Mifepristone in Obstetrics and Gynaecology
Saswati Sanyal Choudhury
Mifepristone acts by antagonising the biological action of progesterone acting as competitive receptor antagonist. Medical abortion with mifepristone and prostaglandin is an effective method. Continuous administration of mifepristone in a dose of 2mg/day for 30 days inhibits ovulation and delays menstruation. It has also been used in a dose of 600 mg as post-coital contraception within 72 hours. It has marked effect on cervical dilatation and myometrial contractility and therefore justifies its future trial for use in induction of labour. It can be used for the treatment of ectopic pregnancy and endometriosis but further verification is needed by randomized controlled trials. Mifepristone reduces BCL-2, decreases EGF expression in uterine fibroid cells and increases TNF and thereby reducing fibroid size and volume. Recent cochrane study revealed that mifepristone reduces heavy menstrual bleeding and improved fibroid specific quality of life but does not reduce fibroid volume significantly and further studies are required for recommendation for treatment.