Relugolix-estradiol-norethisterone (brand name Ryeqo) is a three-in-one pill that works by blocking specific hormones that contribute to endometriosis, as well as providing hormone replacement therapy for patients who\u2019ve been put into early menopause<\/a> to tackle their condition.<\/p>\n Developed for women who\u2019ve already tried and failed with other options, the new pill is a \u2018late-stage treatment option,\u2019 explains Dr Jan Toledano, a menopause specialist at the London Hormone Clinic.<\/p>\n Endometriosis typically affects the ovaries, fallopian tubes and inside the pelvic area, where the tissue, called endometrium, behaves just like tissue in the womb; during the menstrual cycle, the rise in oestrogen causes the tissue to thicken and spread.<\/p>\n Louise Spice, 29, recently had an elective hysterectomy \u2013 to remove her womb \u2013 which she hopes will finally end her misery<\/p>\n Menopause specialist Dr Jan Toledano says: ‘We repeatedly see women being told their pain is something to put up with’<\/p>\n As with the womb lining, these patches of endometrial tissue break down and bleed during a period, but cannot leave the body. The build-up of abnormal tissue can lead to inflammation, cysts and scar tissue.<\/p>\n Bands of fibrous tissue called adhesions may also form, causing pelvic tissues and organs to stick to each other.<\/p>\n As well as leading to debilitating pain and extreme tiredness, endometriosis is one of the most common causes of female infertility.<\/p>\n There is no cure: current treatment involves pain relief or hormonal treatments such as the contraceptive pill or Mirena coil, which help to thin the endometrial lining, suppressing growth and reducing pain.<\/p>\n When medication doesn\u2019t work, a laparoscopy, where a small camera is inserted into the pelvis and the endometrium is scaped off \u2013 or laser surgery, where it is burned off \u2013 may be offered.<\/p>\n \u2018The patient can feel better for a while but these are short-term solutions unless the underlying hormone causes are corrected and the tissue can grow back,\u2019 says Dr Toledano.<\/p>\n In severe cases and if all options have failed to help, doctors may suggest a woman is put into early menopause \u2013 either \u2018chemically\u2019, using drugs called gonadotropin-releasing hormone (GnRH) antagonists to stop the ovaries from working in an injection, or surgically via a hysterectomy.<\/p>\n Putting a woman into an early menopause stops the production of key hormones such as oestrogen. These women then must also take hormone replacement therapy (HRT) to relieve menopausal symptoms including hot flushes, night sweats and vaginal dryness. HRT also offers protection against osteoporosis and heart disease by replacing some of the lost hormones.<\/p>\n The surgically induced menopause is permanent and means that women can no longer have children.<\/p>\n However, the chemically induced menopause with injections may be reversible.<\/p>\n This is where the new pill comes in. As well as HRT \u2013 containing estradiol, a form of oestrogen, and norethisterone, a synthetic form of progesterone \u2013 the new Ryeqo tablet contains relugolix. A GnRH antagonist, this is the same drug that is given as an injection, but the advantage of the three-in-one pill is that patients can administer their treatment at home rather than needing regular injections in hospital.<\/p>\n The nature of it being a pill also means that hormone levels return to normal faster than when stopping an injection or removing an implant. This makes it easier to come off if the woman experiences side-effects (these may include dizziness, weight gain bloating and mood swings) or plans to have a baby.<\/p>\n With an injection or implant, it can take four to 12 weeks for the body to adjust.<\/p>\n However, Dr Toledano says the new pill can still have side-effects such as bloating, breast tenderness, migraines, brain fog and weight gain.<\/p>\n The advantage of the three-in-one pill is that patients can administer their treatment at home<\/p>\n And it is not suitable for all. She says: \u2018If this treatment helps, that\u2019s great. But it\u2019s certainly not suitable for everyone with endometriosis.<\/p>\n \u2018It would be far better to give younger women with signs of the condition preventative treatments such as high doses of progesterone alone, to prevent their disease getting to this stage where it is so severe that we need to target it in different ways.\u2019<\/p>\n The main problem is late diagnosis in many cases of endometriosis. Diagnosis typically takes nine years from the time symptoms first appear. Years of endometriosis cause scarring and damage to the reproductive organs and bowel, causing pain but also possible irreversible infertility. Treating it early helps to prevent this.<\/p>\n A survey last year for the charity Endometriosis UK found that 78 per cent of women interviewed who later went on to be diagnosed<\/a> had been told by at least one doctor that they were \u2018making a fuss about nothing,\u2019 says the charity\u2019s chief executive Emma Cox.<\/p>\n Symptoms of endometriosis \u2013 which include pelvic pain, periods that interfere with daily life, heavy menstrual bleeding, pain during sex, painful bowel movements or when urinating and difficulties getting pregnant \u2013 are \u2018all too often dismissed as \u201cnormal\u201d,\u2019 she says.<\/p>\n Louise pushed her GP to ensure she was referred for a scan. This revealed she had what doctors said was endometriosis<\/p>\n![\"Louise](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/05\/98524433-14726861-image-a-13_1747649331009.jpg\")
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