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Ulipristal acetate oral 5mg

Updated 2 Feb 2023 | Progesterone antagonist


Oral formulations of ulipristal acetate.

Drugs List

  • ESMYA 5mg tablets
  • ulipristal 5mg tablets
  • Therapeutic Indications


    Intermittent treatment of uterine fibroids: not eligible for surgery

    Intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age who have not reached menopause when uterine fibroid embolisation or surgical treatment options are not suitable or have failed.



    Intermittent treatment of moderate to severe symptoms of uterine fibroids if surgery not appropriate
    5mg once daily for up to 3 months starting during the first week of menstruation.
    Treatment course may be repeated if necessary. Re-treatment should start no sooner than during the first week of the second menstruation following completion of the previous course.
    The treating physician should explain to the patient the requirement for treatment free intervals.
    Repeated intermittent treatment has been studied up to 4 intermittent courses.

    Additional Dosage Information

    If a patient misses a dose, the patient should take ulipristal acetate as soon as possible. If the dose was missed by more than 12 hours, the patient should not take the missed dose and resume the usual dosing schedule.


    Children under 18 years
    Breast cancer
    Cervical cancer
    Hepatic disorder
    Ovarian carcinoma
    Severe uncontrolled asthma
    Undiagnosed gynaecological haemorrhage
    Uterine neoplasm

    Precautions and Warnings

    Severe renal impairment

    Advise ability to drive/operate machinery may be affected by side effects
    Treatment to be initiated and supervised by a specialist
    Exclude pregnancy prior to initiation of treatment
    Perform liver function tests before commencing therapy
    Monitor hepatic function 2 to 4 weeks after discontinuation
    Monitor liver function tests monthly during treatment
    Perform annual endometrial ultrasound
    Advise patient/carer to contact GP immediately if signs of liver disorder
    Discontinue if jaundice or other clinical symptoms of hepatic injury
    Suspend treatment if transaminases >3 times upper limit of normal
    Inform pathology lab of this medicine if endometrial/cervical tissue sent
    Advise patient not to take St John's wort concurrently
    Advise patient to avoid grapefruit products
    Female: Barrier or non-hormonal contraception advised during treatment

    Cases of liver injury and hepatic failure some requiring liver transplantation have been reported. Do not initiate ulipristal acetate in women with baseline alanine transaminase (ALT) or aspartate aminotransferase (AST) more than 2 times the upper limit of normal, this is either in isolation or combination with bilirubin more than 2 times the upper limit of normal.

    Ulipristal acetate has a specific pharmacodynamic action on the endometrium. Changes in the histology of the endometrium may be observed in patients treated with ulipristal acetate. These changes are reversible after treatment cessation. These histological changes are denoted as Progesterone Receptor Modulator Associated Endometrial changes (PAEC) and should not be mistaken for endometrial hyperplasia. A reversible increase in the thickness of the endometrium may occur.

    In repeated intermittent treatment periodic monitoring of the endometrium is recommended. This includes annual ultrasound to be performed after resumption of menstruation during off treatment period. If endometrial thickening is noted and persists after the return of menstruations during off-treatment periods or beyond 3 months following the end of treatment and/or an altered bleeding pattern is noted, investigate to exclude other underlying conditions, including endometrial malignancy.

    In case of hyperplasia (without atypia), monitoring as per usual clinical practice would be recommended. In case of atypical hyperplasia, investigation and management as per usual clinical practice should be performed.

    Ulipristal acetate use usually leads to a significant reduction in menstrual blood loss or amenorrhoea within the first 10 days of treatment. Should excessive bleeding persist, patients should notify their physician. Menstrual periods will generally return within 4 weeks after the end of each treatment course. If, during repeated treatment, after the initial reduction in bleeding or amenorrhoea, an altered persistent or unexpected bleeding pattern occurs such as inter-menstrual bleeding, investigation of the endometrium including endometrial biopsy should be performed to exclude other underlying conditions, including endometrial malignancy.

    Pregnancy and Lactation


    Ulipristal acetate is contraindicated during pregnancy.

    The manufacturer states that there is limited data regarding the use of ulipristal acetate in pregnant women. No teratogenic potential was observed however animal data is insufficient with regards to reproductive toxicity.


    Ulipristal acetate is contraindicated during breastfeeding.

    The manufacturer states that ulipristal acetate is excreted in human milk. The effects on newborns and infants has not been studied, therefore a risk cannot be excluded.

    Side Effects

    Abdominal pain
    Back pain
    Breast discomfort
    Breast pain
    Breast swelling
    Breast tenderness
    Dry mouth
    Dry skin
    Elevated triglyceride levels
    Emotional disorder
    Endometrial hyperplasia
    Hepatic failure
    Hot flushes
    Hypersensitivity reactions
    Increase in plasma cholesterol
    Musculoskeletal pain
    Ovarian cysts
    Pelvic pain
    Urinary incontinence
    Uterine haemorrhage
    Vaginal discharge
    Weight gain

    Effects on Laboratory Tests

    Endometrial thickening
    If hysterectomy or endometrial biopsy specimens are sent for histology, the laboratory should be aware of the treatment.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2021

    Reference Sources

    Summary of Product Characteristics: Esmya 5 mg Tablets. Gedeon Richter (UK) Ltd. Revised January 2021.

    NICE Evidence Services Available at: Last accessed: 23 March 2021

    MHRA Drug Safety Update February 2021
    Available at:
    Last accessed: 17 March 2021

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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