Mechanisms involved in the contraceptive effects of ulipristal acetate

Munuce, María José; Gómez-Elías, Matías D; Caille, Adriana; Bahamondes, Luís; Cuasnicú, Patricia S.; Cohen, Débora J.

doi:10.1530/rep-19-0355

Cited by 8 publications

(3 citation statements)

References 76 publications

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“…The most effective method is a copper intrauterine device (Cu-IUD), which can be left in place as ongoing contraception afterwards. Selective progesterone receptor modulators such as ulipristal acetate are among the most effective emergency contraceptive pills (ECPs) available [ 25 ]. ECPs containing levonorgestrel are another method of EC.…”

Section: Main Textmentioning

confidence: 99%

The role of legal medicine professionals in preventing pregnancy and sexually transmitted infections among female victims of sexual assault

Yesodharan

Kamath

Renjith

et al. 2023

Forensic Sci Med Pathol

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Sexual violence can have an overwhelming impact on the victim’s physical and mental health; the consequences include unintended pregnancy and sexually transmitted infections (STIs). Therefore, the examiners must assess victims for possible pregnancy and sexually transmitted infections as a part of the sexual assault examination. This article aims to orient the medico-legal examiners towards their role in preventing unintended pregnancy and sexually transmitted infections among victims of sexual assault. Prompt detection of pregnancy or STIs is critical, as any delay would adversely affect the successful administration of emergency contraception and post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) and other sexually transmitted infections.

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Section: Main Textmentioning

confidence: 99%

The role of legal medicine professionals in preventing pregnancy and sexually transmitted infections among female victims of sexual assault

Yesodharan

Kamath

Renjith

et al. 2023

Forensic Sci Med Pathol

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“…In spite of this, the authors conclude verbatim that "the mechanism of action of UPA when used as an EC does not disrupt the implantation process", and always refer to implantation in the abstract's Study Question, Summary Answer and Conclusions. This message seems intentionally deceiving, It should be clear, at this point, that the prevalent MOA of ellaOne ® is linked to its antiprogestational effect on the endometrium and not to any effect on the process of ovulation 60 . All this information, however, was already evident when ellaOne ® was introduced into the market as an anti-ovulatory drug 31 : the papers describing its effects in women are the same discussed above.…”

Section: Ellaone ® and Endometriummentioning

confidence: 99%

Ulipristal Acetate (UPA) in Emergency Contraception: The Mechanism of Action, Toxicity and Perspectives

Mozzanega

2022

MRAJ

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After recalling that Levonorgestrel Emergency Contraceptive Pills never delay or suppress ovulation, but impair the luteal body functions, and, consequently, the embryo-implantation, we focus on the mechanism of action (MOA) of ellaOne®: micronized UPA (Ulipristal Acetate) 30mg and on UPA- toxicity. EMA and, after it, the National Drug Regulatory Institutions and the most renowned International Gynecological Societies present ellaOne® as an anti-ovulatory drug which is safe even in repeated assumption, also during the same menstrual cycle. We’ll try to understand whether this dogma is supported by experimental data in literature. As to the MOA, EMA reports (EMEA-261787-2009) that Ulipristal blocks the synthesis of the proteins necessary to begin and maintain pregnancy, and that Ulipristal and mifepristone were approximately equipotent as to their ability to terminate pregnancy. Besides, EMA further evidences (EMA/73099/2015) that it is unknown whether it is possible to use ellaOne® for abortion. Data in Literature evidence that ellaOne® can delay ovulation only when is taken in the very first fertile days of the cycle. In the pre-ovulatory, most fertile, days - when most intercourses do occur and over 70% fertilizations ensue - it never prevents ovulation, like placebo. On the contrary, whenever it is taken in the cycle, it consistently impairs the endometrium that becomes an inhospitable ground for the embryo: endometrial gene expression is completely subverted compared with that of the normal luteal phase. Recently, an UPA-based drug used for uterine fibroids-treatment (Esmya®) was withdrawn from the market because it caused fulminant hepatitis requiring transplantation (EMA/455818/2020). It was prescribed by the hospital for 3-6 months and carefully followed-up. The strict post-marketing surveillance allowed to link UPA-administration and tissue-accumulation to liver-failure. Surprisingly EMA, while revoking Esmya®, warranted for the safety of ellaOne®, though it is taken by millions of women unaware of the risk, repeatedly without prescription, without medical supervision and any possibility of post-marketing surveillance, in UPA-cumulating doses even greater than with Esmya®. Finally, we criticize the attempt to propose UPA in daily contraceptive pills, at doses even double than in Esmya® and for much longer periods, to fertile women aiming at preserving their fertility and health.

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“…5.Ulipristal acetate, brand name ellaOne, is a different EC that recent studies have shown has high suggestibility of post-fertilization effects by decreasing endometrium suitability for implantation; therefore, this paper will focus solely on LVG (Munuce et al 2020; Lira-Albarrán et al 2017). …”

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confidence: 99%

Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscientious Provision

2022

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While many Catholic hospitals permit the prescription of the emergency contraception drug levonorgestrel for rape victims, some continue to prohibit this practice as a matter of institutional conscience. While the standard approach to this issue has been to offer an argument that levonorgestrel either is or is not morally permissible, we have taken a different tack. We begin by briefly describing and acknowledging that reasonable disagreement exists on this question (part one), and then arguing that the reasonable disagreement itself can serve as a compelling basis for Catholic leadership at hospitals that prohibit emergency contraception for rape victims to accommodate physicians who wish to provide levonorgestrel as a matter of conscience (part two). We end by anticipating and responding to some objections.

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Mechanisms involved in the contraceptive effects of ulipristal acetate

Cited by 8 publications

References 76 publications

The role of legal medicine professionals in preventing pregnancy and sexually transmitted infections among female victims of sexual assault

The role of legal medicine professionals in preventing pregnancy and sexually transmitted infections among female victims of sexual assault

Ulipristal Acetate (UPA) in Emergency Contraception: The Mechanism of Action, Toxicity and Perspectives

Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscientious Provision

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