Endometriosis UK believes that women and those assigned female at birth in the UK, should be able to choose the right treatment and management options for them. 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.
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.
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.
