Goefibro-U

Ulipristal acetate is a synthetic selective progesterone receptor modulator (SPRM) that acts as a progesterone agonist/antagonist, primarily indicated for emergency contraception to prevent pregnancy after unprotected intercourse or contraceptive failure and for the management of moderate to severe symptoms associated with uterine fibroids in premenopausal women.[1][2] Approved in various formulations—such as 30 mg for emergency use (e.g., ella)—it inhibits or delays ovulation even when administered shortly before the luteinizing hormone surge, demonstrating superior efficacy to levonorgestrel in some clinical scenarios, particularly beyond 72 hours post-intercourse.[3][4] For uterine fibroids (e.g., 5 mg as Esmya or Fibristal), it reduces bleeding and fibroid volume, achieving amenorrhea in over 90% of patients across treatment courses in phase III trials, though its long-term use has been curtailed due to rare but serious hepatotoxicity risks.[5][6] Regulatory agencies, including the EMA, have imposed restrictions and suspensions on fibroid indications following post-marketing reports of liver injury, including failures necessitating transplantation, prompting mandatory liver function monitoring and contraindications for those with hepatic impairment.[7][8] While the 30 mg emergency contraceptive dose shows no elevated liver risks in population studies, the fibroid treatment's benefit-risk profile remains debated, with some analyses questioning the causality of isolated hep