New NHS-approved endometriosis pill – but only for some patients

People with endometriosis may soon have access to a new pill on the NHS. According to the (NICE), approximately 1,000 women in England each year “could benefit from this new treatment.”

The pill, known as relugolix–estradiol–norethisterone (or relugolix combination therapy, branded as Ryeqo), is considered a breakthrough for the 1.5 million people in the UK living with endometriosis—many of whom remain undiagnosed. It works by blocking specific hormones that contribute to the condition.

NICE states that their latest recommendations for this first long-term daily pill for endometriosis “could transform how this painful condition is managed.” Initially rejected, the treatment was later approved after its manufacturer, Gedeon Richter, provided evidence addressing concerns about effectiveness, cost, and value for taxpayers.

Dr Sue Mann, NHS national clinical director for women’s health, said: “This first-of-a-kind treatment for endometriosis – a condition which can be extremely debilitating – will give women greater control of their own health by potentially allowing them to get the treatment they need in the comfort of their own homes, without the need to attend regular appointments.”

Who can take the endometriosis pill?

NICE guidelines state: “The treatment will be available through routine NHS commissioning for patients for whom medical or surgical treatment for endometriosis has failed.”

Helen Knight, director of medicines evaluation at NICE said: “This new treatment marks a potential step-change in how we manage endometriosis, putting control back in patients’ hands while ensuring value for the taxpayer.”

“Instead of travelling to clinics for injections, there is now a daily tablet that can be taken at home,” she added. “The treatment can also be stopped and started more easily, which is particularly important for those planning to have children and for managing side effects.”

How much does the new endometriosis pill cost?

The new pill will cost £72 for a 28-day supply, NICE said. This is excluding VAT.

What are the symptoms of endometriosis?

“Endo,” short for endometriosis, occurs when tissue similar to the lining of the womb grows in other areas of the body. Symptoms can range from heavy and painful periods to pelvic pain outside of menstruation. It can also cause severe fatigue, chronic pain in various parts of the body, and, in some cases, infertility. Importantly, symptoms can occur even when you’re not on your period, and some individuals may experience no symptoms at all.

Despite its significant impact, diagnosis often takes around nine years from the onset of symptoms. Many women report feeling unheard by medical professionals, frequently being dismissed with remarks like “it’s just a bad period” and advised to “get on with it.” Fortunately, this pill can be taken at home, eliminating the need for travel.

It also “combines all needed hormones in one pill” and “returns hormone levels to normal faster when stopped.” NICE explains: “The treatment, called relugolix–estradiol–norethisterone (also known as relugolix combination therapy or Ryeqo), works by blocking specific hormones that contribute to endometriosis while also providing necessary hormone replacement in a single daily tablet. This new treatment marks a potential step-change in how we manage endometriosis, putting control back in patients’ hands while ensuring value for the taxpayer.”

Endometriosis UK statement on new pill

The charity have released a statement saying: “We recommend that treatment decisions are always made in partnership with the individual and their medical practitioner. There are far too few options available due to the historic lack of research into endometriosis.

“Endometriosis UK welcomes the approval of relugolix-estradiol-norethisterone (Ryeqo) by NICE for NHS use in England to treat adult women of reproductive age for symptoms of endometriosis, and hope this medication is accepted for use across the whole of the UK. Also known as relugolix combination therapy, it is a type of ‘medical menopause’ combined with HRT, and we note that it may be suitable for only a small proportion of the 1.5 million with the disease.

“Relugolix combination therapy (CT) is an all-in-one tablet containing the gonadotrophin releasing hormone (GnRH) antagonist, Relugolix; and add-back hormonal therapy (ABT, commonly known as hormone replacement therapy) estradiol (oestrogen) and norethisterone acetate (progestogen).”

“For those with a history of previous medical or surgical treatment for their endometriosis, Relugolix CT is an alternative option if treatments such as tranexamic acid, hormonal contraceptives, and intrauterine delivery systems have not worked or are unsuitable.

“Relugolix CT is currently the only licensed GnRH antagonist option and is an alternative secondary medical option to GnRH agonists (eg Prostap® & Zoladex®) which are only licensed for up to six months. Relugolix CT can be taken up until menopause. The recommendation is for a dual X ray absorptiometry (DXA) scan after one year of treatment. In patients with risk factors for osteoporosis or bone loss, a DXA scan is recommended prior to starting treatment.”

They conclude: “In addition to the creation of new treatments, Endometriosis UK is keen to see more investment in research to find the cause of the disease, better management and treatment options, and one day a cure.”

Endometriosis pill pro vs. cons

The charity has listed the benefits of the pill below as well as some cons which you may want to consider before taking it. They are as follows

Benefits of Relugolix CT:

• It is taken daily, so if side effects are deemed unmanageable it can be stopped quickly. Current GnRH agonists can be given as injections or with an implant (which is injected under the skin) and lasts for 4 – 12 weeks.
• There is also a quicker onset in symptoms management without the initial ‘flare-up’ response when compared to GnRH agonists.
• It is an all-in-one treatment where the patient does not have to remember to additionally take ABT (add-back therapy, commonly known as hormone replacement therapy) as a separate tablet.
• Longer duration of treatment can be continued up until menopause, current GnRH agonists are licensed for 6 months (although commonly given longer with add-back therapy).

Disadvantages of Relugolix CT:

• Not suitable for those where ABT is contraindicated.
• As ABT is included as an all-in-one tablet there is no flexibility in adjusting ABT medication and dosing.
• As with all hormone treatments Relugolix CT is not suitable for those trying for a pregnancy.