Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology

Abstract

Importance: Mifepristone (RU-486) is a selective progesterone receptor modulator that has antagonist properties on the uterus and cervix. Mifepristone is an effective abortifacient, prompting limitations on its use in many countries. Mifepristone has many uses outside of induced abortion, but these are less well known and underutilized by clinicians because of challenges in accessing and prescribing this medication.Objective: To provide clinicians with a history of the development of mifepristone and mechanism of action and safety profile, as well as detail current research on uses of mifepristone in both obstetrics and gynecology.Evidence Acquisition: A PubMed search of mifepristone and gynecologic and obstetric conditions was conducted between January 2018 and December 2021. Other resources were also searched, including guidelines from the American College of Obstetricians and Gynecologists and the Society of Family Planning.Results: Mifepristone is approved by the Food and Drug Administration for first-trimester medication abortion but has other off-label uses in both obstetrics and gynecology. Obstetric uses that have been investigated include management of early pregnancy loss, intrauterine fetal demise, treatment of ectopic pregnancy, and labor induction. Gynecologic uses that have been investigated include contraception, treatment of abnormal uterine bleeding, and as an adjunct in treatment of gynecologic cancers.Conclusions and Relevance: Mifepristone is a safe and effective medication both for its approved use in first-trimester medication abortion and other off-label uses. Because of its primary use as an abortifacient, mifepristone is underutilized by clinicians. Providers should consider mifepristone for other indications as clinically appropriate.Target Audience: Obstetricians and gynecologists, family physicians.Learning Objectives: After completing this activity, the learner should be better able to describe the history of the development of mifepristone, including its mechanism of action and safety profile; and explain the uses for mifepristone in both obstetrics and gynecology.Jill M. Hagey and Amy G. Bryant have disclosed that the U.S. Food and Drug Administration has not approved the use of any drugs or devices for the treatment of early pregnancy loss, intrauterine fetal demise, ectopic pregnancy, pregnancy prevention, abnormal uterine bleeding, or gynecologic cancers as discussed in this article. Please consult the product's labeling for approved information.All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.

Multiple Clinical Indications of Mifepristone: A Systematic Review

“…Aside from abortion, mifepristone is used for both gynecologic and obstetric conditions. Obstetric conditions include induction of labor, postpartum hemorrhage, intrauterine fetal demise, ectopic pregnancies, and miscarriages [2]. Gynecological conditions that can be treated with mifepristone include abnormal uterine bleeding, post-coital contraception, and treatment of gynecological cancers [3].…”