Mifepristone and Endometrial Polyps: A Paradigm Shift in Gynecological Outcomes – A Case Report

Abstract

Mifepristone, a selective progesterone receptor modulator (SPRM), is increasingly used for the medical management of uterine leiomyomas and abnormal uterine bleeding. Prolonged exposure, however, may induce a distinct spectrum of endometrial change termed progesterone receptor modulator-associated endometrial changes (PAEC), characterised by cystic glandular dilatation, endometrial thickening, polypoid change and an altered gland-to-stroma ratio, which can mimic premalignant pathology. We report the case of a 45-year-old multiparous woman with heavy and irregular menstrual bleeding, previously treated outside with mifepristone 25 mg once daily for six months for symptomatic fibroids. Ultrasonography showed intramural leiomyomas together with cystic endometrial change and a focal vascular endometrial lesion. Hysteroscopy revealed a polypoidal endometrium with a dominant 1 x 1.5 cm mucosal polyp and several smaller satellite polyps. She underwent hysteroscopy-guided polypectomy with endometrial biopsy and levonorgestrel intrauterine system insertion. Histopathology confirmed a benign endometrial polyp with proliferative glands and no atypia. This case illustrates that a detailed drug history is essential to recognise mifepristone-related PAEC, avoid diagnostic overcall and unnecessary intervention, and guide targeted hysteroscopic management.