- Design
- Systematic review and meta-analysis of 87 randomised trials; GRADE certainty assessed
- Population
- About 36,000 reproductive-age women within 5 days of unprotected intercourse
- Primary outcome
- Pregnancy
- Effect
- vs levonorgestrel RR 0.73 (0.59–0.90) low-dose, 0.67 (0.49–0.91) mid-dose; vs Yuzpe RR 0.14 (0.05–0.41)
A meta-analysis of 87 randomised trials in about 36,000 women compared mifepristone with other emergency contraceptives. Against levonorgestrel — the default oral agent in most of India — mifepristone lowered pregnancy risk, with high-certainty evidence against low-dose and moderate-certainty against mid-dose levonorgestrel. Against the older Yuzpe regimen the advantage was larger, with less nausea and vomiting.
The trade-off is menstrual: mifepristone delays the next period more often than levonorgestrel or Yuzpe, so a woman should be warned that a late period is expected and is not a sign of failure. The direct comparison with the copper intrauterine device was inconclusive, so the device remains the most effective option overall.
Where mifepristone is accessible for emergency contraception, this gives a more effective oral choice for women who decline or cannot have a copper device. Availability for this indication varies, so the practical step is to know what your setting can actually offer.
- Across 87 trials (~36,000 women), mifepristone lowered pregnancy risk versus levonorgestrel — risk ratio 0.73 (95% CI 0.59–0.90) against low-dose and 0.67 (0.49–0.91) against mid-dose.
- Against the Yuzpe regimen the advantage was larger (risk ratio 0.14, 0.05–0.41), with less nausea and vomiting.
- Mifepristone delays the next menses more often — warn the woman so a late period is not read as failure.
- The comparison with the copper intrauterine device was inconclusive, so the device remains the most effective choice overall.
Why it matters
Levonorgestrel is the default oral emergency contraceptive across much of India; this puts a more effective oral option on the table where mifepristone can be accessed.
Don't overread it
The direct comparison with the copper intrauterine device and with ulipristal was inconclusive — this does not make mifepristone the single best emergency contraceptive.
The statistics, in plain English
A risk ratio below 1 favours mifepristone: 0.73 means about a quarter fewer pregnancies than low-dose levonorgestrel, and the interval staying below 1 makes the benefit unlikely to be chance. The inconclusive copper-device comparison means we cannot rank mifepristone above it.
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