{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:59:51Z","timestamp":1792007991925,"version":"4.4.0"},"reference-count":17,"publisher":"BMJ","issue":"Suppl 1","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2025,10,2]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency contraception refers to contraceptive methods used following unprotected sexual intercourse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To review the literature on safety of repeated use of emergency contraceptive pills (ECPs) in the same menstrual cycle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched multiple databases from inception through February 2024 for articles on repeated ECP use. We assessed the risk of bias for each study and certainty of evidence for all outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 4565 articles identified, six met the inclusion criteria. Four studies of repeated levonorgestrel (LNG)-ECP use provided very low certainty evidence. Among women who became pregnant after at least one use of LNG-ECP in the conception cycle, women with ectopic pregnancy had increased odds of repeated LNG-ECP use in the conception cycle compared with women with intrauterine pregnancy (adjusted OR (aOR) 2.5, 95% CI 1.0 to 6.2). One non-comparative study reported few serious adverse events with repeated pericoital use of LNG-ECP, and two cohort studies of LNG-ECP failure found no differences in pregnancy, fetal\/neonatal, infant or child outcomes comparing higher (2.25\u20139\u2009mg LNG) and lower (0.75\u20131.5\u2009mg LNG) doses in the conception cycle. Two studies of repeated ulipristal acetate (UPA) use provided very low certainty evidence. One non-comparative study observed no serious adverse events, no abnormal laboratory results and normal endometrial biopsies with UPA (30\u2009mg, 4\u20136 doses\/month). One randomised controlled trial in a clinical setting observed no serious adverse events with UPA (10\u2009mg, 20\u2009mg or 50\u2009mg for 10 days) compared with placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evidence on the safety of repeated ECP use is limited and of very low certainty, but overall does not suggest safety concerns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2025-202841","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T20:05:14Z","timestamp":1762200314000},"page":"s1.2-s8","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Safety of repeated use of emergency contraceptive pills in the same menstrual cycle: a systematic review"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8300-7985","authenticated-orcid":false,"given":"Petrus Schonken","family":"Steyn","sequence":"first","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8973-7350","authenticated-orcid":false,"given":"Erin","family":"Fleurant","sequence":"additional","affiliation":[{"name":"Division of Complex Family Planning, Department of Obstetrics and Gynecology, Endeavor Health, Evanston, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6430-4415","authenticated-orcid":false,"given":"Emma Marie","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Complex Family Planning, Kaiser Permanent Medical Centre, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4180-7858","authenticated-orcid":false,"given":"James N","family":"Kiarie","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"2025110511351258000_51.Suppl_1.s1-a.1","unstructured":"World Health Organization Department of Sexual and Reproductive Health and Research (WHO\/SRH) and Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP) Knowledge SUCCESS . Family planning: a global handbook for providers (2022 update). Baltimore, MD and Geneva, Switzerland: CCP\/WHO, 2022."},{"key":"2025110511351258000_51.Suppl_1.s1-a.2","unstructured":"World Health Organization (WHO) . Medical eligibility criteria for contraceptive use. 5th edn. Geneva, Switzerland: World Health Organization, 2015."},{"key":"2025110511351258000_51.Suppl_1.s1-a.3","unstructured":"World Health Organization (WHO) . Selected practice recommendations for contraceptive use. 3rd edn. Geneva, Switzerland: World Health Organization, 2016."},{"key":"2025110511351258000_51.Suppl_1.s1-a.4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.contraception.2015.11.001","article-title":"Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception","volume":"93","author":"Jatlaoui","year":"2016","journal-title":"Contraception"},{"key":"2025110511351258000_51.Suppl_1.s1-a.5","doi-asserted-by":"crossref","first-page":"8487","DOI":"10.1038\/srep08487","article-title":"Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: a multicenter case-control study","volume":"5","author":"Zhang","year":"2015","journal-title":"Sci Rep"},{"key":"2025110511351258000_51.Suppl_1.s1-a.6","unstructured":"Nguyen AT , Curtis KM , Fleurant M , et al . Safety of repeated emergency contraceptive pill use: a systematic review: PROSPERO 2024 CRD42024569900. 2024. Available: https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42024569900"},{"key":"2025110511351258000_51.Suppl_1.s1-a.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025110511351258000_51.Suppl_1.s1-a.8","unstructured":"Covidence systematic review software. Melbourne, Australia: Veritas Health Innovation; 2023. Available: https:\/\/www.covidence.org\/"},{"key":"2025110511351258000_51.Suppl_1.s1-a.9","unstructured":"Higgins JPT , Savavoic J , Page MJ , et al . Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT , Thomas J , Chandler J , eds. Cochrane handbook for systematic reviews of interventions version 63. 2022."},{"key":"2025110511351258000_51.Suppl_1.s1-a.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025110511351258000_51.Suppl_1.s1-a.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"2025110511351258000_51.Suppl_1.s1-a.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"2025110511351258000_51.Suppl_1.s1-a.13","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev341"},{"key":"2025110511351258000_51.Suppl_1.s1-a.14","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.contraception.2015.12.015","article-title":"A prospective, open-label, multicenter study to assess the pharmacodynamics and safety of repeated use of 30 mg ulipristal acetate","volume":"93","author":"Jesam","year":"2016","journal-title":"Contraception"},{"key":"2025110511351258000_51.Suppl_1.s1-a.15","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.12065"},{"key":"2025110511351258000_51.Suppl_1.s1-a.16","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dep076"},{"key":"2025110511351258000_51.Suppl_1.s1-a.17","doi-asserted-by":"crossref","DOI":"10.1095\/biolreprod.113.117226","article-title":"Physical and mental development of children after levonorgestrel emergency contraception exposure: a follow-up prospective cohort study","volume":"91","author":"Zhang","year":"2014","journal-title":"Biol Reprod"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2025-202841","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T19:35:22Z","timestamp":1762371322000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2025-202841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":17,"journal-issue":{"issue":"Suppl 1","published-online":{"date-parts":[[2025,11,3]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjsrh-2025-202841"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2025-202841","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}