Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- assintomático
- Sangramento menstrual intenso
- massa pélvica central firme e irregular
Outros fatores diagnósticos
- dor pélvica
- pressão pélvica
- dismenorreia
- distensão abdominal
- fadiga e perda de produtividade no trabalho
- infertilidade
- queixas urinárias
- constipação
- útero aumentado (contorno regular)
- dispareunia
Fatores de risco
- aumento no peso da paciente
- idade na faixa dos 40 anos
- etnia negra
- hipovitaminose de vitamina D
- hipertensão
- menarca precoce (menos de 10 anos)
- uso de contraceptivos orais (se iniciados antes dos 16 anos de idade)
- nuliparidade
- idade mais tenra ao primeiro parto
- baixa ingestão de vitamina A
- alta ingestão alimentar de carne bovina e outras carnes vermelhas
- exposição a hormônios sexuais
- história menstrual
- tabagismo
- consumo de bebidas alcoólicas
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- ultrassonografia
- biópsia do endométrio
Investigações a serem consideradas
- sono-histerografia
- histeroscopia
- RNM
- laparoscopia
Novos exames
- sonoelastografia
- Elastografia por RM
Algoritmo de tratamento
fertilidade desejada
fertilidade não desejada
Colaboradores
Autores
Ayman Al-Hendy, MD PhD FRCSC FACOG CCRP
Professor (visiting) and Director
Translational Research
Department of Obstetrics and Gynecology
University of Illinois
Chicago
IL
Declarações
AAH serves on the external advisory board of Bayer, AbbVie, Myovant, Pfizer, ObsEva and Allergan, and has received research funding from the National Institutes of Health. AAH is an author of references cited in this topic.
Obianuju Sandra Madueke-Laveaux, MD MPH
Assistant Professor of Obstetrics and Gynecology
Department of Obstetrics and Gynecology
University of Illinois
Chicago
IL
Declarações
OSML declares that she has no competing interests. OSML is an author of references cited in this topic.
Vuslat Lale Bakir, MD
Assistant Professor of Obstetrics and Gynecology
Department of Obstetrics and Gynecology
Haseki Training and Research Hospital
Health Sciences University
Istanbul
Turkey
Declarações
VLB declares that she has no competing interests.
Agradecimentos
Dr Al-Hendy, Dr Madueke-Laveaux, and Dr Bakir would like to gratefully acknowledge Dr Mohamed Mitwally, Dr Intisar Elnahhas, and Dr Robert J. Fischer, the previous contributors to this topic.
Declarações
MM, IE, and RJF declare that they have no competing interests.
Revisores
Everett Magann, MD
Chairman
Department of Obstetrics and Gynecology
Naval Medical Center
Portsmouth
VA
Declarações
EM declares that he has no competing interests.
Amy Niederhauser, MD
Doctor
Department of Obstetrics and Gynecology
Naval Medical Center
Portsmouth
VA
利益声明
AN declares that she has no competing interests.
Adam Magos, BSc, MB, BS, MD, FRCOG
Consultant Gynaecologist
University Department of Obstetrics and Gynaecology
Royal Free Hospital
London
UK
利益声明
AM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Stewart EA, Cookson CL, Gandolfo RA, et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017 Sep;124(10):1501-12.全文 摘要
Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997 Dec;90(6):967-73. 摘要
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 228: management of symptomatic uterine leiomyomas. Jun 2021 [internet publication].全文
Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016 Mar;59(1):2-24.全文 摘要
American College of Radiology. ACR Appropriateness Criteria®. Fibroids. 2022 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Adenomiose
- Pólipo endometrial
- Hiperplasia endometrial
更多 鉴别诊断指南
- ACR appropriateness criteria: clinically suspected adnexal mass
- ACR appropriateness criteria: fibroids
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Mioma: perguntas a fazer ao seu médico
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