Mifepristone, often dubbed the “abortion pill,” has been a topic of heated debate since it was approved for use in the United States in 2000. The drug was developed by the French pharmaceutical company Roussel Uclaf and has since revolutionized abortion care, now accounting for almost two-thirds of all abortions in the United States. However, focusing solely on its role in abortion overlooks its broader medical potential in treating a wide range of conditions. The tense political climate around the topic of abortion has played a huge role in the drug’s fate.
The Feminist Majority Foundation was a key player in the drug’s introduction into the United States. FMF founder and President, Eleanor Smeal, in partnership with other feminist leaders, continuously advocated for mifepristone, citing that the medication could be a treatment for numerous life-threatening conditions. Eventually, their efforts prevailed. In December 1999, FMF was given the responsibility of distributing mifepristone to patients for compassionate use — a pathway for patients with life-threatening conditions to use an investigational medicine that has not gone through extensive clinical trials — after the original manufacturer said they could no longer do it.
How Does Mifepristone Work?
At its core, mifepristone blocks the cells that respond to progesterone at low doses and blocks the effects of glucocorticoid hormone at high doses. Progesterone prepares the uterus for pregnancy by thickening the uterine lining and increasing blood supply to the area. By inhibiting this hormone, mifepristone can effectively terminate a pregnancy by causing the uterine lining to shed, expelling the fertilized egg. But its ability to block these hormones also opens the door to a variety of other therapeutic applications.
Men have progesterone as well, helping them produce and mature sperm, prevent hair loss, and improve sleep. Glucocorticoids play a role in glucose, protein and fat breakdown, the fight-or-flight stress response, and maintaining mood. They also have anti-inflammatory, anti-allergic, and immunosuppressive properties. Mifepristone is used to treat conditions by either lowering cortisol, the hormone responsible for the fight-or-flight response, or blocking progesterone.
Beyond Abortion: Uses of Mifepristone
Outside of being used as an abortifacient, mifepristone is known to have numerous other uses, previously discovered in clinical trials. Just a few of the most studied conditions that mifepristone has been shown to effectively treat are Cushing’s Syndrome, some types of breast cancer, Gulf War Illness, Psychotic Depression, and Alzheimer’s Disease.
Cushing’s Syndrome
Cushing’s Syndrome is caused by an increase in cortisol, a glucocorticoid that is commonly known as the stress hormone. The increase can be caused by a tumor on the pituitary or adrenal gland, other tumors that stimulate the release of cortisol, taking glucocorticoid supplements, or simply, the body uncontrollably making too much cortisol for long periods of time. Symptoms of this condition include a change in body fat distribution in which the individual has thin arms and legs with more fat in the trunk, round moon-shaped face, a buffalo hump (a lump of fat deposited between the shoulders), purplish stretch marks on the abdomen, fragile or thin skin, slow wound healing, acne, irregular periods, thick dark hair growth usually on the face, low sex drive, erectile dysfunction, infertility, fatigue, muscle weakness, mood swings or depression, increased risk of infections, skin darkening, and brittle bones. Cushing’s Disease typically affects 20-50 year olds, with women being more commonly affected. Treatment usually consists of radiation or surgery, which are both invasive and hard on the body in the long run. Mifepristone has been approved for treatment of this condition since 2012 and it works by effectively lowering blood pressure and blood sugar in those with Cushing’s Syndrome.
Breast Cancer
The breast has different parts, any of which can be the primary site for cancer. Subtypes of breast cancer include estrogen receptor positive, progesterone receptor positive, both receptors present, both absent, or positive for other proteins that allow cancer cells to grow, like HER2 or BRCA. Men can also develop breast cancer. Mifepristone treatment can optimize the chemotherapy medications because it inactivates any glucocorticoid-responding cells that may be preventing the chemo from working. Mifepristone can also decrease tumor size or inhibit tumor growth in progesterone receptor positive breast cancer. This drug used in combination with tamoxifen (a common breast cancer drug that inhibits the estrogen responding cells) is very effective at inhibiting cancer growth because both drugs target different cells.
Mifepristone is also known to slow cancer growth in other body parts as well. This includes prostate, pancreatic, ovarian, brain, stomach, kidney, colon, and lung cancers.
Gulf War Illness / Chronic Multisymptom Illness
Gulf War Illness refers to a group of chronic symptoms experienced by veterans of the Persian Gulf War. About one-third of the veterans that engaged in this war are affected by this illness. Exposure to pesticides, nerve agents, pyridostigmine bromide pills (anti-nerve agents), harmful smoke and fumes, and petrochemicals are thought to promote the development of this condition. These agents led to the generation of reactive oxygen species that damaged neurons and muscle tissue, leading to horrible and chronic symptoms such as fatigue, headaches, joint pain, muscle aches, indigestion, insomnia, dizziness, respiratory disorders, memory issues, mood dysfunction, rashes, and diarrhea. The underlying cause of this condition is said to be attributed to an increase in the stress hormone, so mifepristone works by blocking the effects of these hormones. Although studies have shown that mifepristone treatment does not lead to an improvement of physical symptoms in these patients, there was a boost in certain cognitive functions.
Psychotic Depression
Psychotic Depression is a form of depression that has associated feelings of psychosis, meaning that the individual has loss of touch with reality. They may have issues recognizing what is real and what is not or have hallucinations (seeing or hearing things that do not exist) or delusions (false beliefs). A person with psychotic depression may have fatigue, disturbed sleep, appetite changes, difficulty concentrating, thoughts of suicide, and feelings of worthlessness. People with depression commonly have high levels of cortisol. Mifepristone alleviates these symptoms by preventing the effects of this hormone. This drug also has less bothersome side effects than typical antipsychotic drugs.
There have been studies that also show that mifepristone can curb alcohol use disorder or cocaine dependence in people affected by these illnesses. However, more research needs to be done on this correlation.
Alzheimer’s Disease
Alzheimer’s Disease is a form of dementia that progressively worsens over time. The brain shrinks, brain cells die, and proteins deposit in the brain which leads to loss of memory, thinking, behavior, and social skills. It has been shown that high levels of glucocorticoids cause a faster decline in cognition over time and quicker onset of dementia. Glucocorticoids also shrink the structure in the brain that controls memory and learning, the hippocampus. Lowered levels of cortisol in these patients showed better concentration, memory and attention, but it has not been shown to cure the condition. Mifepristone works to achieve this, protects the neurons from damage, and prevents inflammation.
The Bigger Picture: Implications and Advocacy
Despite the political battle surrounding this drug, banning mifepristone would be a grave mistake. Beyond its critical role in reproductive healthcare, mifepristone’s potential spans a range of serious conditions, many of which do not currently have effective treatments. The positive implications of this drug are endless. Many of the conditions that this drug can treat affect both men and women, and usually result in fatal or life-threatening surgeries that could be prevented just by taking mifepristone, which has less side effects than other drugs commonly used to treat these conditions.
If we advocate for its continued use and lessen restrictions on this drug, physicians will be able to freely prescribe it and scientists can continue to carry out clinical trials that will yield life-changing results. The possibilities are vast, and the benefits of mifepristone extend far beyond its current political controversy, holding the promise of life-changing impacts for countless individuals.
