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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Keep Inflammation At Bay
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How to Prevent (or Reduce) Inflammation
You asked us to do a main feature on inflammation, so here we go!
Before we start, it’s worth noting an important difference between acute and chronic inflammation:
- Acute inflammation is generally when the body detects some invader, and goes to war against it. This (except in cases such as allergic responses) is usually helpful.
- Chronic inflammation is generally when the body does a civil war. This is almost never helpful.
We’ll be tackling the latter, which frees up your body’s resources to do better at the former.
First, the obvious…
These five things are as important for this as they are for most things:
- Get a good diet—the Mediterranean diet is once again a top-scorer
- Exercise—move and stretch your body; don’t overdo it, but do what you reasonably can, or the inflammation will get worse.
- Reduce (or ideally eliminate) alcohol consumption. When in pain, it’s easy to turn to the bottle, and say “isn’t this one of red wine’s benefits?” (it isn’t, functionally*). Alcohol will cause your inflammation to flare up like little else.
- Don’t smoke—it’s bad for everything, and that goes for inflammation too.
- Get good sleep. Obviously this can be difficult with chronic pain, but do take your sleep seriously. For example, invest in a good mattress, nice bedding, a good bedtime routine, etc.
*Resveratrol (which is a polyphenol, by the way), famously found in red wine, does have anti-inflammatory properties. However, to get enough resveratrol to be of benefit would require drinking far more wine than will be good for your inflammation or, indeed, the rest of you. So if you’d like resveratrol benefits, consider taking it as a supplement. Superficially it doesn’t seem as much fun as drinking red wine, but we assure you that the results will be much more fun than the inflammation flare-up after drinking.
About the Mediterranean Diet for this…
There are many causes of chronic inflammation, but here are some studies done with some of the most common ones:
- Beneficial effect of Mediterranean diet in systemic lupus erythematosus patients
- How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis
- The effects of the Mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease
- Adherence to Mediterranean diet and 10-year incidence of diabetes: correlations with inflammatory and oxidative stress biomarkers*
*Type 1 diabetes is a congenital autoimmune disorder, as the pancreas goes to war with itself. Type 2 diabetes is different, being a) acquired and b) primarily about insulin resistance, and/but this is related to chronic inflammation regardless. It is also possible to have T1D and go on to develop insulin resistance, and that’s very bad, and/but beyond the scope of today’s newsletter, in which we are focusing on the inflammation aspects.
Some specific foods to eat or avoid…
Eat these:
- Leafy greens
- Cruciferous vegetables
- Tomatoes
- Fruits in general (berries in particular)
- Healthy fats, e.g. olives and olive oil
- Almonds and other nuts
- Dark chocolate (choose high cocoa, low sugar)
Avoid these:
- Processed meats (absolute worst offenders are hot dogs, followed by sausages in general)
- Red meats
- Sugar (includes most fruit juices, but not most actual fruits—the difference with actual fruits is they still contain plenty of fiber, and in many cases, antioxidants/polyphenols that reduce inflammation)
- Dairy products (unless fermented, in which case it seems to be at worst neutral, sometimes even a benefit, in moderation)
- White flour (and white flour products, e.g. white bread, white pasta, etc)
- Processed vegetable oils
See also: 9 Best Drinks To Reduce Inflammation, Says Science
Supplements?
Some supplements that have been found to reduce inflammation include:
(links are to studies showing their efficacy)
Consider Intermittent Fasting
Remember when we talked about the difference between acute and chronic inflammation? It’s fair to wonder “if I reduce my inflammatory response, will I be weakening my immune system?”, and the answer is: generally, no.
Often, as with the above supplements and dietary considerations, reducing inflammation actually results in a better immune response when it’s actually needed! This is because your immune system works better when it hasn’t been working in overdrive constantly.
Here’s another good example: intermittent fasting reduces the number of circulating monocytes (a way of measuring inflammation) in healthy humans—but doesn‘t compromise antimicrobial (e.g. against bacteria and viruses) immune response.
See for yourself: Dietary Intake Regulates the Circulating Inflammatory Monocyte Pool ← the study is about the anti-inflammatory effects of fasting
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The Secret to Better Squats: Foot, Knee, & Ankle Mobility
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We’ve talked before about how Slav squats, Asian squats, deep squats, sitting squats, or various other things they might by called (these are all different names for the same thing), are one of the most anti-aging exercises, if not outright the most anti-aging exercise. Yet, how to get good at them?
“Just squat more” is fine advice and will get you there eventually, but there are ways to shorten the time it takes, by unlocking whatever part(s) might be holding you back:
Piece by piece
The key to improving the whole is to not neglect any of the parts—so here they are:
- Foot rolls: roll your foot onto its outer and inner edges to stretch; repeat for both legs.
- Toe lifts: lift your toes up and down while keeping your legs straight.
- Toe curls: curl your toes to engage foot muscles.
- Foot circles: rotate your feet in circles; repeat for both legs.
- Heel raises: stand tall, raise your heels off the ground, and engage your core.
- Tibialis anterior exercise: lean against a wall or similar, and lift your toes off ground to strengthen your tibialis anterior (important and oft-forgotten muscle, responsible for more than people think!)
- Heel drops: perform dynamic heel drops with your feet back, to stretch your ankles.
- Hamstring curls & leg extension: curl your leg back toward your glutes, and then extend it forwards; alternate legs.
- Dynamic calf stretch: bend and straighten your knees alternately in a forward lunge position.
- Squat to heel raise: perform squats with your heels lifting off the floor and your arms raised.
- Banded ankle dorsiflexion: use a yoga strap or towel to stretch your feet, calves, and hamstrings.
- Seated feet circles: extend your legs and rotate your feet in outward and inward circles.
- Dorsiflexion/plantar flexion: alternate one foot up and the other down dynamically.
- Seated knee flexion & extension: alternate lifting your knees and extending your legs, while seated.
Note: “seated” in all cases means on the floor, not a chair!
For more on all of these plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
What Nobody Teaches You About Strengthening Your Knees ← about that tibialis anterior muscle and what it means for your knees
Take care!
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Pistachios vs Peanuts – Which is Healthier?
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Our Verdict
When comparing pistachios to peanuts, we picked the peanuts.
Why?
The choice might be surprising; after all, peanuts are usually the cheapest and most readily available nuts, popularly associated with calories and not much else. However! This one was super-close, and peanuts won very marginally, as you’ll see.
In terms of macros, pistachios have slightly more fiber and nearly 2x the carbs, while peanuts have slightly more protein and fats. What we all as individuals might prioritize more there is subjective, but this could arguably be considered a tie. About the fiber and carbs: peanuts have the lower glycemic index, but not by much. And about those fats: yes, they are healthy, and the fat breakdown for each is almost identical: pistachios have 53% monounsaturated, 33% polyunsaturated, and 14% saturated, while peanuts have 53% monounsaturated, 34% polyunsaturated, and 14% saturated. Yes, that adds up to 101% in the case of peanuts, but that’s what happens with rounding things to integers. However, the point is clear: both of these nuts have almost identical fats.
In the category of vitamins, pistachios have more of vitamins A, B1, B2, B6, and C, while peanuts have more of vitamins B3, B5, B9, E, and choline, So, a 5:5 tie on vitamins.
When it comes to minerals, pistachios have more calcium, copper, phosphorus, and potassium, while peanuts have more iron, magnesium, manganese, selenium, and zinc. So, a marginal victory for peanuts (and yes, the margins of difference were similar in each case).
Adding up the tie, the other tie, and the marginal victory for peanuts, means a marginal victory for peanuts in total.
A quick note in closing though: this was comparing raw unsalted nuts in both cases, so do take that into account when buying nuts, and at the very least, skip the salted, unless you are deficient in sodium. Or if you’re using them for cooking, then buying salted nuts because they’re usually cheaper is fine; just soak and rinse them to remove the salt.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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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:
Click Here If The Embedded Video Doesn’t Load Automatically!
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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Bath vs Shower – Which is Healthier?
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Our Verdict
When comparing bathing to showering, we picked the shower.
Why?
For the basic task of getting your body clean, the shower is better as it is an entirely one-way process. Clean water hits your body, dirty water leaves it, and no dirt is making its way back.
Baths do not have this advantage, and if you enter a bath dirty, you will then be sitting in dirty water. You will leave it a lot cleaner than you entered it (because a lot of the dirt stayed in the bathwater to be drained away after the bath), but not as clean as if you had showered.
One could argue soap or equivalent will prevent the dirt re-sticking, and that’s true, but it’s true for soap in the shower too, so it doesn’t offset anything.
Additionally, being immersed in water for more than 15 minutes can start to have a (paradoxically) dehydrating effect on the skin; this happens not only because of losing skin oils to the water, but also because of osmosis, the resultant mild edema, the body’s homeostatic response to the mild edema, then getting out the bath and drying, leaving one with the response having now just caused dehydrated skin.
Baths do have some health advantages! And these come primarily from the mental health benefits of relaxation in warm water and/or generally pampering oneself. Additionally, some bath oils or bath salts can be beneficial in a way that couldn’t be administered the same way in the shower.
Best of both worlds?
In some parts of the world (Thailand and Turkey come to mind; doubtlessly there are many others) there are traditions of first taking a shower to get clean, and then taking a bath for the rest of the bathing experience. As a bonus, the bathing experience is then all the more pleasant for the water remaining just as clean as it was to start with.
However, if you do have to pick one (and for the purpose of our “This or That” exercise, we do), then it’s the shower, hands-down.
Want to read more?
You might want to also take into account how it’s still possible to have too much of a good thing:
Enjoy!
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Does This New Machine Cure Depression?
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Let us first talk briefly about the slightly older tech that this may replace, transcranial magnetic stimulation (TMS).
TMS involves electromagnetic fields to stimulate the left half of the brain and inhibit the right half of the brain. It sounds like something from the late 19th century—“cure your melancholy with the mystical power of magnetism”—but the thing is, it works:
The main barriers to its use are that the machine itself is expensive, and it has to be done in a clinic by a trained clinician. Which, if it were treating one’s heart, say, would not be so much of an issue, but when treating depression, there is a problem that depressed people are not the most likely to commit to (and follow through with) going somewhere probably out-of-town regularly to get a treatment, when merely getting out of the door was already a challenge and motivation is thin on the ground to start with.
Thus, antidepressant medications are more often the go-to for cost-effectiveness and adherence. Of course, some will work better than others for different people, and some may not work at all in the case of what is generally called “treatment-resistant depression”:
Antidepressants: Personalization Is Key!
Transcranial stimulation… At home?
Move over transcranial magnetic stimulation; it’s time for transcranial direct-current stimulation (tDCS).
First, what it’s not: electroconvulsive therapy (ECT). Rather, it uses a very low current.
What it is: a small and portable headset (as opposed to the big machine to go sit in for TMS) that one can use at home. Here’s an example product on Amazon, though there are more stylish versions around, this is the same basic technology.
In a recent study, 45% of those who received treatment with this device experienced remission in 10 weeks, significantly beating placebo (bearing in mind that placebo effect is strongest when it comes to invisible ailments such as depression).
See also: How To Leverage Placebo Effect For Yourself ← this explains more about how the placebo effect works, to the extent that it can even be an adjuvant tool to augment “real” therapies
And as for the study, here it is:
…which rather cuts through the “depressed people don’t make it to the clinic consistently, if at all” problem. Of course, it still requires adherence to its use at home, for example three 30-minute sessions per week, but honestly, “lie/sit still” is likely within the abilities of the majority of depressed people. However…
Important note: you remember we said “in 10 weeks”? That may be critical, because shorter studies (e.g. 6 weeks) have previously returned without such glowing results:
Home-Use Transcranial Direct Current Stimulation for the Treatment of a Major Depressive Episode
This means that if you get this tech for yourself or a loved one, it’ll be necessary to persist for likely 10 weeks, certainly more than 6 weeks, and not abandon it after a few sessions when it hasn’t been life-changing yet. And that may be more of a challenge for a depressed person, so likely an “accountability buddy” of some kind is in order (partner, close friend, etc) to help ensure adherence and generally bug you/them into doing it consistently.
And then, of course, you/they might still be in the 55% of people for whom it didn’t work. And that does suck, but random antidepressant medications (i.e., not personalized) don’t fare much better, statistically.
Want something else against depression meanwhile?
Here are some strategies that not only can significantly help, but also are tailored to be actually doable while depressed:
The Mental Health First-Aid You’ll Hopefully Never Need ← written by your writer who has previously suffered extensively from depression and knows what it is like
Take care!
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