[Efficacy of low-dose mifepristone in patients with thrombotic disorders complicated by heavy menstrual bleeding]

Objective: To evaluate the efficacy and safety of low-dose mifepristone (10-25 mg) in patients with thromboembolic disorders complicated by heavy menstrual bleeding (HMB). Methods: The data of 13 patients (median age:37 years) with thrombotic disorders and HMB treated with low-dose mifepristone in Peking University People's Hospital from January 2020 to March 2025 were retrospectively analyzed. The changes of acute bleeding control, menstrual blood loss [assessed by pictorial blood loss assessment chart (PBAC)], hemoglobin level, coagulation function and quality of life [assessed by menorrhagia multi-attribute scale (MMAS)] were evaluated. Results: (1) Among the 13 patients, venous thrombosis occurred in 8 cases (8/13), arterial thrombosis in 3 cases (3/13), and other types of thrombosis in 2 cases (2/13), including 1 case of local thrombosis after stent placement for anastomotic stenosis after renal transplantation, requiring long-term aspirin and clopidogrel, and 1 case of arteriovenous fistula thrombosis in a renal failure patient with long-term dialysis. (2) Nine patients (9/13) received antithrombotic medication, 1 patient (1/13) received inferior vena cava filter, and 3 patients (3/13) did not receive antithrombotic therapy due to platelet count <50×10⁹/L and high risk of bleeding. (3) Management of acute bleeding stage: 6 patients with massive vaginal bleeding in emergency department were treated with dose reduction or withdrawal of antithrombotic drugs, 5 cases were treated with intrauterine Foley balloon compression hemostasis combined with mifepristone, 1 case was treated with oral norethindrone combined with mifepristone, and the bleeding was successfully stopped, and the antithrombotic therapy was resumed after 1-2 days. (4) Mifepristone treatment (median course: 6 months): 7 patients without bleeding were treated with oral mifepristone directly. All patients had amenorrhea after 1 month of treatment, and PBAC score (1, 3, 6 months), hemoglobin level and quality of life were significantly improved (all P<0.05). During the follow-up period, there was no recurrence or new onset of thrombosis, and there were no statistically significant differences in coagulation function indexes (including prothrombin time, activated partial thromboplastin time, fibrinogen) compared with those before treatment (all P>0.05). The level of D-dimer was lower than that before treatment, considering that it was related to the control of thrombotic diseases. Patients were subsequently transitioned to other modalities for long-term menstrual management. Conclusions: Low-dose mifepristone is a viable bridging therapy for patients with thromboembolic disorders and HMB. It effectively induces amenorrhea, enabling patients to safely navigate high-risk periods for both thrombosis and bleeding without significantly impacting coagulation function. This approach facilitates subsequent long-term menstrual management and treatment of the primary thromboembolic disorder, ultimately improving patient prognosis.