Does mifepristone cause uterine fibroids?

In the past, it was believed that the occurrence of uterine fibroids was related to estrogen, so the androgen testosterone propionate was used to counteract it; or the estrogen receptor blocker tamoxifen was used to reduce the effect of estrogen on uterine fibroids, but the effects of these drugs were not satisfactory. In 1983, Filicori pioneered the use of GnRH-a (gonadotropin-releasing hormone agonist) to treat uterine fibroids. The mechanism is through a series of pharmacological chain reactions, resulting in hypogonadism (its low estrogen environment is similar to medical ovarian removal), and reduced blood flow to the uterus and fibroids, and finally shrinking the fibroids. This drug has a significant effect in shrinking uterine fibroids, which is difficult to match with previous drugs. However, due to the high price of this drug and the need for daily intramuscular injections, the treatment period is as long as 3-6 months, which limits its widespread use.

In recent years, with the rapid development of medical science, it is believed that the occurrence of uterine fibroids is also related to progesterone. Based on this mechanism, Murphy first used the progesterone receptor blocker Ru486 (domestic drug name mifepristone) to treat uterine fibroids in 1993 to block the effect of progesterone on uterine fibroids, and achieved satisfactory results. According to recent literature reports, compared with GnRH-a, mifepristone has similar efficacy in shrinking uterine fibroids, but its side effects are mild and the incidence is low, and the recurrence rate of uterine fibroids after discontinuation of the drug is also lower than that of the latter. This drug is a tablet, which can be taken orally once a day, and the price is also low. These advantages make this drug easy for patients to accept and easy to promote.

Clinical use of this drug shows that myomas have shrunk to varying degrees, anemia symptoms have disappeared, and red blood cell and hemoglobin indicators have returned to normal. This drug is particularly suitable for the following two situations: First, for menopausal women with uterine myomas, the drug can shrink uterine myomas, and some experts believe that it can also have the effect of early menopause.

For patients with menopausal functional uterine bleeding, this drug can achieve three goals at once. After taking the drug, most patients stop menstruating that month and the bleeding stops (after the course of treatment, menstruation usually resumes within six weeks). The second type is patients with huge uterine fibroids and severe anemia. Before surgery, this drug can shrink the fibroids, facilitate hysterectomy, and reduce intraoperative bleeding. Since mifepristone has been used to treat uterine fibroids, a considerable number of patients have been spared the pain of surgery. However, this drug must be used under the guidance of an experienced specialist. In clinical applications, its indications and contraindications must be strictly and carefully mastered. It is contraindicated for patients with asthma, angina pectoris, ulcerative colitis, arrhythmia, heart failure, adrenal cortex insufficiency, etc.