{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:00:42Z","timestamp":1790182842078,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["203545745"],"award-info":[{"award-number":["203545745"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2026,7,4]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency contraception (EC) prevents pregnancy after unprotected sexual intercourse using oral medications or intrauterine devices. Comparative evidence on effectiveness and safety is essential to inform emergency contraceptive counselling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the effectiveness, safety and acceptability of mifepristone compared with other EC methods among reproductive-age women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, Scopus conference abstracts, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform through 28 February 2025. Randomised controlled trials enrolling women within 5\u2009days of unprotected sexual intercourse and comparing mifepristone with oral EC methods (levonorgestrel (LNG), Yuzpe regimen, ulipristal acetate) or intrauterine devices (IUDs) (copper or LNG) were included. Pregnancy was the primary outcome. Risk of bias was assessed using the Risk of Bias 1 (RoB 1) tool. Meta-analyses used fixed or random-effects models and certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-seven trials including approximately 36\u2009000 participants were analysed. Mifepristone reduced pregnancy risk compared with the Yuzpe regimen (risk ratio (RR) 0.14, 95%\u2009CI 0.05 to 0.41; moderate-certainty evidence). It was more effective compared with LNG with either low-dose (&lt;25\u2009mg; RR 0.73, 95%\u2009CI 0.59 to 0.90; high-certainty) or mid-dose (25\u201350\u2009mg; RR 0.67, 95%\u2009CI 0.49 to 0.91; moderate-certainty) levels. Evidence was inconclusive regarding comparisons with the copper IUD. Mifepristone causes less nausea and vomiting than Yuzpe. Mifepristone increases the risk of delayed menses relative to both Yuzpe and LNG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mifepristone is an effective emergency contraceptive, potentially more effective than commonly used oral EC methods, with a favourable side effect profile aside from delayed menstruation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2026-203328","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:05:16Z","timestamp":1790179516000},"page":"s3-s12","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness, safety and acceptability of mifepristone compared with other interventions in reproductive-age women using emergency contraception for the prevention of pregnancy: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3013-9292","authenticated-orcid":false,"given":"Shaalini","family":"Ramanadhan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5040-7288","authenticated-orcid":false,"given":"Alison","family":"Edelman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Che","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research and Training, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Paynter","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian T","family":"Henderson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA"},{"name":"Cochrane Fertility Regulation Group, Oregon Health & Science University, Portland, Oregan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"2026092309050930000_52.Suppl_2.s3.1","unstructured":"United Nations Population Fund (UNFPA) . Seeing the unseen: the case for action in the neglected crisis of unintended pregnancy. 2022. Available: https:\/\/www.unfpa.org\/sites\/default\/files\/pub-pdf\/EN_SWP22%20report_0.pdf"},{"key":"2026092309050930000_52.Suppl_2.s3.2","unstructured":"World Health Organization (WHO) . Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division. 2023. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240068759"},{"key":"2026092309050930000_52.Suppl_2.s3.3","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181deff2a"},{"key":"2026092309050930000_52.Suppl_2.s3.4","doi-asserted-by":"crossref","unstructured":"Salcedo J , Cleland K , Bartz D , et al . Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023;121. doi:10.1016\/j.contraception.2023.109958","DOI":"10.1016\/j.contraception.2023.109958"},{"key":"2026092309050930000_52.Suppl_2.s3.5","unstructured":"Puig C . Russian Federation: Mifepristone EC pills less accessible, 2025. Available: https:\/\/www.ec-ec.org\/russian-federation-mifepristone-ec-pills-less-accessible"},{"key":"2026092309050930000_52.Suppl_2.s3.6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.contraception.2020.08.005","article-title":"Mifepristone for emergency contraception: Case for recommendation in practice guidelines","volume":"102","author":"Rodriguez","year":"2020","journal-title":"Contraception"},{"key":"2026092309050930000_52.Suppl_2.s3.7","article-title":"Interventions for emergency contraception","volume":"1","author":"Shen","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092309050930000_52.Suppl_2.s3.8","first-page":"5","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","volume":"6","author":"Chandler","year":"2024"},{"key":"2026092309050930000_52.Suppl_2.s3.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2012.09.003"},{"key":"2026092309050930000_52.Suppl_2.s3.10","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":"2026092309050930000_52.Suppl_2.s3.11","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2478\/afmnai-2014-0019","article-title":"Mechanism of action, efficacy and safety of emergency hormonal contraception (levonorgestrel and ulipristal acetate) and attitudes of pharmacists","volume":"31","author":"Milosavljevi\u0107","year":"2014","journal-title":"AFMN Biomedicine"},{"key":"2026092309050930000_52.Suppl_2.s3.12","doi-asserted-by":"publisher","DOI":"10.1177\/1933719113519178"},{"key":"2026092309050930000_52.Suppl_2.s3.13","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6874-14-54","article-title":"A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception","volume":"14","author":"Shohel","year":"2014","journal-title":"BMC Womens Health"},{"key":"2026092309050930000_52.Suppl_2.s3.14","unstructured":"World Health Organization (WHO) . Emergency contraception. 2021. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/emergency-contraception"},{"key":"2026092309050930000_52.Suppl_2.s3.15","unstructured":"Faculty of Sexual and Reproductive Healthcare (FSRH) . FSRH Guideline: Emergency contraception. 2017. Available: https:\/\/www.communitypharmacy.scot.nhs.uk\/media\/3132\/fsrh-guideline-ec-dec-17.pdf"},{"key":"2026092309050930000_52.Suppl_2.s3.16","doi-asserted-by":"crossref","unstructured":"Ramanadhan S , Edelman A , Che Y , et al . 2026 Effectiveness, safety and acceptability of mifepristone compared to other interventions in reproductive age women using emergency contraception for the prevention of pregnancy [Dataset]. Cochrane Database Syst Rev CD016275.","DOI":"10.1002\/14651858.CD016275"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2026-203328","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:05:23Z","timestamp":1790179523000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2026-203328"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":16,"journal-issue":{"issue":"Suppl 2","published-online":{"date-parts":[[2026,9,23]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjsrh-2026-203328"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2026-203328","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}