Uses of ulipristal acetate beyond emergency contraception: A narrative review

Objectives

Ulipristal acetate (UPA) is a selective progesterone receptor modulator and the most effective oral emergency contraceptive (EC) method available in the United States. The aim of this review is to identify and describe uses of UPA beyond EC and to further discuss the concerns regarding the possible off-target liver effects.

Study design

We conducted a literature search in August 2024, using Embase, Medline (PubMed), and Cochrane, utilizing a combination of MeSH and keywords for UPA, excluding animal studies, and limiting to English language publications. After excluding duplicates using covidence, two authors reviewed the remaining 610 results and identified 340 studies. We further excluded case reports and case series.

Results

UPA has shown significant promise for indications outside of EC, most notably treatment of uterine leiomyomas, but also ongoing contraception, prevention and treatment of breast cancer, and abnormal uterine bleeding. While UPA has extensive potential for use both within and beyond reproductive health, unfortunately any ongoing development is at a standstill due to concerns regarding its possible role in causing serious liver injury. The role of UPA in causing drug-induced liver injury is not confirmed and preclinical studies during development did not demonstrate a concern that UPA causes drug-induced liver injury.

Conclusions

Access to UPA is crucial not only for EC but for the treatment of many other gynecological and nongynecological conditions.

Implications

Ulipristal acetate (UPA) has shown significant promise for indications outside of EC, including uterine leiomyomas, prevention and treatment of breast cancer, and abnormal uterine bleeding. Access to UPA is crucial not only for EC but for the treatment of many other gynecologic and non-gynecologic conditions.