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Miomas Uterinos

¿Qué es y cómo se trata?

Los miomas uterinos son tumores benignos (no cancerosos) del útero.

Clínicamente se detectan hasta en un 25% de las mujeres, pero con las técnicas de imagen más modernas la prevalencia clínica verdadera podría llegar hasta el 77%.

La mayoría de los miomas uterinos no produce síntomas, pero algunas mujeres pueden tener problemas graves ya que éstos pueden crecer en diversas partes del útero y variar mucho en tamaño; algunos son muy pequeños mientras que un mioma grande o múltiples miomas, pueden hacer que el útero aumente de tamaño hasta el equivalente a un embarazo de seis o siete meses.

¿Cuáles son las causas?

Aunque se desconoce la razón exacta por la que se desarrollan,  los investigadores han asociado al problema con dos factores: genéticos y hormonales.

  • Genéticos: se sabe que los miomas uterinos se producen con una frecuencia al menos tres veces mayor entre las mujeres de raza negra.
  • Hormonales: durante el embarazo los miomas uterinos pueden aumentar muchísimo de tamaño influidos por el incremento de estrógeno –la hormona femenina– que se produce de forma natural durante la gravidez. Después del parto suelen volver al tamaño anterior. A la inversa, durante la menopausia los niveles de estrógenos se reducen, y eso también ocurre con los miomas uterinos, aliviando los síntomas. Pero si la paciente hace un tratamiento hormonal sustitutivo (THS) durante la menopausia, mantiene sus niveles de estrógenos y los miomas pueden no reducirse.

¿Cuáles son los síntomas?

La mayoría de las mujeres comienza a tener síntomas hacia fines de la cuarta década de vida, o principios de la quinta. Según la localización, tamaño y número de miomas, puede tener síntomas como: períodos menstruales prolongados, sangrados inusuales (a veces con coágulos) que pueden producir anemia, fuertes calambres menstruales, dolor o presión en la pelvis y/o en la espalda, en los costados de la cintura o en las piernas, dolor durante las relaciones sexuales, mayor frecuencia urinaria por la presión sobre la vejiga, estreñimiento y/o gases por la presión sobre el intestino y aumento anormal del abdomen.

¿Cómo se realiza el diagnóstico?

Los miomas uterinos suelen diagnosticarse durante una revisación ginecológica. El médico también puede comprobar el tamaño del útero mediante una exploración pélvica. Igualmente, pueden diagnosticarse con resonancia magnética (RM) o tomografía computada (TC).

¿En que consiste el tratamiento? 

Este depende del tamaño, localización e intensidad de los síntomas.

Si la paciente no tiene síntomas el médico puede decidir no realizar un tratamiento, aunque siempre se recomienda efectuar controles anuales.

Cuando hay síntomas, el tratamiento puede ser médico, quirúrgico o no quirúrgico.

  • El tratamiento médico puede incluir fármacos como antiinflamatorios no esteroideos,  anticonceptivos orales y tratamiento hormonal.
  • En el tratamiento quirúrgico hay dos opciones: la miomectomía (una técnica con la que se eliminan los miomas de la pared del útero) y la histerectomía (un procedimiento quirúrgico en el que se extirpa el útero entero).
  • En el tratamiento no quirúrgico se realiza la embolización de los miomas uterinos (EMU). Este es un planteo menos invasivo, diseñado para conservar el útero: se inserta un catéter en un vaso sanguíneo a través de la ingle hasta la arteria uterina y se inyectan pequeñas partículas. Éstas bloquean el vaso sanguíneo impidiendo que la sangre alcance a los miomas, así con el tiempo éstos reducen su tamaño.

Prevención 

Dado que las causas son genéticas y/u hormonales, no hay manera de prevenirlos. Sin embargo se aconseja realizar controles anuales, para detectar si surge un mioma y tratarlo a tiempo.