Ryeqo for Endometriosis and Fibroid Treatment

Ryeqo is an oral medication for treatment of Endometriosis and Fibroids. Ryeqo first became available for treatment of heavy vaginal bleeding due to Fibroids in Australia in 2022 . Subsequently Ryeqo also became available for treatment of Endometriosis since February 2024 in Australia. Ryeqo is approved for the treatment of moderate to severe pain associated with Endometriosis.

Ryeqo Patient Information Booklet

Click Here to Download an Information Brochure regarding Ryeqo

What is Ryeqo?

Ryeqo is an oral tablet that contains 3 active ingredients: Relugolix (40mg), Estradiol (1mg) and Norethisterone (0.5mg).

  • Relulolix is a drug that blocks a particular peptide from releasing other hormones. The action of this drug is to reduce the overall levels of oestrogen and progesterone in the body.
  • Estradiol is a naturally occurring oestrogen that helps to regulate the menstrual cycle.
  • Norethisterone is a synthetic hormone, similar to the progesterone found in many oral contraceptive pills.
Ryeqo the newly approved Endometriosis and Fibroid treatment

Ryeqo – the newly approved Endometriosis and Fibroid medication

The Estradiol and Norethisterone components of Ryeqo are designed as “add-back” therapy, compensating the effects of Relulolix in reducing the natural oestrogen/progesterone levels. This reduces the potential for side effects such as hot flushes and bone density loss, and the Norethisterone protects the effects of the Estradiol on the uterus.

How to take Ryeqo?

Ryeqo is an oral tablet, taken once a day, ideally at around the same time each day. You can take it with or without food.

When in the Menstrual Cycle should I start taking Ryeqo?

Ryeqo should generally be started within the first 5 days of the menstrual period. If Ryeqo is started at another time in the menstrual cycle, there may be some initial irregular or heavy vaginal bleeding.

Does Ryeqo work as a Contraceptive to Prevent Pregnancies?

You will need to have taken Ryeqo for at least 1 month before you can rely on Ryeqo to provide contraceptive effect to prevent pregnancy. You should use alternative contraception (e.g. condoms) for at least 1 month when starting Ryeqo.

After 1 month of using Ryeqo, ovulation is inhibited by the Ryeqo, providing adequate contraception. Ovulation can resume as soon as you stop using Ryeqo, and so it is important to ensure you have alternative reliable contraception when stopping Ryeqo treatment.

What Should I Do if I Forget to take a Dose of Ryeqo?

If 1 Ryeqo tablet is missed, the missed tablet should be taken as soon as possible, and then you should continue taking Ryeqo at the usual time the next day.

If 2 or more Ryeqo tablets are missed for consecutive days, then contraceptive protection is reduced, and alternative non-hormonal contraception must be used until you have taken Ryeqo for another 7 days.

Can I use Ryeqo and the Oral Contraceptive Pill at the same time?

Ryeqo should not be taken whilst you are still taking the Oral Contraceptive Pill or the new generation Progesterone Only Pill (Slinda).

What are the Possible Side Effects from Ryeqo?

All medications have potential side effects. Most of the side effects from Ryeqo are minor and temporary, but if you have any concerns after taking Ryeqo, you should stop using Ryeqo and seek further advice from your doctor.

Possible side effects from Ryeqo include:

  • headaches
  • hot flushes and night sweats
  • excessive, irregular or prolonged vaginal bleeding
  • hair loss
  • decreased interest in sex
  • irritability
  • increased sweating
  • breast lump (benign)
  • indigestion
  • back pain and joint pain
  • vaginal dryness

Can Ryeqo Affect my Bones?

Ryeqo can cause bone density loss. A Bone Mineral Density scan (DEXA scan) should be considered as a baseline test before starting Ryeqo. A follow-up DEXA scan is recommended after 1 year of treatment with Ryeqo. The DEXA scan is not covered by Medicare, and can cost around $500.

Does Ryeqo Cause Weight Gain?

Ryeqo has not been shown to cause weight gain.

Can I take Ryeqo whilst Breastfeeding?

Ryeqo cannot be taken when breastfeeding or when you are pregnant.

How Much Does Ryeqo Cost?

Ryeqo costs approximately $140 per month. Ryeqo is not currently listed on the Australian Pharmaceutical Benefits Scheme (PBS). If you have private health insurance, you may be eligible for rebates for this private prescription.

Do I Need a Prescription to Buy Ryeqo?

Ryeqo is a prescription medication. A detailed consultation with your gynaecologist or GP is essential in order to see if Ryeqo is an appropriate treatment for your condition.

What are the Alternatives to Ryeqo?

Endometriosis can also be treated with:

  • Pain killers (e.g. Paracetamol, Ibuprofen and other anti-inflammatories)
  • Oral Contraceptive Pill
  • New generation Progesterone Only Pill – Slinda
  • Mirena
  • Other hormonal therapy (e.g Zoladex)
  • Laparoscopic Keyhole Surgery

Fibroids can be managed surgically with myomectomy (hysteroscopic or laparoscopic/robotic), or with hysterectomy. Click here to find out more about Robotic Myomectomy and Robotic Hysterectomy.

Uterine Fibroids Subserosal fibroid Intramural fibroid Pedunculated fibroid Subserosal fibroid

Dr Ken Law is a Brisbane gynaecologist specialising in the management of pelvic pain, Endometriosis and Fibroids. Click on the “Request an Appointment” button below to arrange an appointment with Dr Ken Law to discuss the option of using Ryeqo, or consider the option for laparoscopic keyhole surgery to confirm the diagnosis of Endometriosis, and treat the Endometriosis by cutting it out (excision) at the same laparoscopy.

Greenslopes Obstetrics and Gynaecology