Mifepristone for uterine fibroids

Area of Science:

• Gynecology
• Reproductive Endocrinology

Background:

• Uterine fibroids are common benign tumors in women of reproductive age.
• Mifepristone (RU-486) inhibits progesterone receptors and has shown potential in reducing fibroid size.
• Fibroid growth is influenced by sexual steroids, making mifepristone a potential therapeutic agent.

Purpose of the Study:

• To evaluate the efficacy and safety of mifepristone for uterine fibroid management in pre-menopausal women.
• To assess mifepristone's impact on fibroid volume, uterine volume, and associated symptoms.
• To review adverse effects reported in randomized controlled trials.

Main Methods:

• Systematic search of multiple databases including Cochrane, MEDLINE, EMBASE, PsycINFO, and CINAHL up to November 2011.
• Inclusion of only randomized controlled trials comparing mifepristone to placebo or other medical therapies.
• Data extraction and quality assessment by four authors, with meta-analyses using fixed-effect models.

Main Results:

• Mifepristone significantly reduced heavy menstrual bleeding compared to placebo (2 RCTs, 77 women).
• No significant reduction in fibroid volume (3 studies, 99 women) or uterine volume (2 studies, 72 women) was observed.
• Increased adverse events, including abnormal endometrial histology and hyperplasia, were associated with mifepristone treatment (2 RCTs, 54 women).

Conclusions:

• Mifepristone effectively alleviates heavy menstrual bleeding and enhances fibroid-specific quality of life.
• Mifepristone does not demonstrate efficacy in reducing uterine fibroid volume.
• Further robust, adequately powered randomized controlled trials are necessary to establish definitive recommendations for mifepristone use in treating uterine fibroids.