{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:03Z","timestamp":1792787283236,"version":"4.5.0"},"reference-count":43,"publisher":"BMJ","issue":"3","funder":[{"name":"Chinese Health Education Center Project","award":["202401"],"award-info":[{"award-number":["202401"]}]},{"name":"Opening Foundation of NHC Key Laboratory of Contraceptives Vigilance and Fertility Surveillance","award":["JSHD202401"],"award-info":[{"award-number":["JSHD202401"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2023ZD0509801"],"award-info":[{"award-number":["2023ZD0509801"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2025,10,23]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the efficacy and safety of emergency contraception (EC) interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Literature published until 28 December 2024 was retrieved from nine databases. Randomised controlled trials (RCTs) evaluating the efficacy of copper or levonorgestrel intrauterine devices (Cu-IUDs or LNG-IUDs), oral levonorgestrel (LNG), mifepristone (MFP), ulipristal acetate (UPA) and oral EC plus cyclooxygenase inhibitor (COX) were considered eligible. A Bayesian network meta-analysis was conducted to evaluate the relative risk (RR) with a 95% credible interval (CrI) for efficacy and adverse events. Evidence certainty was graded using the CINeMA GRADE application. Pairwise meta-analyses, robustness analyses and Bayesian meta-regressions were conducted to verify the reliability of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 17\u2009244 studies, 92 involving 37\u2009260\u2009women were included. With robustness verified, the Cu-IUD was the most effective EC treatment. No significant differences in EC efficacy were observed between LNG-IUD and all other treatments, but with low- or very-low-certainty evidence. With acceptable adverse events, co-treatment with LNG and COX (LNG-COX) was more efficacious than single-dose (RR=0.112, 95%CrI: 0.005, 0.686) or double-dose LNG (RR=0.095, 95%CrI: 0.004, 0.605) with high certainty. MFP (25\u2009mg) and UPA had comparable EC efficacy (RR=0.782, 95%CrI: 0.425, 1.433), whereas MFP tended to induce advancement of the subsequent menstrual period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although the efficacy of LNG-COX was confirmed by high-certainty evidence, large-scale validation trials are required before it can be recommended clinically. Owing to within-study bias and imprecision, large RCTs are strongly recommended to assess the efficacy of ECs for interventions without direct comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>CRD42024627671.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2025-202892","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:20:35Z","timestamp":1762885235000},"page":"218-226","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and safety of emergency contraception interventions: a systematic review and Bayesian network meta-analysis"],"prefix":"10.1136","volume":"52","author":[{"given":"Yazhen","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Public Health, Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuening","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Health Commission (NHC) Key Laboratory of Contraceptives Vigilance and Fertility Surveillance, Nanjing, China"},{"name":"Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yidan","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinglong","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Health Commission (NHC) Key Laboratory of Contraceptives Vigilance and Fertility Surveillance, Nanjing, China"},{"name":"Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0071-9755","authenticated-orcid":false,"given":"Hui","family":"Jin","sequence":"additional","affiliation":[{"name":"School of Public Health, Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China"},{"name":"School of Public Health, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"2026102002202395000_52.3.218.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.02.018"},{"key":"2026102002202395000_52.3.218.2","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000056"},{"key":"2026102002202395000_52.3.218.3","doi-asserted-by":"crossref","DOI":"10.1186\/s40834-018-0067-8","article-title":"State of emergency contraception in the U.S., 2018","volume":"3","author":"Haeger","year":"2018","journal-title":"Contracept Reprod Med"},{"key":"2026102002202395000_52.3.218.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.08.021"},{"key":"2026102002202395000_52.3.218.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.07.004"},{"key":"2026102002202395000_52.3.218.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2021-201446"},{"key":"2026102002202395000_52.3.218.7","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0140-6736(23)01240-0","article-title":"Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial","volume":"402","author":"Li","year":"2023","journal-title":"Lancet"},{"key":"2026102002202395000_52.3.218.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.07.025"},{"key":"2026102002202395000_52.3.218.9","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.contraception.2016.01.009","article-title":"Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study","volume":"93","author":"Turok","year":"2016","journal-title":"Contraception"},{"key":"2026102002202395000_52.3.218.10","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det454"},{"key":"2026102002202395000_52.3.218.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2022141"},{"key":"2026102002202395000_52.3.218.12","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1080\/00273171.2022.2115965","article-title":"A Gentle Introduction to Bayesian Network Meta-Analysis Using an Automated R Package","volume":"58","author":"Liu","year":"2023","journal-title":"Multivariate Behav Res"},{"key":"2026102002202395000_52.3.218.13","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-015-0133-0","article-title":"Network meta-analysis incorporating randomized controlled trials and non-randomized comparative cohort studies for assessing the safety and effectiveness of medical treatments: challenges and opportunities","volume":"4","author":"Cameron","year":"2015","journal-title":"Syst Rev"},{"key":"2026102002202395000_52.3.218.14","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"2026102002202395000_52.3.218.15","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7302a1"},{"key":"2026102002202395000_52.3.218.16","unstructured":"World Health Organization (WHO) . Selected practice recommendations for contraceptive use. 3rd edn. WHO, 2016."},{"key":"2026102002202395000_52.3.218.17","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s40261-020-00901-x","article-title":"A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive","volume":"40","author":"Leelakanok","year":"2020","journal-title":"Clin Drug Investig"},{"key":"2026102002202395000_52.3.218.18","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2024.102926","article-title":"Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials","volume":"78","author":"Liu","year":"2024","journal-title":"EClinicalMedicine"},{"key":"2026102002202395000_52.3.218.19","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":"2026102002202395000_52.3.218.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003082","article-title":"CINeMA: An approach for assessing confidence in the results of a network meta-analysis","volume":"17","author":"Nikolakopoulou","year":"2020","journal-title":"PLoS Med"},{"key":"2026102002202395000_52.3.218.21","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.ajog.2021.06.090","article-title":"Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials","volume":"225","author":"de Wit","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"2026102002202395000_52.3.218.22","doi-asserted-by":"crossref","unstructured":"Dias S , Ades A , Welton NJ , et al . Network meta-analysis for decision making. Wiley, 2018.","DOI":"10.1002\/9781118951651"},{"key":"2026102002202395000_52.3.218.23","doi-asserted-by":"crossref","unstructured":"Gelman A , Carlin JB , Stern HS , et al . Bayesian data analysis. 3rd edn. Chapman and Hall\/CRC, 2013.","DOI":"10.1201\/b16018"},{"key":"2026102002202395000_52.3.218.24","doi-asserted-by":"publisher","DOI":"10.2307\/1390675"},{"key":"2026102002202395000_52.3.218.25","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9868.00353"},{"key":"2026102002202395000_52.3.218.26","doi-asserted-by":"crossref","first-page":"471","DOI":"10.2147\/IJWH.S213815","article-title":"The efficacy of intrauterine devices for emergency contraception and beyond: a systematic review update","volume":"11","author":"Goldstuck","year":"2019","journal-title":"Int J Womens Health"},{"key":"2026102002202395000_52.3.218.27","doi-asserted-by":"crossref","first-page":"100615","DOI":"10.1016\/j.srhc.2021.100615","article-title":"The intrauterine device versus oral hormonal methods as emergency contraceptives: A systematic review of recent comparative studies","volume":"28","author":"Cheung","year":"2021","journal-title":"Sex Reprod Healthc"},{"key":"2026102002202395000_52.3.218.28","article-title":"Interventions for emergency contraception","volume":"1","author":"Shen","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2026102002202395000_52.3.218.29","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/des140"},{"key":"2026102002202395000_52.3.218.30","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(03)00110-0"},{"key":"2026102002202395000_52.3.218.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60101-8"},{"key":"2026102002202395000_52.3.218.32","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.ejogrb.2023.10.035","article-title":"Emergency contraception - A review","volume":"291","author":"Rudzinski","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2026102002202395000_52.3.218.33","article-title":"Progestin intrauterine devices versus copper intrauterine devices for emergency contraception","volume":"2023","author":"Ramanadhan","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"2026102002202395000_52.3.218.34","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/AOG.0000000000004118","article-title":"Risk of Pregnancy With Levonorgestrel-Releasing Intrauterine System Placement 6-14 Days After Unprotected Sexual Intercourse","volume":"137","author":"Boraas","year":"2021","journal-title":"Obstet Gynecol"},{"key":"2026102002202395000_52.3.218.35","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/AOG.0000000000005466","article-title":"The Levonorgestrel-Releasing Intrauterine Device as Emergency Contraception","volume":"143","author":"Ramanadhan","year":"2024","journal-title":"Obstet Gynecol"},{"key":"2026102002202395000_52.3.218.36","doi-asserted-by":"publisher","DOI":"10.1093\/jb\/mvu081"},{"key":"2026102002202395000_52.3.218.37","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den260"},{"key":"2026102002202395000_52.3.218.38","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/968141","article-title":"Diverse roles of prostaglandins in blastocyst implantation","volume":"2014","author":"Salleh","year":"2014","journal-title":"ScientificWorldJournal"},{"key":"2026102002202395000_52.3.218.39","doi-asserted-by":"publisher","DOI":"10.1177\/0897190014544795"},{"key":"2026102002202395000_52.3.218.40","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2019-3149","article-title":"Emergency Contraception","volume":"144","author":"Upadhya","year":"2019","journal-title":"Pediatrics"},{"key":"2026102002202395000_52.3.218.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2009.03.021"},{"key":"2026102002202395000_52.3.218.42","doi-asserted-by":"publisher","DOI":"10.1080\/07853890600925843"},{"key":"2026102002202395000_52.3.218.43","article-title":"Repeated use of pre- and postcoital hormonal contraception for prevention of pregnancy","volume":"2014","author":"Halpern","year":"2014","journal-title":"Cochrane Database Syst Rev"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2025-202892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:21:22Z","timestamp":1792488082000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2025-202892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,10]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjsrh-2025-202892"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2025-202892","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}