Oral emergency contraception is ineffective after ovulation, but it is hard to predict ovulation date. Ulipristal acetate (UPA) is the first choice for women who have had UPSI or contraception failure within five days of their predicted ovulation date or when their ovulation date is unknown. It is also licensed for use for multiple episodes of UPSI within 120 hours.
UPA is a P medicine and can be sold over the counter or included in patient group directions (PGDs). In its most recent guidance, the Faculty of Sexual and Reproductive Health (FSRH) states the following in relation to UPA:
Women should be advised that it has been demonstrated to be more effective than levonorgestrel
It is the first-line oral emergency contraceptive for a woman who has had UPSI between 96 and 120 hours ago and for UPSI that took place within five days of the predicted ovulation date
It can be offered to a woman if she has had UPSI earlier in the same menstrual cycle, as well as within the last five days
Evidence suggests that it does not disrupt an existing pregnancy nor is it associated with foetal abnormality
It can be sold for any woman of childbearing age, including adolescents
If vomiting occurs within three hours, the dose should be repeated
Its effectiveness could be reduced if a woman takes progestogen in the five days after taking UPA
The effectiveness of UPA could theoretically be reduced if a woman has taken progestogen in the seven days prior to taking UPA
A delay (of at least five days) in starting hormonal contraception after taking UPA is required and it will be longer before hormonal contraceptive cover is established
Breastfeeding women should be advised not to breastfeed and to express and discard milk for a week after they have taken UPA
UPA is contraindicated in severe asthma that is not sufficiently controlled by oral corticosteroids
It is not advisable to use UPA in the same cycle as levonorgestrel.
Ulipristal acetate