Publication:

Therapeutic role of low-dose mifepristone in the management of uterine fibroids: clinical outcomes and contemporary perspective

Background Uterine fibroids are the most common benign tumors of the female reproductive tract and are a major cause of menstrual disturbances and anemia. Conservative medical therapies are increasingly preferred over surgical options in women desiring uterine preservation. Mifepristone, a progesterone receptor antagonist, has shown promising results in reducing fibroid volume and associated symptoms. Objectives were to evaluate the clinical efficacy and safety of low-dose mifepristone (25 mg daily) in reducing fibroid size and improving clinical symptoms among perimenopausal women with symptomatic leiomyomas.

Methods This prospective observational study was conducted from June 2024 to July 2025 at the Department of Gynecology, Government Peripheral Hospital, Tondiarpet, Chennai. Ninety-three perimenopausal women aged 35-50 years with ultrasonographically confirmed symptomatic fibroids were treated with 25 mg mifepristone daily for three months. Clinical parameters, uterine and fibroid volumes, hemoglobin, and endometrial thickness were evaluated before and after therapy.

Results Amenorrhea was achieved in 92.7% of patients. Mean uterine and myoma volumes decreased to 63.7% and 53.6% of baseline, respectively. Mean hemoglobin levels increased by 2.8 g/dl (37%) post-treatment. Endometrial thickening was mild in most patients, with two cases of simple hyperplasia without atypia. Headache was the most frequent adverse effect (12%), with no major hepatic or renal complications reported. Hysterectomy was avoided in 87.8% of patients.

Conclusions Low-dose mifepristone (25 mg daily) is a safe, effective, and affordable therapeutic option for managing symptomatic uterine fibroids in perimenopausal women. It significantly reduces fibroid and uterine volume, controls bleeding, and improves hemoglobin levels, minimizing the need for surgical intervention.