Selective progesterone receptor modulator (SPRM)
ATC code: G03AD02 (Ulipristal)
Selective progesterone receptor modulator. For emergency contraception, 30 mg blocks the LH surge and delays ovulation by 5 days, even when taken immediately before expected ovulation. Effective up to 120 h post-coitus. Per Lancet 2010 meta-analysis, more effective than levonorgestrel, especially at 72-120 h and in BMI ≥30.
First line
Emergency contraception within 120 h of unprotected sex or method failure. Per SEGO 2023 and FIGO 2023, first-line. Single 30 mg oral tablet ASAP. Pregnancy rate 1.4% (vs 2.2% for levonorgestrel). Preferred for BMI ≥30. After dosing – barrier method backup for 5 days, then resume usual contraception.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ulipristal while breastfeeding. Per EllaOne SmPC and SEGO 2023, pump and discard milk for 7 days after a dose – infant safety data are limited. Hale L3. For breastfeeding women, levonorgestrel 1.5 mg is preferred (Hale L2, RID about 1.3%, no feeding interruption) or a copper IUD.
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Do not use in confirmed pregnancy. Accidental use is not linked to birth defects – pregnancy may safely continue.
Pump and discard milk for 7 days after a dose. RID not precisely estimated, Hale L3 due to limited data. For breastfeeding women, prefer levonorgestrel 1.5 mg (Hale L2) or copper IUD.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ulipristal acetate is evaluated for the following indications with varying evidence strength: Emergency contraception (evidence tier A), Contraception during breastfeeding (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ulipristal acetate (≥ 1 in 100): Headache (18%), Nausea (12%), Abdominal pain, Menstrual irregularity, Fatigue. See the Safety section for uncommon and serious reactions.
FDA category X. Do not use in confirmed pregnancy. Accidental use is not linked to birth defects – pregnancy may safely continue.
Pump and discard milk for 7 days after a dose. RID not precisely estimated, Hale L3 due to limited data. For breastfeeding women, prefer levonorgestrel 1.5 mg (Hale L2) or copper IUD.
Ulipristal acetate is contraindicated in: Hypersensitivity; Confirmed pregnancy; Severe hepatic impairment; Severe asthma on systemic steroids. Full list in the Safety section.