The immninent dawn of SPRMs in obstetrics and gynecology

Selective progesterone receptor modulators (SPRMs) have been developed since the late 70s when mifepristone was first described. They act through nuclear progesterone receptors and can have agonist or mixed agonist antagonist actions depending on the cell and tissue. Mifepristone has unique major antagonist properties allowing its use for pregnancy termination. Ulipristal acetate has been marketed in 2009 for emergency contraception and has been recently approved for preoperative myoma treatment. Further perspectives for SPRMs use include long term estrogen free contraception, endometriosis treatment. However long term applications will be possible only after confirmation of endometrial safety.

► SPRMs administration suppresses ovulation and induces amenorrhea, but maintains estradiol secretion.
► Mifepristone is used to treat hypercorticism, and for pregnancy termination.
► Ulipristal acetate is labelled for emergency contraception, and preoperative treatment of fibroids.
► Future applications include estrogen-free contraception and eventually endometriosis.
► Further assessment of endometrial safety of long-term use of SPRMs is required.