First-lineEllaOne
Ulipristal acetate 30 mg (EC)
Selective progesterone receptor modulator (EC)
EC up to 120 h — more effective than levonorgestrel near ovulation.
Oral
First-line for
- Emergency contraception up to 120 h after UPSI when Cu-IUD declined
Mechanism
Delays LH surge → postpones ovulation by ~5 days.
"UPA delays; LNG only pre-surge"
- Best from LH rise until peak
- Vomit within 3 h → re-dose
- Hold hormonal contraception for 5 d after
Dosing
- Dose
- 30 mg PO single dose within 120 h
Contraindications
- AbsoluteConfirmed pregnancy
- CautionSevere asthma on oral steroids
Side effects
- Headache, nausea
- Menstrual disturbance
- Dysmenorrhoea
Fetal & maternal notes
- • Not teratogenic in exposure data; avoid breastfeeding for 1 week (express and discard)
Key interactions
Progestogens (including quick-start POP)
AvoidReduce UPA efficacy — wait 5 days before starting hormonal contraception
Enzyme inducers
Caution↓ efficacy — consider Cu-IUD
Clinical pearls
- 💡 Not to be given twice in same cycle
- 💡 Not for BMI > 35 without discussion — Cu-IUD preferred
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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