What is Ryeqo, the recently approved medicine for endometriosis?
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For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that impacts their daily life. It is a condition that is both difficult to diagnose and treat, with many women needing either surgery or regular medication.
A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.
Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.
What does Ryeqo do?
Endometriosis affects 14% of women of reproductive age. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.
Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone.
Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the treatment of prostate cancer. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in menopausal hormone therapy. Norethisterone is a synthetic hormone commonly used in birth control medications and to delay menstruation and help with heavy menstrual bleeding.
All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms.
Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).
Is it really new?
The maker of Ryeqo claims it is the first new drug for endometriosis in Australia in 13 years.
But individually, all three active ingredients in Ryeqo have been in use since 2019 or earlier.
Ryeqo has been available in Australia since 2022, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of uterine fibroids, which share some common symptoms with endometriosis and have related causes.
In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved.
The oral medicine Dienogest was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as Sayana Press which was approved in a smaller dose form for self-injection in 2023.
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How to take it and what not to do
Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.
It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.
Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although it will take at least one month of use to be effective. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.
Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.
The possible side effects of Ryeqo are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.
It’s costly for now
Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis.
While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the normal PBS price of up to A$31.60, it has been reported it may cost as much as $135 for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.
Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Huperzine A: A Natural Nootropic
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Huperzine A: A Natural Nootropic
Huperzine A is a compound, specifically a naturally occurring sesquiterpene alkaloid, that functions as an acetylcholinesterase inhibitor. If that seems like a bunch of big words, don’t worry, we’ll translate in a moment.
First, a nod to its origins: it is found in certain kinds of firmoss, especially the “toothed clubmoss”, Huperzia serrata, which grows in many Asian countries.
What’s an acetylcholinesterase inhibitor?
Let’s do this step-by-step:
- An acetylcholinesterase inhibitor is a compound that inhibits acetylcholinesterase.
- Acetylcholinesterase is an enzyme that catalyzes (speeds up) the breakdown of acetylcholine.
- Acetylcholine is a neurotransmitter; it’s an ester of acetic acid and choline.
- This is the main neurotransmitter of the parasympathetic nervous system, and is also heavily involved in cognitive functions including memory and creative thinking.
What this means: if you take an acetylcholinesterase inhibitor like huperzine A, it will inhibit acetylcholinesterase, meaning you will have more acetylcholine to work with. That’s good.
What can I expect from it?
Huperzine A has been well-studied for a while, mostly for the prevention and treatment of Alzheimer’s disease:
- New insights into huperzine A for the treatment of Alzheimer’s disease
- Huperzine A: Is it an Effective Disease-Modifying Drug for Alzheimer’s Disease?
- Huperzine A and Its Neuroprotective Molecular Signaling in Alzheimer’s Disease
However, research has suggested that huperzine A is much better as a prevention than a treatment:
❝A central event in the pathogenesis of Alzheimer’s disease (AD) is the accumulation of senile plaques composed of aggregated amyloid-β (Aβ) peptides.
Ex vivo electrophysiological experiments showed that 10 μM of Aβ1-40 significantly decreased the effect of the AChE inhibitor huperzine A on the synaptic potential parameters. ❞
~ Dr. Irina Zueva
In other words: the answer to the titular question is “Yes, yes it can”
And, to translate Dr. Zueva’s words into simple English:
- People with Alzheimer’s have amyloid-β plaque in their brains
- That plaque reduces the effectiveness of huperzine A
So, what if we take it in advance? That works much better:
❝Pre-treatment with [huperzine A] at concentrations of 50, 100, and 150 µg/mL completely inhibited the secretion of PGE2, TNF-α, IL-6, and IL-1β compared to post-treatment with [huperzine A].
This suggests that prophylactic treatment is better than post-inflammation treatment. ❞
~ Dr. Thu Kim Dang
Source: Anti-neuroinflammatory effects of alkaloid-enriched extract from Huperzia serrata
As you may know, neuroinflammation is a big part of Alzheimer’s pathology, so we want to keep that down. The above research suggests we should do that sooner rather than later.
Aside from holding off dementia, can it improve memory now, too?
There’s been a lot less research done into this (medicine is generally more concerned with preventing/treating disease, than improving the health of healthy people), but there is some:
^This is a small (n=68) old (1999) study for which the full paper has mysteriously disappeared and we only get to see the abstract. It gave favorable results, though.
The effects of huperzine A and IDRA 21 on visual recognition memory in young macaques
^This, like most non-dementia research into HupA, is an animal study. But we chose to spotlight this one because, unlike most of the studies, it did not chemically lobotomize the animals first; they were and remained healthy. That said, huperzine A improved the memory scores most for the monkeys that performed worst without it initially.
Where can I get it?
As ever, we don’t sell it, but here’s an example product on Amazon for your convenience
Enjoy!
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Banana vs Goji Berries – Which is Healthier?
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Our Verdict
When comparing banana to goji berries, we picked the goji berries.
Why?
Both are great! But…
In terms of macros, goji berries have much more fiber, carbs, and protein, thus making it the most nutrient-dense option, as we might expect from a dried fruit being compared to a non-dried fruit—since the non-dried fruit has water weight that the dried fruit doesn’t, its percentages of other things will be proportionally lower, because the percentages must still add up to 100%, and if 75% is water (as is the case for bananas, compared to goji berries’ 7.5% water), then that only leaves 25% to work with, while goji berries have 92.5% to work with. In short, an easy and expected win for goji berries.
In the category of vitamins, bananas have more of vitamin B6, while goji berries have more of vitamins A, B1, B3, B5, B9, C, E, and K. A clear win for goji berries.
When it comes to minerals, bananas are not higher in any minerals, while goji berries have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Another easy win for goji berries.
As for polyphenols, you may well imagine that the brightly-colored bitter-tasting berries have more, and you’d be right; you can read more about the exciting phytochemical properties of goji berries in the links below.
Meanwhile, adding up the sections show a clear overall win for goji berries, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
- The Top Micronutrient Deficiency In High Blood Pressure ← it’s potassium, and because of some popular mentions in TV shows, people get hung up on bananas being a good source of potassium. Which they are, but they’re not even in the top 10 of fruits for potassium. Here’s a non-exhaustive list of fruits that have more potassium than bananas, portion for portion
- Goji Berries: Which Benefits Do They Really Have? ← many!
- The Sugary Food That Lowers Blood Sugars ← it’s goji berries!
Enjoy!
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Overcoming Tendonitis – by Dr. Steven Low & Dr. Frank Skretch
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If you assumed tendonitis to be an inflammatory condition, you’re not alone. However, it’s not; the “-itis” nomenclature is a misnomer, and while one can rarely go wrong with reducing chronic/systemic inflammation, it’s not the cure for tendonitis.
What, then, is tendonitis and what does cure it? It’s a non-inflammatory proliferation disorder, meaning, something is growing (or in this case, simply being replaced) in a way it shouldn’t. As to fixing it, that’s more complex.
This book does cover 20 interventions (sorted into “major” and “minor”), ranging from exercise therapies to surgery, with many things between. It also examines popular myths that do not help, such as rest, ice, heat, and analgesics.
The style of this book is hard science, but don’t worry, it explains everything along the way. It does however mean that if you’re not very accustomed to wading through scientific material, you can’t just dip into the middle of the book and be guaranteed to understand what’s going on. Indeed, before even getting to discussing tendonitis/tendinopathy, the first chapter is very reassuringly dedicated to “understanding the levels and classification of evidence in studies”, along with the assorted scales and guidelines of the Center for Evidence-Based Medicine.
The rest, however, is about the etiology, diagnosis, and treatment of tendonitis and tendinopathy more generally. One interesting thing is that, according to the abundant high-quality evidence presented in this book, what works for one body part’s tendonitis does not necessarily work for another body part, so we get quite a part-by-part rundown.
Bottom line: this book has a wealth of useful, applicable information about management of tendonitis, making it indispensable if you or a loved one suffer from such—but settle in, because it’s not a light read.
Click here to check out Overcoming Tendonitis, and overcome tendonitis!
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How To Survive A Heart Attack When You’re Alone
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Dr. Alan Mandel emphasizes the importance of staying calm and following these steps to improve survival chances:
Simple is best
Here’s how you will survive a heart attack alone: briefly.
So, you will need to get help as quickly as possible. 90% of people who make it to a hospital alive, go on to survive their heart attack, so that’s your top priority.
Call emergency services as soon as you suspect you are having a heart attack. Stay on the line, and stay calm.
While having a heart attack is not an experience that’s very conducive to relaxation, heightened emotions will exacerbate things, so focus on breathing calmly. One of the commonly reported symptoms of heart attack that doesn’t often make it to official lists is “a strong sense of impending doom”, and that is actually helpful as it helps separate it from “is this indigestion?” or such, but once you have acknowledged “yes, this is probably a heart attack”, you need to put those feelings aside for later.
If you have aspirin available, Dr. Mandel says that the time to take it is once you have called an ambulance. However, if aspirin is not readily available, do not exert yourself trying to find some; indeed, don’t move more than necessary.
Do not drive yourself to hospital; it will increase the risk of fainting, and you may crash.
While you are waiting, your main job is to remain calm; he recommends deep breathing, and lying with knees elevated or feet on a chair; this latter is to minimize the strain on your heart.
For more on all this, plus the key symptoms and risk factors, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Heart Attack: His & Hers (Be Prepared!)
Take care!
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Olive oil is healthy. Turns out olive leaf extract may be good for us too
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Olive oil is synonymous with the Mediterranean diet, and the health benefits of both are well documented.
Olive oil reduces the risk of heart disease, cancer, diabetes and premature death. Olives also contain numerous healthy nutrients.
Now evidence is mounting about the health benefits of olive leaves, including from studies in a recent review.
Here’s what’s in olive leaves and who might benefit from taking olive leaf extract.
mtphoto19/Shutterstock What’s in olive leaves?
Olive leaves have traditionally been brewed as a tea in the Mediterranean and drunk to treat fever and malaria.
The leaves contain high levels of a type of antioxidant called oleuropein. Olives and olive oil contain this too, but at lower levels.
Generally, the greener the leaf (the less yellowish) the more oleuropein it contains. Leaves picked in spring also have higher levels compared to ones picked in autumn, indicating levels of oleuropein reduce as the leaves get older.
Olive leaves also contain other antioxidants such as hydroxytyrosol, luteolin, apigenin and verbascoside.
Antioxidants work by reducing the oxidative stress in the body. Oxidative stress causes damage to our DNA, cell membranes and tissues, which can lead to chronic diseases such as cancer and heart disease.
Are olive leaves healthy?
One review and analysis combined data from 12 experimental studies with 819 participants in total. Overall, olive leaf extract improved risk factors for heart disease. This included healthier blood lipids (fats) and lowering blood pressure.
The effect was greater for people who already had high blood pressure.
Most studies in this review gave olive leaf extract as a capsule, with daily doses of 500 milligrams to 5 grams for six to 48 weeks.
Another review and analysis published late last year looked at data from 12 experimental studies, with a total of 703 people. Some of these studies involved people with high blood lipids, people with high blood pressure, people who were overweight or obese, and some involved healthy people.
Daily doses were 250-1,000mg taken as tablets or baked into bread.
Individual studies in the review showed significant benefits in improving blood glucose (sugar) control, blood lipid levels and reducing blood pressure. But when all the data was combined, there were no significant health effects. We’ll explain why this may be the case shortly.
Olive leaves can be brewed into tea. Picture Partners/Shutterstock Another review looked at people who took oleuropein and hydroxytyrosol (the antioxidants in olive leaves). This found significant improvement in body weight, blood lipid profiles, glucose metabolism and improvements in bones, joints and cognitive function.
The individual studies included tested either the two antioxidants or olive leaf incorporated into foods such as bread and cooking oils (but not olive oil). The doses were 6-500mg per day of olive leaf extract.
So what can we make of these studies overall? They show olive leaf extract may help reduce blood pressure, improve blood lipids and help our bodies handle glucose.
But these studies show inconsistent results. This is likely due to differences in the way people took olive leaf extract, how much they took and how long for. This type of inconsistency normally tells us we need some more research to clarify the health effects of olive leaves.
Can you eat olive leaves?
Olive leaves can be brewed into a tea, or the leaves added to salads. Others report grinding olive leaves into smoothies.
However the leaves are bitter, because of the antioxidants, which can make them hard to eat, or the tea unpalatable.
Olive leaf extract has also been added to bread and other baked goods. Researchers find this improves the level of antioxidants in these products and people say the foods tasted better.
Olive leaves can taste bitter, which can put people off. But you can bake the extract into bread. Repina Valeriya/Shutterstock Is olive leaf extract toxic?
No, there seem to be no reported toxic effects of eating or drinking olive leaf extract.
It appears safe up to 1g a day, according to studies that have used olive leaf extract. However, there are no official guidelines about how much is safe to consume.
There have been reports of potential toxicity if taken over 85mg/kg of body weight per day. For an 80kg adult, this would mean 6.8g a day, well above the dose used in the studies mentioned in this article.
Pregnant and breastfeeding women are recommended not to consume it as we don’t know if it’s safe for them.
What should I do?
If you have high blood pressure, diabetes or raised blood lipids you may see some benefit from taking olive leaf extract. But it is important you discuss this with your doctor first and not change any medications or start taking olive leaf extract until you have spoken to them.
But there are plenty of antioxidants in all plant foods, and you should try to eat a wide variety of different coloured plant foods. This will allow you to get a range of nutrients and antioxidants.
Olive leaf and its extract is not going to be a panacea for your health if you’re not eating a healthy diet and following other health advice.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can You Step Backwards Without Your Foot Or Torso Turning Out?
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Walking backwards is often overlooked, but research shows it can enhance forward walking, especially in stroke patients; it has other benefits for everyone else, too. The physiotherapists at Fitness4Life Physical Therapy explain:
…and one step back
How it works: walking backwards heightens proprioception and stimulates muscles, improving balance and posture. Additionally, our daily lives tend to involve forward-leaning postures, causing upper back bending, and walking backwards helps counterbalance this.
Extra benefits: training to walk backwards can reduce the risk of falls, as stepping back is a common movement that is often untrained.
Exercise: try doing backwards lunges, to assess your skill and balance while moving backward. If foot rotation or torso rotation occurs during the exercise, then there’s room for improvement. Correcting these movements is then simply a matter of practicing backward lunges without turning.
10almonds tip: any exercise is only as good as your will to actually do it. For this reason, dancing is a great exercise in this case, as almost all forms of dance involve stepping backwards (in order to have steps without travelling somewhere, forwards steps are usually balanced with backwards ones)
For more on all this, plus a visual demonstration of the exercise, enjoy:
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Want to learn more?
You might also like to read:
Fall Special ← About how to avoid falling, and how to avoid (and failing that, at least minimize) injury if you do fall. If you think this only happens to other/older people, remember, there’s a first time for everything, so it is better to be prepared in advance!
Take care!
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