Endometriosis, a chronic condition where tissue similar to the womb’s lining grows elsewhere in the body, affects millions of women globally. In a significant development, the National Health Service in England has approved Ryeqo, a new oral treatment for endometriosis. This once-daily pill combines three active ingredients – relugolix, oestradiol, and norethisterone acetate – to alleviate symptoms such as pelvic pain and heavy bleeding. Three women’s health experts have shared insights into how Ryeqo works, who it benefits, and the broader challenges of managing this debilitating condition.
Dr Nikki Ramskill, a general practitioner and founder of The Female Health Doctor Clinic, welcomed the approval. “Ryeqo offers a once-daily oral alternative to existing endometriosis treatments,” she said. “Monthly cycles contribute to the severity of endometriosis through inflammation, pain, and heavy bleeding. Ryeqo’s main ingredient, relugolix, blocks the production of these hormones, helping to stop the interaction between the hormones and the endometriosis.” Dr Ramskill noted that Ryeqo suits women who have not responded to other hormonal treatments or surgery, those seeking long-term non-surgical options, and those preferring to avoid injections like Postap.
But Ryeqo is not suitable for all. Women who cannot use Ryeqo include those who:
- Have had blood clots
- Have experienced strokes
- Have had heart attacks
- Have had liver tumours, benign or malignant
- Have hormone-sensitive cancers, such as breast or genital cancer.
- Suffer from osteoporosis
- Experience severe migraines with auras
- Are pregnant
- Are breastfeeding
- Are experiencing unexplained vaginal bleeding
Moboladale Ojutiku, an obstetrician and gynaecologist, described Ryeqo as a step forward in patient autonomy. “This is an important development in giving personal control over treatment for endometriosis, and is another step in the passage to managing and getting this common disease under control,” he said. “The way it works is that it turns off the fuel for endometriosis – the hormone/chemical changes within the brain – acting as a GnRH antagonist. Oestrogen and progesterone are added to reduce the symptoms associated – oestrogen treats symptoms that can be similar to the menopause, and progesterone protects the lining of the womb. It can be a long-term treatment, and one doesn’t need to use contraception with it.”
Dr Ramskill emphasised the need for systemic improvements beyond Ryeqo’s approval. “Ryeqo is a big step forward in endometriosis treatment, offering a new choice for women who have struggled with existing options,” she said. “However, it’s crucial that more education is provided to both patients and healthcare professionals to ensure better awareness and access. Research into non-hormonal alternatives also needs to continue, as not all women can or want to use hormone-based treatments.” She called for broader changes in diagnosis, treatment access, and research funding to enhance care for women with endometriosis.
Shree Datta, a consultant obstetrician and gynaecologist, highlighted the challenges of diagnosing and managing endometriosis. “Despite being a prevalent issue, it often takes an average of nearly seven years to receive a diagnosis,” she said. “Understanding its symptoms, causes, and treatment options can significantly improve quality of life and management of this long-term condition.” Ms Datta explained that symptoms vary widely but typically worsen in the second half of the menstrual cycle, peaking just before menstruation.
Common symptoms of endometriosis
* Pain before and during periods, often easing once menstruation begins.
* Pain during intercourse, ranging from mild discomfort to sharp, stabbing sensations.
* Pain during bowel movements or urination, particularly during menstruation.
* Bloating and mood changes, intensifying in the menstrual cycle’s latter half.
Datta noted that the exact cause of endometriosis remains unknown, with theories including retrograde menstruation – where period blood flows back into the pelvic cavity – and surgical scarring. Diagnosis often involves internal ultrasounds, examinations, and, in some cases, laparoscopy, a day-case surgery considered the gold standard. Endometriosis can affect areas like the ovaries, bowel, or even lungs, requiring tailored treatment plans.
Treatment options for endometriosis
- Pain relief, using over-the-counter or prescription medications
- Hormonal treatments, such as the contraceptive pill or Mirena coil, to manage symptoms
- Lifestyle and dietary changes to support overall well-being
- Surgical treatments to remove endometrial tissue in severe cases
“Endometriosis is a long-term condition that can significantly impact a woman’s life,” Datta said. “Effective management involves accurate diagnosis, appropriate treatment, and ongoing support. Regular follow-ups with your healthcare provider are essential to ensure that the chosen treatment plan remains effective and to make adjustments as needed.”
