Adenomyosis is when the tissue lining the uterus (endometrium) grows into the muscular wall of the uterus (myometrium). This leads to a thickening of the uterine walls and can cause numerous symptoms such as dysmenorrhea (absence of a menstrual period), secondary anemia, an enlarged uterus, fertility issues, higher possibility for miscarriage, and obstetric complications. The exact cause of adenomyosis is unknown, but it may be linked to hormonal imbalances and inflammation.
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According to a randomized clinical trial published in the Journal of American Medical Association around 20% of people of reproductive age with a uterus are diagnosed with adenomyosis, and 82% of those diagnosed undergo a hysterectomy(the surgical removal of one’s uterus) which results in a loss of fertility. There are no approved treatments for adenomyosis, so there is a very large unmet need for helping patients with this disease.
Mifepristone is a synthetic selective progesterone-receptor modulator used frequently in reproductive health; there are various disease states that use mifepristone as first or second line treatments. In a previous article, some of the same researchers found that mifepristone downregulates the expression of CDK1, CDK2, cyclin B, cyclin E, and CXCR4, which results in inhibiting the proliferation and migration of endometrial cells into the myometrium.
The authors took their previous research and applied it to the first placebo-controlled randomized clinical trial of mifepristone vs placebo for the treatment of adenomyosis. They observed the safety, tolerability, and efficacy of mifepristone 10mg once a day vs placebo for 12 weeks and found that mifepristone resulted in a significant remission of adenomyosis symptoms. They did not observe serious adverse effects aside from mild liver function abnormalities. Mifepristone is a relatively old drug, hence why it is trustworthy to use in long-term administration.
This recent double-blind randomized clinical trial evaluating the use of mifepristone as a potential treatment for adenomyosis has shown promising results in terms of symptom remission. Further research and larger clinical studies are necessary to explore the safety, long-term efficacy, and optimal dosing of mifepristone for the management of adenomyosis and to provide effective therapeutic options for individuals affected by this condition and is highly anticipated!
Sources: Journal of American Medical Association, Hopkins Medicine, Expert Opinion on Pharmacotherapy, Journal of Cellular and Molecular Medicine
