A new combination pill, relugolix–estradiol–norethisterone, has been approved for treating endometriosis on the NHS.
This marks the first long-term, daily oral treatment for the condition, offering a significant advancement in endometriosis management.
Ryeqo works by blocking hormones that contribute to endometriosis while simultaneously providing essential hormone replacement.
This dual-action mechanism distinguishes it from injectable treatments, which can initially exacerbate symptoms.
The pill’s at-home administration eliminates the need for clinic visits and offers a faster-acting solution for eligible patients.
Availability through the NHS will be limited to patients who have not found relief through previous medical or surgical interventions.
While this new treatment offers hope, Endometriosis UK acknowledges that it may only be suitable for a small percentage of the 1.5 million people affected by the disease.
We spoke with leading endometriosis experts who debunked some common myths about the condition and highlighted several of its key symptoms.
What is endometriosis?
“Endometriosis is a chronic and often very painful condition affecting millions of women worldwide,” says Dr Lucy Coyne, medical director at Care Fertility.
“It occurs when tissue from the lining of the uterus (womb) grows outside the uterus, leading to a range of symptoms that can significantly impact daily life and fertility.
“It is the second most common gynaecological condition in the UK.”
What are some common myths about endometriosis?
A common misconception about the condition is that the symptoms are simply a heavy or painful period.
“Endometriosis is a chronic inflammatory condition, not just painful periods,” Dr Coyne says.
“The pain can occur at any time during the cycle and may affect daily life, including work, relationships, and mental health.”
Another myth is that if you have endometriosis, you are infertile.
“While 30–50 per cent of women with endometriosis may have fertility challenges, many can still conceive naturally or with fertility treatments,” explains Dr Coyne.
“Early diagnosis and management can help improve fertility outcomes.”
What are the common symptoms of endometriosis?
“Key symptoms to look out for are; painful and sometimes heavy periods that affect day to day life, pain during or after sex, chronic fatigue, issues with bowel movements or urination, especially in and around periods and difficulty conceiving,” says Dr Coyne.
“Symptoms can vary significantly from person to person with some patients having debilitating symptoms and some being completely asymptomatic.”
How is endometriosis diagnosed?
“If you suspect you have endometriosis, it is a good idea to speak to your GP in the first instance who will take a history from you and examine you,” advises Mr Hemant Vakharia, consultant gynaecologist, specialising in endometriosis and advanced minimal access surgery at London Gynaecology.
“Often, they will request an ultrasound of the pelvis and discuss the results with you.”
However, endometriosis does not always show up on standard imaging, such as ultrasounds or MRIs.
“This is especially true in superficial endometriosis where the signs can be very subtle or when the disease affects areas not easily visualised,” highlights Dr Vakharia.
“If you have been told your scan is normal but have persistent symptoms, such as chronic pelvic pain, heavy periods, or pain during sex, it’s essential to advocate for yourself and seek a specialist for further evaluation.”
When should you seek medical help?
“It can be difficult to differentiate between ‘normal’ periods and ‘heavy or painful’ periods as there is often no objective way of comparing,” says Narendra Pisal, consultant gynaecologist at London Gynaecology.
“A lot of women just put up with that ‘time of the month’ and are told to get on with it.“
However, if you have to put your life on hold for those few days or if your sex life is affected by pain during sex, it is time to take note and ask for some tests.”
Mr Pisal acknowledges that it can be challenging for a GP to identify the root cause during a 10-minute appointment, so suggests keeping a diary to track when your symptoms occur and how intense the pain is.
What treatment options are available for endometriosis?
“Patients can be treated with the combined pill, progesterone-only pill, progesterone intrauterine device or surgery,” says Dr Vakharia.
“Sometimes, we also use medications that induce a temporary menopause by blocking hormonal signals to the ovary which reduces stimulation of the endometriotic tissue. This option is often used before surgery for severe disease.
“A laparoscopy will allow diagnosis and excision of disease which can improve symptoms. In patients with severe disease, they may need a two-stage procedure.”