Quando a dor não é normal: março amarelo, mês de conscientização da endometriose

por Feito para Ela
Condição atinge entre 10% a 15% das mulheres no mundo, mas diagnóstico é complexo e tratamento deve ser multidisciplinar para devolver a qualidade de vida à paciente

Você tem dores fortes durante o período menstrual e nas relações sexuais? Por vezes, tem dificuldades para evacuar ou episódios de diarreia? Sente, também, desconforto para urinar? E ainda está com dificuldades para engravidar? Esses sintomas, em conjunto ou isoladamente, podem indicar que você está com endometriose.

As causas da doença ainda não são completamente conhecidas pela ciência, mas acredita-se que ela tenha ligação com o sistema imunológico e que seja induzida geneticamente. É caracterizada pela presença de tecido endometrial (aquele que é eliminado mensalmente na menstruação) na parte de fora do útero, em locais como a tuba uterina, ovários e mesmo nos intestinos e na bexiga. Esse tecido se inflama e, por isso mesmo, costuma causar dores fortes que comprometem a qualidade de vida da mulher, tanto durante o período menstrual quanto fora dele.

Neste mês em que se celebra o Março Amarelo, mês de conscientização sobre a endometriose, o Feito para ELA responde as principais dúvidas sobre a doença. Vamos lá?

 

Quais são os sintomas e como é feito o diagnóstico?

Os sintomas são divididos em dois grupos principais, que podem, inclusive, apresentar-se ao mesmo tempo: infertilidade e dor. Por se tratarem de sintomas que podem ter sua origem em várias outras doenças, o diagnóstico é complexo. Quem explica é o ginecologista Julio Cesar Rosa e Silva, presidente da CNE Endometriose da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) e diretor científico da Sociedade Brasileira de Endometriose (SBE). “Hoje a principal forma de diagnóstico é pelo histórico clínico da paciente, já que os exames de imagem, como ultrassom e ressonância magnética, confirmam apenas os casos que já estão mais avançados. Portanto, é muito importante a escuta atenta dos sintomas”, alerta.

Por falta de conhecimento tanto dos médicos quanto das próprias pacientes, que acreditam que dores são normais no período menstrual, o diagnóstico da endometriose pode levar até 14 anos! E como se trata de uma doença com caráter progressivo, esse longo período pode agravar ainda mais o quadro.

 

Quais são os tratamentos disponíveis?

Com a comprovação do diagnóstico de endometriose, Silva explica que há duas principais possibilidades de tratamento:

  • Clínico: tem como objetivo o alívio dos sintomas por meio do uso de anticoncepcionais orais combinados ou progestagênios isolados, além da associação de analgésicos para o controle da dor. “Embora recomendado em alguns casos mais graves, costuma-se evitar o uso de opiáceos porque eles trazem efeitos colaterais, principalmente a possibilidade de adicção (vício)”, destaca Silva.
    Além da medicação, é fundamental também que a mulher conte com um acompanhamento multidisciplinar, que envolve nutricionista para o controle da dieta, psicológico para o manejo da dor, educador físico para a prática de atividades físicas e até mesmo o fisioterapeuta para indicar exercícios que ajudem com a dor.
    O especialista ainda lembra que a taxa de sucesso do tratamento clínico fica entre 60% e 80% dos casos.
  • Cirúrgico: recomendado principalmente quando as possibilidades de sucesso do tratamento clínico são esgotadas ou quando há comprometimento funcional de algum órgão pela endometriose, como o intestino ou a bexiga. Silva lembra que o procedimento deve ser sempre realizado em centros especializados, com equipes multiprofissionais, porque são cirurgias de alta complexidade.

 

O que fazer em casos de infertilidade?

A endometriose costuma causar infertilidade em 50% dos casos, ao mesmo tempo em que 50% dos casos de infertilidade tem a endometriose como origem. A boa notícia é que é possível engravidar mesmo portando a doença – inclusive naturalmente.

Para aquelas que estão tentando há muito tempo e não conseguiram, a recomendação principal do especialista é seguir pela via da fertilização in vitro. “Claro que é fundamental avaliar se a mulher apresenta condições psicológicas e financeiras para esta opção, mas ela é a que obtém maiores taxas de sucesso”, recomenda. No caso das mulheres impossibilitadas de recorrer à fertilização por qualquer motivo, o caminho, em geral, costuma ser a cirurgia.

 

Quais são os avanços da ciência no estudo da endometriose?

Embora ainda sejam necessários muitos avanços tanto no diagnóstico quanto no tratamento da endometriose, em março, justamente o mês de conscientização sobre a doença, um novo estudo trouxe esperanças para quem convive com o quadro.

Nele, um grupo de cientistas franceses obteve sucesso no diagnóstico da doença por meio da busca de um painel de microRNAs em amostras de saliva, associado à tecnologia de inteligência artificial. “O estudo ainda precisa passar por validação externa, ou seja, ser submetido a um grupo maior de pacientes em várias localidades do mundo para comprovação da eficácia. Mas é um caminho importante na busca pelo diagnóstico mais precoce”, explica Silva.

 

Qual o papel da conscientização sobre o tema?

Enquanto a ciência não avança, o caminho é mesmo o da conscientização. Por isso, iniciativas como o Março Amarelo são fundamentais para levar mais conhecimento à população em geral e, também, aos médicos das demais especialidades.

O recado de Silva é um só: quem tem dores fortes e comprometimento geral da qualidade de vida deve sempre relatar ao médico. “Dor intensa no período menstrual não é normal e deve ser sempre investigada”, garante.

 

Fontes

https://www.febrasgo.org.br/pt/component/k2/item/1382-atualizacao-no-diagnostico-e-tratamento-da-endometriose?Itemid=439&highlight=WyJlbmRvbWV0cmlvc2UiXQ==

https://saude.abril.com.br/medicina/chegou-o-mes-de-conscientizacao-da-endometriose-o-que-saber-sobre-ela/

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