Background: This study aimed to explore the effect of mifepristone pretreatment on stress response and sex hormone levels after combined laparoscopic treatment for cesarean scar pregnancy. Methods: We conducted a prospective, randomized, controlled study from January 2020 to September 2022. A total of 98 pregnant women with cesarean scar pregnancy were included and divided into two groups by the random number table method. The control group received hysteroscopy combined with laparoscopy treatment, and the observation group received mifepristone pretreatment before hysteroscopy, combined with laparoscopy treatment. The surgical efficacy, surgical indices, menstrual recovery time, postoperative residual muscle layer, and scar morphology were observed and evaluated. The ovarian hemodynamic indices, stress indices, and sex hormone levels were measured, and the incidence of complications such as postoperative infection and liver function impairment was calculated. Results: There was no significant difference in the surgical success rate between the two groups (97.96% vs 95.92%), as well as the thickness and proportion of residual muscle layer, the width, length, and depth of scars, and the incidence of postoperative complications (p > 0.05). Combined mifepristone pretreatment reduced intraoperative bleeding, shortened the average time for beta human chorionic gonadotropin (\beta-hCG) to fall to negative (20.5 days, p 0.05) and vaginal bleeding (19.8 days, p 0.05), lowered Vmax (49.8 cm/s, p 0.05), and elevated resistance index (RI) (0.7, p 0.05) and pulsatility index (PI) (2.5, p 0.05). Moreover, combined mifepristone pretreatment reduced C-reactive protein (CRP: 8.1 mg/L, p 0.05), cortisol (COR: 21.7 mg/L, p 0.05), adrenocorticotropic hormone (ACTH: 40.2 ng/L, p 0.05), as well as progesterone (P: 10.2 mmol/L, p 0.05), luteinizing hormone (LH: 13.2 µg/L, p 0.05), and follicle-stimulating hormone (FSH: 14.8 µg/L, p 0.05). Combined mifepristone pretreatment promoted the recovery of menstruation (25 days, p 0.05). Conclusion: Mifepristone pretreatment can promote postoperative recovery, reduce postoperative stress response, improve hemodynamics, regulate sex hormone levels, and promote the early recovery of menstruation in patients with cesarean scar pregnancy. Clinical Trial Registration: The study was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn), registration number: ChiCTR1800015514.