzksIU6iKXoTQatQ\/view?usp=sharing\" target=\"_blank\" rel=\"noopener\">here<\/a><\/strong>[:][:]"},"excerpt":{"rendered":"","protected":false,"raw":""},"author":4,"featured_media":6442,"parent":0,"template":"page-news-details.php","blog_news":[],"class_list":["post-10650","news","type-news","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nou\u0103 informa\u021bie despre endometrioza publicata de OMS - Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nou\u0103 informa\u021bie despre endometrioza publicata de OMS - Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive\" \/>\n<meta property=\"og:description\" content=\"Endometriosis 31 March 2021 Key facts Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and\/or infertility (1). Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally (2). It is a chronic disease associated with severe, life-impacting pain during periods, sexual [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/\" \/>\n<meta property=\"og:site_name\" content=\"Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive\" \/>\n<meta property=\"article:modified_time\" content=\"2023-12-08T15:12:01+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/\",\"url\":\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/\",\"name\":\"Nou\u0103 informa\u021bie despre endometrioza publicata de OMS - Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive\",\"isPartOf\":{\"@id\":\"https:\/\/cidsr.md\/#website\"},\"datePublished\":\"2021-04-15T10:17:37+00:00\",\"dateModified\":\"2023-12-08T15:12:01+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"\u0413\u043b\u0430\u0432\u043d\u0430\u044f \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430\",\"item\":\"https:\/\/new.cidsr.md\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Nou\u0103 informa\u021bie despre endometrioza publicata de OMS\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cidsr.md\/#website\",\"url\":\"https:\/\/cidsr.md\/\",\"name\":\"Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive\",\"description\":\"Promov\u0103m s\u0103n\u0103tatea \u0219i drepturile sexuale \u0219i reproductive!\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/cidsr.md\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Nou\u0103 informa\u021bie despre endometrioza publicata de OMS - Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/cidsr.md\/%news-slug%\/noua-informatie-despre-endometrioza-publicata-de-oms\/","og_locale":"en_US","og_type":"article","og_title":"Nou\u0103 informa\u021bie despre endometrioza publicata de OMS - Centrul de Instruire \u00een Domeniul S\u0103n\u0103t\u0103\u0163ii Reproductive","og_description":"Endometriosis 31 March 2021 Key facts Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and\/or infertility (1). 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S\u0103n\u0103t\u0103\u0163ii Reproductive","description":"Promov\u0103m s\u0103n\u0103tatea \u0219i drepturile sexuale \u0219i reproductive!","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/cidsr.md\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"}]}},"meta":{"_ru_post_content":"\n\n<span style=\"font-size: 14pt;\"><strong>\u042d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437<\/strong><\/span>\n\n<span style=\"font-size: 10pt;\">31 \u043c\u0430\u0440\u0442\u0430 2021 \u0433.<\/span>\n\n<strong>\u041a\u043b\u044e\u0447\u0435\u0432\u044b\u0435 \u0444\u0430\u043a\u0442\u044b<\/strong>\n<ul>\n \t<li><strong>\u042d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437 - \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435, \u043f\u0440\u0438 \u043a\u043e\u0442\u043e\u0440\u043e\u043c \u0442\u043a\u0430\u043d\u044c, \u0430\u043d\u0430\u043b\u043e\u0433\u0438\u0447\u043d\u0430\u044f \u043d\u0430\u0445\u043e\u0434\u044f\u0449\u0435\u0439\u0441\u044f \u0432\u043e \u0432\u043d\u0443\u0442\u0440\u0435\u043d\u043d\u0435\u043c \u0441\u043b\u043e\u0435 \u043c\u0430\u0442\u043a\u0438, \u0440\u0430\u0437\u0440\u0430\u0441\u0442\u0430\u0435\u0442\u0441\u044f \u0437\u0430 \u043f\u0440\u0435\u0434\u0435\u043b\u0430\u043c\u0438 \u043c\u0430\u0442\u043a\u0438, \u0432\u044b\u0437\u044b\u0432\u0430\u044f \u0431\u043e\u043b\u0438 \u0438\/\u0438\u043b\u0438 \u0431\u0435\u0441\u043f\u043b\u043e\u0434\u0438\u0435 (1).<\/strong><\/li>\n \t<li><strong>\u042d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u043e\u043c \u0441\u0442\u0440\u0430\u0434\u0430\u044e\u0442 \u043e\u043a\u043e\u043b\u043e 10% (190 \u043c\u0438\u043b\u043b\u0438\u043e\u043d\u043e\u0432) \u0436\u0435\u043d\u0449\u0438\u043d \u0438 \u0434\u0435\u0432\u0443\u0448\u0435\u043a \u0440\u0435\u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438\u0432\u043d\u043e\u0433\u043e \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430 \u0432\u043e \u0432\u0441\u0435\u043c \u043c\u0438\u0440\u0435 (2).<\/strong><\/li>\n \t<li><strong>\u042d\u0442\u043e \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435, \u0441\u043e\u043f\u0440\u043e\u0432\u043e\u0436\u0434\u0430\u044e\u0449\u0435\u0435\u0441\u044f \u0441\u0438\u043b\u044c\u043d\u043e\u0439, \u043d\u0435 \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u044e\u0449\u0435\u0439 \u0437\u0430\u043d\u0438\u043c\u0430\u0442\u044c\u0441\u044f \u043e\u0431\u044b\u0447\u043d\u043e\u0439 \u0434\u0435\u044f\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u044c\u044e \u0431\u043e\u043b\u044c\u044e \u0432\u043e \u0432\u0440\u0435\u043c\u044f \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u0438, \u043f\u043e\u043b\u043e\u0432\u043e\u0433\u043e \u0430\u043a\u0442\u0430, \u0434\u0435\u0444\u0435\u043a\u0430\u0446\u0438\u0438 \u0438\/\u0438\u043b\u0438 \u043c\u043e\u0447\u0435\u0438\u0441\u043f\u0443\u0441\u043a\u0430\u043d\u0438\u044f, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u0431\u043e\u043b\u044c\u044e \u0432 \u043e\u0431\u043b\u0430\u0441\u0442\u0438 \u0442\u0430\u0437\u0430, \u0432\u0437\u0434\u0443\u0442\u0438\u0435\u043c \u0436\u0438\u0432\u043e\u0442\u0430, \u0442\u043e\u0448\u043d\u043e\u0442\u043e\u0439, \u0443\u0442\u043e\u043c\u043b\u044f\u0435\u043c\u043e\u0441\u0442\u044c\u044e, \u0438\u043d\u043e\u0433\u0434\u0430 \u0434\u0435\u043f\u0440\u0435\u0441\u0441\u0438\u0435\u0439, \u0431\u0435\u0441\u043f\u043e\u043a\u043e\u0439\u0441\u0442\u0432\u043e\u043c \u0438 \u0431\u0435\u0441\u043f\u043b\u043e\u0434\u0438\u0435\u043c.<\/strong><\/li>\n \t<li><strong>\u0420\u0430\u0437\u043d\u043e\u043e\u0431\u0440\u0430\u0437\u043d\u044b\u0435 \u0438 \u043c\u043d\u043e\u0433\u043e\u0447\u0438\u0441\u043b\u0435\u043d\u043d\u044b\u0435 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0430 \u0441\u043e\u043f\u0440\u044f\u0436\u0435\u043d\u044b \u0441 \u0442\u0435\u043c, \u0447\u0442\u043e \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\u043c \u0440\u0430\u0431\u043e\u0442\u043d\u0438\u043a\u0430\u043c \u043d\u0435\u043b\u0435\u0433\u043a\u043e \u0435\u0433\u043e \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u0440\u043e\u0432\u0430\u0442\u044c, \u0438 \u043c\u043d\u043e\u0433\u0438\u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043a\u0438, \u0441\u0442\u0440\u0430\u0434\u0430\u044e\u0449\u0438\u0435 \u0438\u043c, \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e \u043e\u0441\u0432\u0435\u0434\u043e\u043c\u043b\u0435\u043d\u044b \u043e\u0431 \u044d\u0442\u043e\u043c \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0438. \u0412 \u0441\u0432\u044f\u0437\u0438 \u0441 \u044d\u0442\u0438\u043c \u0441 \u043c\u043e\u043c\u0435\u043d\u0442\u0430 \u0432\u043e\u0437\u043d\u0438\u043a\u043d\u043e\u0432\u0435\u043d\u0438\u044f \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u043e\u0432 \u0434\u043e \u043f\u043e\u0441\u0442\u0430\u043d\u043e\u0432\u043a\u0438 \u0434\u0438\u0430\u0433\u043d\u043e\u0437\u0430 \u043c\u043e\u0436\u0435\u0442 \u043f\u0440\u043e\u0439\u0442\u0438 \u0434\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u043f\u0440\u043e\u043c\u0435\u0436\u0443\u0442\u043e\u043a \u0432\u0440\u0435\u043c\u0435\u043d\u0438 (3).<\/strong><\/li>\n \t<li><strong>\u0412 \u043d\u0430\u0441\u0442\u043e\u044f\u0449\u0435\u0435 \u0432\u0440\u0435\u043c\u044f \u043d\u0435 \u0441\u0443\u0449\u0435\u0441\u0442\u0432\u0443\u0435\u0442 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e\u0433\u043e \u0441\u043f\u043e\u0441\u043e\u0431\u0430 \u0438\u0437\u0431\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u043e\u0442 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0430, \u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435, \u043a\u0430\u043a \u043f\u0440\u0430\u0432\u0438\u043b\u043e, \u043d\u0430\u043f\u0440\u0430\u0432\u043b\u0435\u043d\u043e \u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u0435 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u043e\u0432 (4).<\/strong><\/li>\n \t<li><strong>\u0414\u043e\u0441\u0442\u0443\u043f \u043a \u0440\u0430\u043d\u043d\u0435\u0439 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0435 \u0438 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u043c\u0443 \u043b\u0435\u0447\u0435\u043d\u0438\u044e \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0430 \u0432\u0430\u0436\u0435\u043d, \u043e\u0434\u043d\u0430\u043a\u043e \u0432\u043e \u043c\u043d\u043e\u0433\u0438\u0445 \u0441\u043b\u0443\u0447\u0430\u044f\u0445 \u043e\u043d \u043e\u0433\u0440\u0430\u043d\u0438\u0447\u0435\u043d, \u0432 \u0442\u043e\u043c \u0447\u0438\u0441\u043b\u0435 \u0432 \u0441\u0442\u0440\u0430\u043d\u0430\u0445 \u0441 \u043d\u0438\u0437\u043a\u0438\u043c \u0438 \u0441\u0440\u0435\u0434\u043d\u0438\u043c \u0443\u0440\u043e\u0432\u043d\u0435\u043c \u0434\u043e\u0445\u043e\u0434\u0430.<\/strong><\/li>\n \t<li><strong>\u0421\u0443\u0449\u0435\u0441\u0442\u0432\u0443\u0435\u0442 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e\u0441\u0442\u044c \u0432 \u043f\u0440\u043e\u0432\u0435\u0434\u0435\u043d\u0438\u0438 \u0434\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0439 \u0438 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0438 \u043e\u0441\u0432\u0435\u0434\u043e\u043c\u043b\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u0432\u043e \u0432\u0441\u0435\u043c \u043c\u0438\u0440\u0435, \u0447\u0442\u043e\u0431\u044b \u043e\u0431\u0435\u0441\u043f\u0435\u0447\u0438\u0432\u0430\u0442\u044c \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u0443\u044e \u043f\u0440\u043e\u0444\u0438\u043b\u0430\u043a\u0442\u0438\u043a\u0443, \u0440\u0430\u043d\u043d\u044e\u044e \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0443 \u0438 \u0431\u043e\u043b\u0435\u0435 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u0435 \u044d\u0442\u043e\u0433\u043e \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f (2,5).<\/strong><\/li>\n<\/ul>\n<strong>\u0412\u0432\u0435\u0434\u0435\u043d\u0438\u0435 \u0438 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435<\/strong>\n\u042d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437 \u2013 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435, \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0437\u0443\u044e\u0449\u0435\u0435\u0441\u044f \u043d\u0430\u043b\u0438\u0447\u0438\u0435\u043c \u0442\u043a\u0430\u043d\u0438, \u043d\u0430\u043f\u043e\u043c\u0438\u043d\u0430\u044e\u0449\u0435\u0439 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u0439 (\u0432\u043d\u0443\u0442\u0440\u0435\u043d\u043d\u0438\u0439 \u0441\u043b\u043e\u0439 \u043c\u0430\u0442\u043a\u0438), \u0437\u0430 \u043f\u0440\u0435\u0434\u0435\u043b\u0430\u043c\u0438 \u043c\u0430\u0442\u043a\u0438 (1). \u041e\u043d\u0430 \u0432\u044b\u0437\u044b\u0432\u0430\u0435\u0442 \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0443\u044e \u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u0443\u044e \u0440\u0435\u0430\u043a\u0446\u0438\u044e, \u0447\u0442\u043e \u043c\u043e\u0436\u0435\u0442 \u043f\u0440\u0438\u0432\u0435\u0441\u0442\u0438 \u043a \u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043d\u0438\u044e \u0440\u0443\u0431\u0446\u043e\u0432\u043e\u0439 \u0442\u043a\u0430\u043d\u0438 (\u0441\u043f\u0430\u0435\u043a, \u0444\u0438\u0431\u0440\u043e\u0437\u0430) \u0432 \u043e\u0431\u043b\u0430\u0441\u0442\u0438 \u0442\u0430\u0437\u0430 \u0438 \u0434\u0440\u0443\u0433\u0438\u0445 \u043e\u0431\u043b\u0430\u0441\u0442\u044f\u0445 \u0442\u0435\u043b\u0430. \u041e\u043f\u0438\u0441\u0430\u043d\u043e \u043d\u0435\u0441\u043a\u043e\u043b\u044c\u043a\u043e \u0442\u0438\u043f\u043e\u0432 \u043f\u043e\u0440\u0430\u0436\u0435\u043d\u0438\u0439 (1,6):\n<ul>\n \t<li>\u043f\u043e\u0432\u0435\u0440\u0445\u043d\u043e\u0441\u0442\u043d\u044b\u0439 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437, \u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0438\u0432\u0430\u0435\u043c\u044b\u0439, \u043a\u0430\u043a \u043f\u0440\u0430\u0432\u0438\u043b\u043e, \u043d\u0430 \u0431\u0440\u044e\u0448\u0438\u043d\u0435 \u043c\u0430\u043b\u043e\u0433\u043e \u0442\u0430\u0437\u0430;<\/li>\n \t<li>\u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0438\u0434\u043d\u044b\u0435 \u043a\u0438\u0441\u0442\u044b \u044f\u0438\u0447\u043d\u0438\u043a\u043e\u0432 (\u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u043c\u0430), \u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0438\u0432\u0430\u0435\u043c\u044b\u0435 \u0432 \u044f\u0438\u0447\u043d\u0438\u043a\u0430\u0445;<\/li>\n \t<li>\u0433\u043b\u0443\u0431\u043e\u043a\u0438\u0439 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437, \u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0438\u0432\u0430\u0435\u043c\u044b\u0439 \u0432 \u0440\u0435\u043a\u0442\u043e\u0432\u0430\u0433\u0438\u043d\u0430\u043b\u044c\u043d\u043e\u0439 \u043f\u0435\u0440\u0435\u0433\u043e\u0440\u043e\u0434\u043a\u0435, \u043c\u043e\u0447\u0435\u0432\u043e\u043c \u043f\u0443\u0437\u044b\u0440\u0435 \u0438 \u043a\u0438\u0448\u0435\u0447\u043d\u0438\u043a\u0435;<\/li>\n \t<li>\u0432 \u0440\u0435\u0434\u043a\u0438\u0445 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\u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0445 \u0444\u0430\u043a\u0442\u043e\u0440\u043e\u0432. \u0421\u0443\u0449\u0435\u0441\u0442\u0432\u0443\u0435\u0442 \u043d\u0435\u0441\u043a\u043e\u043b\u044c\u043a\u043e \u0433\u0438\u043f\u043e\u0442\u0435\u0437 \u043e \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0436\u0434\u0435\u043d\u0438\u0438 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0430. \u0412 \u043d\u0430\u0441\u0442\u043e\u044f\u0449\u0435\u0435 \u0432\u0440\u0435\u043c\u044f \u0441\u0447\u0438\u0442\u0430\u0435\u0442\u0441\u044f, \u0447\u0442\u043e \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437 \u0432\u043e\u0437\u043d\u0438\u043a\u0430\u0435\u0442 \u043f\u043e \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0438\u043c \u043f\u0440\u0438\u0447\u0438\u043d\u0430\u043c:\n<ul>\n \t<li>\u0420\u0435\u0442\u0440\u043e\u0433\u0440\u0430\u0434\u043d\u0430\u044f \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u044f, \u043f\u0440\u0438 \u043a\u043e\u0442\u043e\u0440\u043e\u0439 \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u043b\u044c\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c, \u0441\u043e\u0434\u0435\u0440\u0436\u0430\u0449\u0430\u044f \u043a\u043b\u0435\u0442\u043a\u0438 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u044f, \u0442\u0435\u0447\u0435\u0442 \u043f\u043e \u0444\u0430\u043b\u043b\u043e\u043f\u0438\u0435\u0432\u044b\u043c \u0442\u0440\u0443\u0431\u0430\u043c \u043e\u0431\u0440\u0430\u0442\u043d\u043e, \u0432 \u043f\u043e\u043b\u043e\u0441\u0442\u044c \u0442\u0430\u0437\u0430, \u0442\u043e\u0433\u0434\u0430 \u043a\u0430\u043a \u043f\u0440\u0438 \u043e\u0431\u044b\u0447\u043d\u043e\u0439 \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u0438 \u043a\u0440\u043e\u0432\u044c \u0432\u044b\u0442\u0435\u043a\u0430\u0435\u0442 \u0438\u0437 \u0442\u0435\u043b\u0430 \u043c\u0430\u0442\u043a\u0438 \u0447\u0435\u0440\u0435\u0437 \u0448\u0435\u0439\u043a\u0443 \u043c\u0430\u0442\u043a\u0438 \u0438 \u0432\u043b\u0430\u0433\u0430\u043b\u0438\u0449\u0435. \u0420\u0435\u0442\u0440\u043e\u0433\u0440\u0430\u0434\u043d\u0430\u044f \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u044f \u043c\u043e\u0436\u0435\u0442 \u043f\u0440\u0438\u0432\u0435\u0441\u0442\u0438 \u043a \u0442\u043e\u043c\u0443, \u0447\u0442\u043e \u043a\u043b\u0435\u0442\u043a\u0438, \u043f\u043e\u0434\u043e\u0431\u043d\u044b\u0435 \u043a\u043b\u0435\u0442\u043a\u0430\u043c \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u044f, \u043e\u043a\u0430\u0437\u044b\u0432\u0430\u044e\u0442\u0441\u044f \u0437\u0430 \u043f\u0440\u0435\u0434\u0435\u043b\u0430\u043c\u0438 \u043c\u0430\u0442\u043a\u0438, \u0433\u0434\u0435 \u043e\u043d\u0438 \u043c\u043e\u0433\u0443\u0442 \u0438\u043c\u043f\u043b\u0430\u043d\u0442\u0438\u0440\u043e\u0432\u0430\u0442\u044c\u0441\u044f \u0438 \u0440\u0430\u0441\u0442\u0438.<\/li>\n \t<li>\u041a\u043b\u0435\u0442\u043e\u0447\u043d\u0430\u044f \u043c\u0435\u0442\u0430\u043f\u043b\u0430\u0437\u0438\u044f, \u043f\u0440\u0438 \u043a\u043e\u0442\u043e\u0440\u043e\u0439 \u043a\u043b\u0435\u0442\u043a\u0438 \u043f\u0435\u0440\u0435\u0445\u043e\u0434\u044f\u0442 \u0438\u0437 \u043e\u0434\u043d\u043e\u0439 \u0444\u043e\u0440\u043c\u044b \u0432 \u0434\u0440\u0443\u0433\u0443\u044e. \u041a\u043b\u0435\u0442\u043a\u0438 \u0437\u0430 \u043f\u0440\u0435\u0434\u0435\u043b\u0430\u043c\u0438 \u043c\u0430\u0442\u043a\u0438 \u043f\u0440\u0435\u0432\u0440\u0430\u0449\u0430\u044e\u0442\u0441\u044f \u0432 \u043a\u043b\u0435\u0442\u043a\u0438, \u043f\u043e\u0434\u043e\u0431\u043d\u044b\u0435 \u043a\u043b\u0435\u0442\u043a\u0430\u043c \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u044f, \u0438 \u043d\u0430\u0447\u0438\u043d\u0430\u044e\u0442 \u0440\u0430\u0441\u0442\u0438.<\/li>\n \t<li>\u0417\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435 \u0432\u044b\u0437\u044b\u0432\u0430\u044e\u0442 \u0441\u0442\u0432\u043e\u043b\u043e\u0432\u044b\u0435 \u043a\u043b\u0435\u0442\u043a\u0438, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0437\u0430\u0442\u0435\u043c \u0440\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u044f\u044e\u0442\u0441\u044f \u043f\u043e \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0443 \u0447\u0435\u0440\u0435\u0437 \u043a\u0440\u043e\u0432\u0435\u043d\u043e\u0441\u043d\u044b\u0435 \u0438 \u043b\u0438\u043c\u0444\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0441\u043e\u0441\u0443\u0434\u044b.<\/li>\n<\/ul>\n\u0421\u043f\u043e\u0441\u043e\u0431\u0441\u0442\u0432\u043e\u0432\u0430\u0442\u044c \u0440\u043e\u0441\u0442\u0443 \u0438\u043b\u0438 \u0441\u043e\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u044e \u044d\u043a\u0442\u043e\u043f\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u0442\u043a\u0430\u043d\u0438 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u044f \u043c\u043e\u0433\u0443\u0442 \u0438 \u0434\u0440\u0443\u0433\u0438\u0435 \u0444\u0430\u043a\u0442\u043e\u0440\u044b. \u0422\u0430\u043a, \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e, \u0447\u0442\u043e \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437 \u0437\u0430\u0432\u0438\u0441\u0438\u0442 \u043e\u0442 \u044d\u0441\u0442\u0440\u043e\u0433\u0435\u043d\u0430, \u0441\u043f\u043e\u0441\u043e\u0431\u0441\u0442\u0432\u0443\u044e\u0449\u0435\u0433\u043e \u0432\u043e\u0441\u043f\u0430\u043b\u0435\u043d\u0438\u044e, \u0440\u0430\u0437\u0440\u0430\u0441\u0442\u0430\u043d\u0438\u044e \u0438 \u0431\u043e\u043b\u044f\u043c, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u044b\u043c \u0441 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435\u043c. \u0422\u0435\u043c \u043d\u0435 \u043c\u0435\u043d\u0435\u0435, \u0441\u0432\u044f\u0437\u044c \u044d\u0441\u0442\u0440\u043e\u0433\u0435\u043d\u0430 \u0441 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u043e\u043c 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\u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b \u0438 \u043f\u043e\u0432\u044b\u0441\u0438\u0442\u044c \u0432\u0435\u0440\u043e\u044f\u0442\u043d\u043e\u0441\u0442\u044c \u043d\u0430\u0441\u0442\u0443\u043f\u043b\u0435\u043d\u0438\u044f \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438, \u0447\u0430\u0441\u0442\u043e \u0437\u0430\u0432\u0438\u0441\u0438\u0442 \u043e\u0442 \u0441\u0442\u0435\u043f\u0435\u043d\u0438 \u0442\u044f\u0436\u0435\u0441\u0442\u0438 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f. \u041a\u0440\u043e\u043c\u0435 \u0442\u043e\u0433\u043e, \u043f\u043e\u0440\u0430\u0436\u0435\u043d\u0438\u044f \u043c\u043e\u0433\u0443\u0442 \u0440\u0435\u0446\u0438\u0434\u0438\u0432\u0438\u0440\u043e\u0432\u0430\u0442\u044c \u0434\u0430\u0436\u0435 \u043f\u043e\u0441\u043b\u0435 \u0443\u0441\u043f\u0435\u0448\u043d\u043e\u0433\u043e \u0443\u0434\u0430\u043b\u0435\u043d\u0438\u044f, \u0430 \u0430\u043d\u043e\u043c\u0430\u043b\u0438\u0438 \u043c\u044b\u0448\u0446 \u0442\u0430\u0437\u043e\u0432\u043e\u0433\u043e \u0434\u043d\u0430 \u0441\u043f\u043e\u0441\u043e\u0431\u043d\u044b \u0432\u044b\u0437\u044b\u0432\u0430\u0442\u044c \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0431\u043e\u043b\u0438 \u0432 \u043e\u0431\u043b\u0430\u0441\u0442\u0438 \u0442\u0430\u0437\u0430. \u041f\u0440\u0438 \u0432\u0442\u043e\u0440\u0438\u0447\u043d\u044b\u0445 \u0438\u0437\u043c\u0435\u043d\u0435\u043d\u0438\u044f\u0445 \u0432 \u043f\u043e\u043b\u043e\u0441\u0442\u0438 \u0442\u0430\u0437\u0430, \u0432 \u0442\u043e\u043c \u0447\u0438\u0441\u043b\u0435 \u0442\u0430\u0437\u043e\u0432\u043e\u0433\u043e \u0434\u043d\u0430, \u0438 \u0446\u0435\u043d\u0442\u0440\u0430\u043b\u044c\u043d\u043e\u0439 \u0441\u0435\u043d\u0441\u0438\u0431\u0438\u043b\u0438\u0437\u0430\u0446\u0438\u0438 \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u043c \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043a\u0430\u043c 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\u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0430, \u0441\u0442\u0438\u043c\u0443\u043b\u044f\u0446\u0438\u044e \u044f\u0438\u0447\u043d\u0438\u043a\u043e\u0432 \u0441 \u0432\u043d\u0443\u0442\u0440\u0438\u043c\u0430\u0442\u043e\u0447\u043d\u043e\u0439 \u0438\u043d\u0441\u0435\u043c\u0438\u043d\u0430\u0446\u0438\u0435\u0439 (\u0412\u041c\u0418) \u0438 \u044d\u043a\u0441\u0442\u0440\u0430\u043a\u043e\u0440\u043f\u043e\u0440\u0430\u043b\u044c\u043d\u043e\u0435 \u043e\u043f\u043b\u043e\u0434\u043e\u0442\u0432\u043e\u0440\u0435\u043d\u0438\u0435 (\u042d\u041a\u041e), \u043e\u0434\u043d\u0430\u043a\u043e \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0438 \u0443\u0441\u043f\u0435\u0448\u043d\u043e\u0441\u0442\u0438 \u0432\u0430\u0440\u044c\u0438\u0440\u0443\u044e\u0442\u0441\u044f (4). \u041f\u0440\u0438 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0435 \u043c\u043e\u0433\u0443\u0442 \u0432\u043e\u0437\u043d\u0438\u043a\u0430\u0442\u044c \u0438 \u0434\u0440\u0443\u0433\u0438\u0435 \u0441\u043e\u043f\u0443\u0442\u0441\u0442\u0432\u0443\u044e\u0449\u0438\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f, \u0442\u0440\u0435\u0431\u0443\u044e\u0449\u0438\u0435 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u044f. \u041c\u0435\u0436\u0434\u0438\u0441\u0446\u0438\u043f\u043b\u0438\u043d\u0430\u0440\u043d\u043e\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u0435, \u043d\u0430\u043f\u0440\u0430\u0432\u043b\u0435\u043d\u043d\u043e\u0435 \u043d\u0430 \u0443\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u0435 \u0438\u043b\u0438 \u043e\u0431\u043b\u0435\u0433\u0447\u0435\u043d\u0438\u0435 \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0445 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u043e\u0432 \u0438 \u043f\u043e\u0434\u0434\u0435\u0440\u0436\u0430\u043d\u0438\u0435 \u043e\u0431\u0449\u0435\u0433\u043e \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u044f \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u044f, \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u043d\u0430\u0438\u0431\u043e\u043b\u0435\u0435 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u044b\u043c, \u043e\u043d\u043e \u0434\u043e\u043b\u0436\u043d\u043e \u0432\u043a\u043b\u044e\u0447\u0430\u0442\u044c \u043e\u0431\u0440\u0430\u0449\u0435\u043d\u0438\u0435 \u043a \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u043c \u0441\u043f\u0435\u0446\u0438\u0430\u043b\u0438\u0441\u0442\u0430\u043c, \u0442\u0430\u043a\u0438\u043c \u043a\u0430\u043a \u0441\u043f\u0435\u0446\u0438\u0430\u043b\u0438\u0441\u0442\u044b, \u0437\u0430\u043d\u0438\u043c\u0430\u044e\u0449\u0438\u0435\u0441\u044f \u043f\u0440\u043e\u0431\u043b\u0435\u043c\u0430\u043c\u0438 \u0431\u043e\u043b\u0438, \u0444\u0438\u0437\u0438\u043e\u0442\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u044b, \u0440\u0430\u0431\u043e\u0442\u0430\u044e\u0449\u0438\u0435 \u0441 \u043e\u0431\u043b\u0430\u0441\u0442\u044c\u044e \u0442\u0430\u0437\u0430, \u0441\u043f\u0435\u0446\u0438\u0430\u043b\u0438\u0441\u0442\u044b \u043f\u043e \u0434\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0438 \u0430\u043b\u044c\u0442\u0435\u0440\u043d\u0430\u0442\u0438\u0432\u043d\u043e\u0439 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0435, \u0442\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u044b \u0438 \u043f\u0441\u0438\u0445\u043e\u043b\u043e\u0433\u0438, \u0430 \u043d\u0435 \u0442\u043e\u043b\u044c\u043a\u043e \u043a \u0433\u0438\u043d\u0435\u043a\u043e\u043b\u043e\u0433\u0430\u043c (2,10).\n\n<strong>\u0412\u0435\u0441\u044c \u0434\u043e\u043a\u0443\u043c\u0435\u043d\u0442 \u0447\u0438\u0442\u0430\u0439\u0442\u0435 <\/strong><a href=\"https:\/\/drive.google.com\/file\/d\/1aSUeV2PGkgmK8U4LMlAMAs78wboDtuPE\/view?usp=sharing\" target=\"_blank\" rel=\"noopener\"><strong>\u0442\u0443\u0442<\/strong><\/a>\n\n","_ru_post_excerpt":"","_ru_post_title":"\u0412\u041e\u0417 \u043e\u043f\u0443\u0431\u043b\u0438\u043a\u043e\u0432\u0430\u043b\u0430 \u043d\u043e\u0432\u0443\u044e \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044e \u043e\u0431 \u044d\u043d\u0434\u043e\u043c\u0435\u0442\u0440\u0438\u043e\u0437\u0435 ","_ru_post_name":"noua-informatie-despre-endometrioza-publicata-de-oms","_ro_post_content":"\n\n<span style=\"font-size: 14pt;\"><strong>Endometrioz\u0103 <\/strong><\/span>\n\n<span style=\"font-size: 10pt;\">31 martie 2021<\/span>\n\n<strong>Date cheie<\/strong>\n<ul>\n \t<li><strong>Endometrioza este o maladie \u00een care \u021besutul similar cu mucoasa uterului cre\u0219te \u00een afara uterului, cauz\u00e2nd durere \u0219i\/sau infertilitate (1).<\/strong><\/li>\n \t<li><strong>Endometrioza afecteaz\u0103 grav 10% (190 milioane) dintre femeile \u0219i fetele cu v\u00e2rst\u0103 de reproducere la nivel global (2).<\/strong><\/li>\n \t<li><strong>Este o boal\u0103 cronic\u0103 asociat\u0103 cu dureri severe, care au un impact asupra vie\u021bii \u00een perioada menstrual\u0103, \u00een timpul actului sexual, mi\u0219c\u0103rilor intestinale \u0219\/sau \u00een timpul urin\u0103rii, durere cronic\u0103 pelvian\u0103, balonare, grea\u021b\u0103, oboseal\u0103 \u0219i, uneori, depresie, anxietate \u0219i infertilitate.<\/strong><\/li>\n \t<li><strong>Simptomele variabile \u0219i pronun\u021bate ale endometriozei demonstreaz\u0103 c\u0103 lucr\u0103torii din sistemul medical nu o pot diagnostica cu u\u0219urin\u021b\u0103 \u0219i multe persoane care sufer\u0103 de aceast\u0103 maladie au cuno\u0219tin\u021be limitate cu privire la afec\u021biune. Acest fapt poate provoca o \u00eent\u00e2rziere \u00eendelungat\u0103 \u00eentre apari\u021bia simptomelor \u0219i diagnostic (3).<\/strong><\/li>\n \t<li><strong>\u00cen prezent, nu exist\u0103 tratament cunoscut pentru endometrioz\u0103, iar tratamentul vizeaz\u0103 de obicei controlarea simptomelor (4).<\/strong><\/li>\n \t<li><strong>Accesul la diagnosticul precoce \u0219i tratamentul eficient pentru endometrioz\u0103 este important, \u00eens\u0103 \u00een multe situa\u021bii este foarte limitat, inclusiv \u00een \u021b\u0103rile cu venituri mici \u0219i medii.<\/strong><\/li>\n \t<li><strong>Este nevoie de mai multe cercet\u0103ri \u0219i con\u0219tientizare \u00een \u00eentreaga lume pentru a asigura o prevenire eficient\u0103, un diagnostic precoce \u0219i o gestionare \u00eembun\u0103t\u0103\u021bit\u0103 a bolii (2,5).<\/strong><\/li>\n<\/ul>\n<strong>Introducere \u0219i defini\u021bie <\/strong>\n\nEndometrioza este o boal\u0103 caracterizat\u0103 prin prezen\u021ba \u021besutului similar endometrului (mucoasa uterului) \u00een afara uterului (1). Ea cauzeaz\u0103 o reac\u021bie cronic\u0103 inflamatoare care poate duce la formarea \u021besutului cicatricial (aderen\u021be, fibroz\u0103) \u00een pelvis \u0219i alte p\u0103r\u021bi ale corpului. Au fost descrise mai multe tipuri de leziuni (1,6):\n<ul>\n \t<li>endometrioz\u0103 superficial\u0103 \u00eent\u00e2lnit\u0103 \u00een special pe peritoneul pelvian<\/li>\n \t<li>endometrioz\u0103 ovarian\u0103 chistic\u0103 (endometriom) \u00eent\u00e2lnit\u0103 \u00een ovare<\/li>\n \t<li>endometrioz\u0103 profund\u0103 \u00eent\u00e2lnit\u0103 \u00een fistula recto-vaginal\u0103, vezic\u0103 \u0219i intestin<\/li>\n \t<li>\u00een rare cazuri, endometrioza a fost g\u0103sit\u0103 \u00een afara pelvisului<\/li>\n<\/ul>\nSimptomele asociate cu endometrioza variaz\u0103 \u0219i includ o combina\u021bie de:\n<ul>\n \t<li>dureri \u00een timpul menstrua\u021biei<\/li>\n \t<li>durere cronic\u0103 pelvian\u0103<\/li>\n \t<li>durere \u00een timpul \u0219i\/sau dup\u0103 actul sexual<\/li>\n \t<li>durere la mi\u0219c\u0103rile intestinale<\/li>\n \t<li>durere la urinare<\/li>\n \t<li>oboseal\u0103<\/li>\n \t<li>depresie sau anxietate<\/li>\n \t<li>balonare \u0219i grea\u021b\u0103<\/li>\n<\/ul>\nSuplimentar la cele expuse mai sus, endometrioza poate cauza infertilitatea. Infertilitatea apare din cauza efectelor probabile ale endometriozei asupra cavit\u0103\u021bii pelviene, ovarelor, trompelor uterine sau a uterului. Exist\u0103 o mic\u0103 corela\u021bie \u00eentre \u00eentinderea leziunilor endometriale \u0219i severitatea sau durata simptomelor: unele persoane cu leziuni vizibil mari au simptome u\u0219oare, iar al\u021bii cu pu\u021bine leziune au simptome grave. Deseori, simptomele se amelioreaz\u0103 dup\u0103 menopauz\u0103, \u00eens\u0103 \u00een unele cazuri pot persista simptome dureroase. Durerea cronic\u0103 poate fi cauzat\u0103 de centrele de durere din creier, care devin hiper-receptive \u00een timp (sensibilizarea central\u0103), care poate ap\u0103rea \u00een orice moment al existen\u021bei endometriozei, inclusiv a endometriozei tratate, tratate insuficient \u0219i netratate \u0219i poate persista chiar \u0219i atunci c\u00e2nd leziunile endometriozei nu mai sunt vizibile. \u00cen unele cazuri, endometrioza poate fi asimptomatic\u0103.\n\n<strong>Care este cauza endometriozei?<\/strong>\n\nEndometrioza este o boal\u0103 complex\u0103 care afecteaz\u0103 unele femei la nivel global, de la \u00eenceputul primei menstrua\u021bii (menarh\u0103) p\u00e2n\u0103 la menopauz\u0103, indiferent de originea etnic\u0103 sau statutul social. Se consider\u0103 c\u0103 originile exacte ale endometriozei sunt multifactoriale, ceea ce \u00eenseamn\u0103 c\u0103 mul\u021bi factori contribuie la dezvoltarea acesteia. Au fost propuse mai multe ipoteze pentru a explica originile endometriozei. \u00cen prezent, se crede c\u0103 endometrioza apare din cauza:\n<ul>\n \t<li>Menstrua\u021biei retrograde, care se \u00eent\u00e2mpl\u0103 atunci c\u00e2nd s\u00e2ngele menstrual, care con\u021bine celule endometriale curge \u00eenapoi prin trompele uterine \u0219i \u00een cavitatea pelvian\u0103, \u00een momentul \u00een care s\u00e2ngele curge din colul uterin \u0219i vagin \u00een timpul menstrua\u021biei. Menstrua\u021bia retrograd\u0103 poate avea ca rezultat depunerea celulelor de tip endometrial \u00een afara uterului, unde ele pot fi implantate \u0219i crescute.<\/li>\n \t<li>Metaplaziei celulare, care este atunci c\u00e2nd celulele se schimb\u0103 de la o form\u0103 la alta. Celulele din afara uterului se schimb\u0103 \u00een celule de tip endometrial \u0219i \u00eencep s\u0103 creasc\u0103.<\/li>\n \t<li>Celulelor stem care dau na\u0219tere bolii, care apoi se r\u0103sp\u00e2nde\u0219te prin corp prin intermediul s\u00e2ngelui \u0219i a vaselor limfatice.<\/li>\n<\/ul>\nAl\u021bi factori pot contribui, de asemenea, la cre\u0219terea sau persisten\u021ba \u021besutului endometrial ectopic. De exemplu, endometrioza este cunoscut\u0103 a fi dependent\u0103 de estrogen, ceea ce faciliteaz\u0103 inflama\u021bia, cre\u0219terea \u0219i durerea asociate bolii. Cu toate acestea, rela\u021bia dintre estrogen \u0219i endometrioz\u0103 este complex\u0103, deoarece absen\u021ba estrogenului nu \u00eentotdeauna exclude prezen\u021ba endometriozei. Se consider\u0103 c\u0103 exist\u0103 mul\u021bi al\u021bi factori care sus\u021bin dezvoltarea, cre\u0219terea \u0219i men\u021binerea leziunilor de endometrioz\u0103. Acestea includ imunitatea modificat\u0103 sau afectat\u0103, influen\u021bele hormonale complexe localizate, genetica \u0219i poten\u021bial, contaminan\u021bii mediului (2,7).\n\n<strong>Beneficii sociale, economice \u0219i de s\u0103n\u0103tate de abordare a endometriozei <\/strong>\n\nEndometrioza are consecin\u021be semnificative \u00een via\u021ba social\u0103, \u00een s\u0103n\u0103tatea public\u0103 \u0219i situa\u021bia economic\u0103 a pacientului. Ea poate sc\u0103dea calitatea vie\u021bii datorit\u0103 durerii severe, oboselii, depresiei, anxiet\u0103\u021bii \u0219i infertilit\u0103\u021bii. Unele persoane care sufer\u0103 de endometrioz\u0103 au dureri debilitante asociate endometriozei care \u00eei \u00eempiedic\u0103 s\u0103 mearg\u0103 la serviciu sau la \u0219coal\u0103 (8,9). \u00cen aceste situa\u021bii, abordarea endometriozei poate reduce absen\u021ba de la \u0219coal\u0103 sau poate cre\u0219te capacitatea unei persoane de a contribui la for\u021ba de munc\u0103. Sexul dureros din cauza endometriozei poate duce la \u00eentreruperea sau evitarea actului \u0219i afecteaz\u0103 s\u0103n\u0103tatea sexual\u0103 a persoanelor afectate \u0219i\/sau a partenerilor lor (9). Abordarea endometriozei le va da putere celor afecta\u021bi de ea, sprijinindu-\u0219i dreptul uman la cel mai \u00eenalt standard de s\u0103n\u0103tate sexual\u0103 \u0219i reproductiv\u0103, calitatea vie\u021bii \u0219i bun\u0103starea general\u0103.\n\n<strong>Prevenirea <\/strong>\n\u00cen prezent, nu exist\u0103 o modalitate cunoscut\u0103 de prevenire a endometriozei. Con\u0219tientizarea sporit\u0103, urmat\u0103 de diagnosticul precoce \u0219i gestionarea pot \u00eencetini sau stopa evolu\u021bia natural\u0103 a bolii \u0219i reduce povara de lung\u0103 durat\u0103 a simptomelor acesteia, inclusiv riscul posibil de sensibilizare a durerii sistemului nervos central, dar, \u00een prezent, nu exist\u0103 nici un remediu.\n\n<strong>Diagnostic<\/strong>\nUn istoric atent al simptomelor menstruale \u0219i a durerii cronice pelviene ofer\u0103 baza suspect\u0103rii endometriozei. De\u0219i au fost propuse \u0219i testate mai multe instrumente \u0219i teste de screening, nici unul dintre acestea nu este validat \u00een prezent pentru a identifica sau a prezice persoanele sau popula\u021bia care ar putea suferi de aceast\u0103 boal\u0103. O suspiciune timpurie a endometriozei este un factor cheie pentru diagnosticarea timpurie, deoarece endometrioza poate deseori prezenta simptome care imit\u0103 alte afec\u021biuni \u0219i contribuie la \u00eent\u00e2rzierea diagnosticului. Pe l\u00e2ng\u0103 istoricul medical, poate fi necesar\u0103 o trimitere de la nivelul asisten\u021bei medicale primare c\u0103tre centrele secundare unde sunt disponibile investiga\u021bii suplimentare. De exemplu, endometriomul ovarian, aderen\u021bele \u0219i formele nodulare profunde ale bolii necesit\u0103 adesea ultrasonografie sau imagistic\u0103 prin rezonan\u021b\u0103 magnetic\u0103 (IRM) pentru detectare. Verificarea histologic\u0103, de obicei \u00een urma vizualiz\u0103rii chirurgicale\/laparoscopice, poate fi util\u0103 la confirmarea diagnosticului, \u00een special pentru cele mai frecvente leziuni superficiale (1,2). Necesitatea confirm\u0103rii histologice\/laparoscopice nu ar trebui s\u0103 \u00eempiedice tratamentul medical empiric.\n\n<strong>Tratament<\/strong>\nTratamentul poate fi efectuat cu medicamente \u0219i\/sau interven\u021bie chirurgical\u0103, \u00een dependen\u021b\u0103 de simptome, leziuni, rezultatul dorit \u0219i alegerea pacientului (4). Steroizii contraceptivi, antiinflamatoarele nesteroidiene \u0219i analgezicele (medicamente \u00eempotriva durerii) sunt terapiile obi\u0219nuite. Toate trebuie prescrise cu aten\u021bie \u0219i monitorizate pentru a evita efecte secundare poten\u021bial problematice. Tratamentele medicale pentru endometrioz\u0103 se concentreaz\u0103 fie pe sc\u0103derea estrogenului, fie pe cre\u0219terea progesteronului, pentru a modifica mediile hormonale care favorizeaz\u0103 apari\u021bia endometriozei. Aceste terapii medicale includ contraceptivele orale combinate, progestinele \u0219i analogii GnRH. Cu toate acestea, nici unul din aceste tratamente nu elimin\u0103 boala, acestea sunt asociate cu efecte secundare, iar simptomele legate de endometrioz\u0103 pot uneori \u2013 \u00eens\u0103 nu \u00eentotdeauna - s\u0103 reapar\u0103 dup\u0103 \u00eentreruperea tratamentului. Alegerea tratamentului depinde de eficien\u021ba individual\u0103, de efectele secundare adverse, de siguran\u021ba pe termen lung, costuri \u0219i disponibilitate. Cel mai actual tratament hormonal nu este potrivit pentru persoanele care sufer\u0103 de endometrioz\u0103, care doresc s\u0103 r\u0103m\u00e2n\u0103 \u00eens\u0103rcinate, deoarece afecteaz\u0103 ovula\u021bia.\n\nInterven\u021bia chirurgical\u0103 poate elimina leziunile de endometrioz\u0103, aderen\u021bele \u0219i \u021besutul cicatricial. Cu toate acestea, succesul \u00een reducerea simptomelor de durere \u0219i cre\u0219terea ratelor de sarcin\u0103 depinde adesea de amploarea bolii. \u00cen plus, leziunile pot reap\u0103rea chiar \u0219i dup\u0103 eradicarea reu\u0219it\u0103, iar anomaliile mu\u0219chiului plan\u0219eului pelvian poate contribui la durere cronic\u0103 pelvian\u0103. Modific\u0103rile secundare ale pelvisului, inclusiv plan\u0219eul pelvian \u0219i sensibilizarea central\u0103, pot beneficia de fizioterapie \u0219i tratamente suplimentare la unii pacien\u021bi. Op\u021biunile de tratament pentru infertilitate cauzat\u0103 de endometrioz\u0103 include \u00eendep\u0103rtarea endometriozei prin interven\u021bie chirurgical\u0103 laparoscopic\u0103, stimularea ovarian\u0103 prin inseminare intrauterin\u0103 (IUI) \u0219i fertilizare in vitro (IVF), \u00eens\u0103 ratele de succes variaz\u0103 (4).\u00a0Pot ap\u0103rea alte comorbidit\u0103\u021bi al\u0103turi de endometrioz\u0103, care solicit\u0103 diagnosticare \u0219i gestionare. Pentru a fi mai eficient, tratamentul multidisciplinar care abordeaz\u0103 diverse simptome \u0219i starea general\u0103 a s\u0103n\u0103t\u0103\u021bii, pe l\u00e2ng\u0103 ginecologi, ar trebui s\u0103 implice diferi\u021bi speciali\u0219ti, precum speciali\u0219ti \u00een durere, speciali\u0219ti \u00een fizioterapia pelvian\u0103, speciali\u0219ti \u00een medicin\u0103 complementar\u0103 \u0219i alternativ\u0103, medici generali\u0219ti \u0219i psihologi (2,10).\n\n<span class=\"aCOpRe\"><span><strong>Citi\u021bi \u00eentregul document <a href=\"https:\/\/drive.google.com\/file\/d\/1Mm0gNt93T4lbzoGGwS70vuCuzIg59xUr\/view?usp=sharing\" target=\"_blank\" rel=\"noopener\">aici<\/a><\/strong> <\/span><\/span>\n\n","_ro_post_excerpt":"","_ro_post_title":"Nou\u0103 informa\u021bie despre endometrioza publicata de OMS","_ro_post_name":"noua-informatie-despre-endometrioza-publicata-de-oms","edit_language":"en"},"_links":{"self":[{"href":"https:\/\/cidsr.md\/en\/wp-json\/wp\/v2\/news\/10650","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cidsr.md\/en\/wp-json\/wp\/v2\/news"}],"about":[{"href":"https:\/\/cidsr.md\/en\/wp-json\/wp\/v2\/types\/news"}],"author":[{"embeddable":true,"href":"https:\/\/cidsr.md\/en\/wp-json\/wp\/v2\/users\/4"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cidsr.md\/en\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/cidsr.md\/en\/wp-json\/wp\/v2\/media?parent=10650"}],"wp:term":[{"taxonomy":"blog_news","embeddable":true,"href":"https:\/\/cidsr.md\/en\/wp-json\/wp\/v2\/blog_news?post=10650"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}