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Miomas uterinos

O que são? Qual é o tratamento?

Os miomas uterinos são tumores benignos (não cancerígenos) no útero.

Clinicamente são detectados em 25% das mulheres, mas com as técnicas de imagem mais modernas a prevalência clínica verdadeira poderia chegar a 77%.

A maioria dos miomas uterinos não produz sintomas, mas algumas mulheres podem ter problemas graves, pois eles podem crescer em diversas partes do útero e variar de tamanho: alguns são bem pequenos, mas um mioma grande ou múltiplos miomas podem fazer com que o útero aumente seu tamanho até ao equivalente a uma gravidez de seis ou sete meses.

Quais são as causas?

Embora não se conheça a razão exata pela qual se desenvolvem, os investigadores têm associado o problema com dois fatores: genéticos e hormonais.

  • Genéticos: é sabido que os miomas uterinos são produzidos com uma frequência de, pelo menos, três vezes mais entre mulheres de raça negra.
  • Hormonais: durante a gravidez os miomas uterinos podem aumentar muito de tamanho, por influência do incremento de estrógeno –o hormônio feminino– que é produzido de forma natural durante a gravidez. Depois do parto, geralmente voltam ao seu tamanho anterior. Ao contrário, durante a menopausa os níveis de estrógenos se reduzem, e isso também ocorre com os miomas uterinos, aliviando os sintomas. Porém, se a paciente fizer um tratamento hormonal substitutivo (THS) durante a menopausa, ela manterá seus níveis de estrógenos e, assim, os miomas podem não reduzir.

Quais são os sintomas?

A maioria das mulheres começa a apresentar sintomas nos finais da quarta década de vida, ou no começo da quinta década. Segundo a localização, o tamanho e a quantidade miomas, pode haver sintomas como: períodos menstruais prolongados, hemorragias não habituais (às vezes com coágulos) que podem produzir anemia, fortes câimbras menstruais, dor ou pressão na pélvis e/ou nas costas, do lado da cintura ou nas pernas, dor durante as relações sexuais, maior frequência urinária pela pressão sobre a bexiga, constipação e/ou gases pela pressão sobre o intestino e aumento anormal do abdômen.

Ao identificar esses sintomas, consulte seu médico.

Como é realizado o diagnóstico?

Os miomas uterinos geralmente são diagnosticados durante um exame ginecológico. O médico também pode verificar o tamanho do útero, através de uma exploração pélvica. Além disso, os miomas podem ser diagnosticados com ressonância magnética (RM) ou tomografia computada (TC).

Em que consiste o tratamento?

Este depende do tamanho, da localização e da intensidade dos sintomas.

Se a paciente não apresentar sintomas, o médico pode decidir não realizar nenhum tratamento, embora sempre seja recomendável realizar controles anuais.

Quando houver sintomas, o tratamento pode ser médico, cirúrgico ou não cirúrgico.

  • O tratamento médico pode incluir fármacos como anti-inflamatórios sem esteróides, anticoncepcionais orais e tratamento hormonal.
  • No tratamento cirúrgico, existem duas opções: a miomectomia (uma técnica na qual os miomas da parede do útero são eliminados) e a histerectomia (um procedimento cirúrgico no qual é extirpado o útero inteiro).

No tratamento não cirúrgico, realiza-se a embolização dos miomas uterinos (EMU). Esta é uma solução menos invasiva, projetada para conservar o útero. Neste insere-se um cateter em um vaso sanguíneo através da virilha até a artéria uterina, e são injetadas pequenas partículas. As partículas bloqueiam o vaso sanguíneo, impedindo que o sangue chegue aos miomas, assim, com o tempo, eles reduzem de tamanho.

Antes de iniciar o tratamento, consultar sempre um médico.

Prevenção  

Dado que as causas são genéticas e/ou hormonais, não há maneira de preveni-los. Porém, aconselha-se realizar controles anuais, para detectar se surge algum mioma e tratá-lo a tempo.