This article in the Drug and Therapeutics Bulletin (DTB) on ulipristal acetate (ellaOne®), a new oral hormonal emergency contraceptive, licensed for use up to 5 days after unprotected sexual intercourse, examines whether it is a therapeutic advance in this area. The following topics are covered:

• About emergency contraception

• What is ulipristal?

• Clinical effectiveness

• Comparative studies with levonorgestrel

• Uncontrolled study evidence

• Unwanted effects

• Precautions and interactions

• Cost

• What guidelines say

The article concludes “Levonorgestrel is still the first choice for emergency hormonal contraception if administered within 72 hours of sexual intercourse. If available and suitable, emergency insertion of a copper intrauterine device (IUD) should also be considered up to 5 days after the earliest likely calculated ovulation. Further evidence is needed before there is a change in practice. In particular, a superiority trial would be needed to prove that ulipristal should be used rather than levonorgestrel, compared with which it is less accessible and more costly, and does not have the same safety data. However, ulipristal provides prescribers with a licensed option for use in women presenting 72–120 hours after unprotected intercourse, if insertion of a copper IUD is not feasible.”