Tratamento atual dos miomas / Current treatment of leiomyomas

Leiomiomas são tumores benignos. Eles surgem no miométrio e contêm quantidade variável de tecido conjuntivo fibroso. Cerca de 75 por cento dos casos são assintomáticos, encontrados ocasionalmente durante exame abdominal, pélvico bimanual ou ultra-sonografia. Os sintomas são relacionados diretamente ao tamanho, ao número e à localização dos miomas. Nessa revisão, são apresentadas as abordagens terapêuticas atuais clínicas (anticoncepcionais orais, progestágenos e antiprogestágenos, análogos do hormônio liberador das gonadotrofinas (GnRH), e antiinflamatórios não esteróides) e cirúrgicas (histerectomia, miomectomia e embolização) para o tratamento de leiomiomas.

Leiomyomas are benign tumors. They appear in the myometrium and present a variable amount of fibrous conjunctive tissue. About 75 percent of the cases are not symptomatic and are usually found during abdominal, bimanual pelvic examination or during ultrasonography. The symptoms are directly related to the size, number and localization of the myomas. In the present review, the current clinical therapeutic procedures (oral anti-conceptive drugs, progestins and anti-progestins, analogues of the gonadothrophins releasing hormone (GnRH), and non-steroid anti-inflammatory drugs), and also the surgical procedures (hysterectomy, myomectomy, embolization) are presented for the treatment of leiomyomas.

The use of levonorgestrel - IUD in the treatment of uterine myoma in Thai women.

OBJECTIVE: This study was designed to evaluate the potential usefulness of the levonorgestrel-releasing intrauterine device (LNG - IUD ; Mirena) in treating women with uterine myomas. DESIGN: Prospective before-and-after (comparing) study. SETTING: Department of Obstetrics and Gynecology King Chulalongkorn Memorial Hospital. SUBJECTS: Sixteen women with uterine myomas who intended to receive treatment with the LNG IUD. INTERVENTION(S): Clinical and ultrasound examinations were performed prior to and at 1, 3 and 6 months after the LNG IUD insertion. MAIN OUTCOME MEASURES: Myoma and Uterine volume, menstrual blood loss assessed with pictorial blood loss assessment charts and hematocrit. RESULTS: Use of the LNG IUD was associated with a statistically significant reduction in the total myoma volume, average uterine size and marked reduction in menstrual blood loss. After 6 months of use, the median total myoma volume decreased from 19.82 mL to 11.63 mL (p < 0.05), median pictorial blood loss assessment chart score declined from 89 to 3 (p < 0.05). Hematocrit level increased over 6 months of use. The most common side effects were bleeding disturbances (68.8%). No pregnancies occurred during the study. CONCLUSION: The LNG IUD was associated with a profound reduction in myoma and uterine volume. For women with myomas of this size, the LNG IUD provides effective medical treatment of bleeding.

Tratamento clínico de mioma uterino com agonista do hormónio liberador de gonadotrofinas (GnRh). Relato de caso e revisão da literatura / Clinical treatment of uterine mioma with GnRh agonist. Case study and literature review

Os autores apresentam um caso de miomatose uterina em paciente jovem. Esta afecção é muito freqüente no período do menacme e nem sempre exige tratamento cirúrgico. O mecanismo de ação, os efeitos benéficos e adversos da utilização de agonistas do GnRh no tratamento clínico de miomas são descritos a seguir.

The authors present a case of uterine leymiomata affecting a young woman. This disease very common during the reproductive age is not always treated by surgery. The role action, benefic and disadvantage effects of the use of GnRh in the clinical management of myomas are described below.