Mioma uterino é maligno? veja sintomas, causas e tratamentos

Miomas uterinos são tumores não cancerosos do útero, que muitas vezes aparecem durante a idade fértil. Eles não estão associados a um risco maior de câncer de útero, e quase nunca se transformam em câncer. Esse tumor benigno atinge cerca de 50% das mulheres na faixa etária dos 30 aos 50 anos.

Como ele se desenvolve?

Também chamado de fibroide uterino, o mioma se desenvolve a partir do tecido muscular liso do útero (miométrio). Uma única célula se divide repetidamente e desenfreadamente, até criar uma massa distinta dos tecidos próximos.

Os padrões de crescimento de miomas uterinos variam, podendo se desenvolver de forma lenta, rapidamente ou permanecer do mesmo tamanho.

Alguns miomas passam por surtos de crescimento, e alguns podem encolher por conta própria. Inclusive, muitos miomas que acontecem durante a gravidez tendem a encolher ou desaparecer após o parto

Os miomas não são indetectáveis pelo olho humano, mas suas massas volumosas podem distorcer ou ampliar o útero. Eles podem ser únicos ou múltiplos, e em casos extremos, a expansão do útero atinge a caixa torácica.

Tipos

Os miomas uterinos se separam em três tipos a depender de sua localização na parede do útero:

Miomas subserosos

Localizam-se na porção mais externa do útero e geralmente crescem para fora. Este tipo de mioma não costuma afetar o fluxo menstrual, porém, pode tornar-se desconfortável pelo seu tamanho e pressão sobre outros órgãos da pelve.

Miomas pediculados
São ligados à superfície uterina por uma ponte fibromuscular e por onde vem também sua circulação. Normalmente assintomáticos, o seu crescimento ao longo do tempo pode predispor à torção de seu pedículo, sendo causa de dor aguda o que pode levar à necessidade de cirurgia de urgência para sua retirada.

Miomas intramurais

Crescem no interior da parede uterina e se expandem, fazendo com que o útero aumente seu tamanho. São os tipos de miomas mais comuns e geralmente provocam um intenso fluxo menstrual, dor pélvica ou sensação de peso.

Miomas submucosos

Ficam na parte mais profunda da do útero, bem por abaixo da capa que reveste a cavidade uterina. São os miomas menos comuns e provocam intensos e prolongados períodos menstruais.

Miomas intracavitários

Localizam-se totalmente dentro da cavidade uterina. Eles costumam causar sangramento entre os períodos e, muitas vezes, causar cólicas.

Causas

Não sabe ao certo porque o mioma uterino se forma, mas existem algumas suspeitas:

Mudanças genéticas

Muitos miomas contêm alterações nos genes que os diferem das células normais do músculo uterino. Há também algumas evidências de que miomas são mais comuns entre membros da mesma família e que as gêmeas idênticas são mais propensas a terem miomas, se comparadas com gêmeas não idênticas.

Fatores hormonais

Quando hormônios como o estrógeno e a progesterona entram em desequilíbrio, é possível que aconteça o crescimento dos fibroides. Miomas podem conter mais receptores de estrógeno e progesterona do que as células musculares do útero normais.

Além disso, alguns miomas tendem a diminuir após a menopausa, provavelmente porque a produção hormonal também diminui.

Outros fatores de crescimento

Substâncias que ajudam o corpo a manter os tecidos podem afetar o crescimento dos miomas.

Fatores de risco

Existem alguns fatores de risco conhecidos para miomas uterinos:

Hereditariedade. Se a sua mãe ou irmã tem miomas, você está em maior risco de desenvolvê-los
Raça: as mulheres negras são mais propensas a ter miomas do que as mulheres de outros grupos raciais. Além disso, as mulheres negras têm miomas em idades mais jovens, e eles também são propensos a ter mais ou maiores miomas
Outros fatores: início da menstruação em idade precoce, ter uma dieta rica em carne vermelha e menor em verduras e frutas e ingestão de álcool parecem aumentar o risco de mioma uterino.

Sintomas de Mioma uterino
Algumas mulheres podem não apresentar sintomas de mioma, tendo o diagnóstico feito em exames de rotina. Para aqueles que apresentam sintomas, os mais comuns são:

Sangramento menstrual pesado
Períodos menstruais prolongados – sete dias ou mais de sangramento menstrual
Sangramentos mensais atípicos, às vezes com coágulos
Pressão ou dor pélvica
Micção frequente
Dificuldade esvaziar a bexiga
Prisão de ventre
Dor durante as relações sexuais.
Dependendo do tipo de mioma, os sintomas podem se diferenciar:

Miomas submucosos: são mais propensos a causar sangramento menstrual prolongado, pesado e às vezes são um problema para as mulheres que tentam engravidar
Miomas subserosos: podem pressionar a bexiga, causando sintomas urinários. Se miomas bojo na parte de trás do seu útero, que ocasionalmente pode pressionar o reto ou em seus nervos espinhais, causando nesse caso dor nas costas
Miomas intramurais: se grande o suficiente, podem distorcer a forma do útero e causar períodos pesados prolongados, bem como dor e pressão
Miomas pediculados: se sofrer torção de sua base e com isso apresentarem parada de sua circulação, causa de dor intensa e aguda, que necessita de cirurgia para sua remoção.

Buscando ajuda médica
Consulte o seu médico se você tiver:

Dor pélvica que não vai embora
Períodos excessivamente pesados ou dolorosos
Sangramento entre os períodos
Dor durante a relação sexual
Útero aumentado e abdômen
Dificuldade esvaziar a bexiga.

Procure atendimento médico imediato se você tiver sangramento vaginal grave ou dor pélvica aguda que vem de repente.

Diagnóstico de Mioma uterino
Miomas uterinos são frequentemente encontrados por acaso durante um exame ginecológico de rotina. O seu médico pode sentir irregularidades na forma do seu útero, o que sugere a presença de miomas. Se você tiver sintomas de miomas uterinos, o médico pode solicitar estes testes:

Ultrassonografia transvaginal
Hemograma completo e outros exames de sangue, para investigar a causa dos sangramentos.

Se os resultados dos primeiros testes não forem conclusivos, podem ser pedidos esses exames:

Ressonância magnética
Ultrassom com infusão de solução salina
Histerossalpingografia
Histeroscopia.

Tratamento de Mioma uterino
Não há uma abordagem única para o tratamento do mioma uterino. Se você tiver sintomas, converse com o médico sobre as opções mais adequadas ao seu caso.

Muitas mulheres com miomas uterinos não experimentam sintomas, ou então apenas sinais leves e pouco irritantes. Se esse for o seu caso, fazer o acompanhamento médico, sem necessariamente usar algum medicamento ou fazer uma cirurgia, pode ser a melhor opção.

Já para as mulheres cujos sintomas de mioma uterino incomodam as atividades diárias ou casos mais avançados, existem algumas modalidades de tratamento:

Medicamentos hormonais para impedir o desenvolvimento do óvulo
(DIU) liberador de progesterona
Contraceptivos
Anti-inflamatórios não esteroides para a dor
Suplemento de vitaminas e ferro, por conta dos nutrientes pedidos no sangramento.
Existem também os procedimentos cirúrgicos não invasivos ou minimamente invasivos:

Cirurgia com ultrassom focalizado guiado por ressonância magnética
Embolização da artéria uterina
Miólise
Laparoscópica ou robótica
Miomectomia histeroscópica
Ablação endometrial e ressecção de miomas submucosos.
Existem também os procedimentos cirúrgicos tradicionais:

Miomectomia abdominal
Histerectomia.

Complicações possíveis
Apesar de miomas uterinos geralmente não serem perigosos, eles podem causar desconforto e levar a complicações, como anemia por perda de sangue.

Saiba mais: Menstruação e corrimento denunciam doenças
Mulheres que fizeram tratamento para endometriose podem sofrer com os sintomas novamente em algum momento da vida, exceto aquelas que fizeram histerectomia. Nesses casos, pequenos miomas que o médico não detectou durante a cirurgia podem eventualmente crescer e causar sintomas que merecem tratamento.

Isso é muitas vezes chamado de taxa de recorrência. Novos miomas, que podem ou não podem exigir tratamento, também podem se desenvolver.

Gravidez e miomas
Miomas uterinos geralmente não interferem na concepção ou na gravidez. No entanto, é possível que alguns miomas atrapalhem a fertilidade ou o desenvolvimento do feto. Miomas submucosos podem impedir a implantação e crescimento de um embrião.

Em tais casos, os médicos geralmente recomendam a remoção desses miomas antes de tentar a gravidez, sob o risco de a mulher sofrer um aborto em casos mais graves.

Raramente, os miomas podem distorcer ou bloquear suas trompas de falópio, ou interferir com a passagem do esperma do seu colo do útero para suas trompas de falópio.

Prevenção
Embora pesquisas estejam sendo feitas para investigar a causas dos miomas, existem poucas evidências científicas conclusivas para prevenção. Pode ser que não seja possível prevenir os miomas uterinos. No entanto, apenas uma pequena percentagem destes tumores necessitam de tratamento.

Revisado por: Jurandir Piassi Passos, ginecologista do Lavoisier Medicina Diagnóstica – CRM 60633

Ministério da Saúde

Sociedade Brasileira de Ginecologia e Obstetrícia

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