Key content Mifepristone, a progesterone receptor antagonist, was initially discovered in the 1980s and has been licensed for use in medical termination since 1991. Subsequently, selective progesterone receptor modulators (SPRM), which have both agonist and antagonist properties, have been developed and have therapeutic advantages over alternative therapies. Ulipristal acetate, a SPRM, was licensed as emergency contraception in 2009 and, in May 2012, as a preoperative treatment for fibroids. There is ongoing research on its use for the long‐term management of uterine fibroids. Learning objectives History of the development of SPRM. Mechanism of action of SPRM. Summary of research on ulipristal acetate for the management of fibroids. Potential advantages of SPRM over the current medical treatments for uterine fibroids. Current licensed uses for ulipristal acetate. Potential uses of SPRM in other gynaecological conditions. Risks and side effects of SPRM.