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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Metabolism Made Simple – by Sam Miller
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The author, a nutritionist, sets out to present exactly what the title promises: metabolism made simple.
On this, he delivers. Explaining things from the most basic elements upwards, he gives a well-rounded introduction to the science of metabolism and what it means for us when it comes to our dietary habits.
The book is in large part a how-to, but with a lot of flexibility left to the reader. He doesn’t advocate for any particular dietary plan, but he does give the reader the tools necessary to make an informed choice and go from there—including the pros and cons of some popular dietary approaches.
He talks a lot about getting the most out of whatever we do choose to—managing appetite, mitigating adaptation, maximizing adherence, optimizing absorption of nutrients, and so forth.
The book does also touch on things like exercise and stress management, but diet is always center-stage and is the main topic of the book.
The style is—as promised by the title—simple. However, this simply means that he avoids unnecessary jargon and explains any necessary terms along the way. As for backing up claims with science, there are 22 pages of references, which is always a good sign.
Bottom line: if you’d like a simple, practical guide to eating for metabolic health, this book will start you off on a good footing.
Click here to check out Metabolism Made Simple, and give your metabolic health a boost!
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Beating Sleep Apnea
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Healthier, Natural Sleep Without Obstruction!
Obstructive Sleep Apnea, the sleep disorder in which one periodically stops breathing (and thus wakes up) repeatedly through the night, affects about 25% of men and 10% of women:
Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study
Why the gender split?
There are clues that suggest it is at least partially hormonal: once women have passed menopause, the gender split becomes equal.
Are there other risk factors?
There are few risk other factors; some we can’t control, and some we can:
- Being older is riskier than being younger
- Being overweight is riskier than not being overweight
- Smoking is (what a shock) riskier than not smoking
- Chronic respiratory diseases increase risk, for example:
- Asthma
- COPD
- Long COVID*—probably. The science is young for this one so far, so we can’t say for sure until more research has been done.
- Some hormonal conditions increase risk, for example:
- Hypothyroidism
- PCOS
*However, patients already undergoing Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea may have an advantage when fighting a COVID infection:
What can we do about it?
Avoiding the above risk factors, where possible, is great!
If you are already suffering from obstructive sleep apnea, then you probably already know about the possibility of a CPAP device; it’s a mask that one wears to sleep, and it does what its name says (i.e. it applies continuous positive airway pressure), which keeps the airway open.
We haven’t tested these, but other people have, so here are some that the Sleep Foundation found to be worthy of note:
Sleep Foundation | Best CPAP Machines of 2024
What can we do about it that’s not CPAP?
Wearing a mask to sleep is not everyone’s preferred way to do things. There are also a plethora of surgeries available, but we’ll not review those, as those are best discussed with your doctor if necessary.
However, some lifestyle changes can help, including:
- Lose weight, if overweight. In particular, having a collar size under 16” for women or under 17” for men, is sufficient to significantly reduce the risk of obstructive sleep apnea.
- Stop smoking, if you smoke. This one, we hope, is self-explanatory.
- Stop drinking alcohol, or at least reduce intake, if you drink. People who consume alcohol tend to have more frequent, and longer, incidents of obstructive sleep apnea. See also: How To Reduce Or Quit Drinking
- Avoid sedatives and muscle relaxants, if it is safe for you to do so. Obviously, if you need them to treat some other condition you have, talk this through with your doctor. But basically, they can contribute to the “airway collapses on itself” by reducing the muscular tension that keeps your airway the shape it’s supposed to be.
- Sleep on your side, not your back. This is just plain physics, and a matter of wear the obstruction falls.
- Breathe through your nose, not through your mouth. Initially tricky to do while sleeping, but the more you practice it while awake, the more it becomes possible while asleep.
- Consider a nasal decongestant before sleep, if congestion is a problem for you, as that can help too.
For more of the science of these, see:
Cultivating Lifestyle Transformations in Obstructive Sleep Apnea
There are more medical options available not discussed here, too:
American Sleep Apnea Association | Sleep Apnea Treatment Options
Take care!
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Sleep Through Insomnia – by Dr. Brandon Peters
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First, what this is not: a guide to get better sleep tonight.
Rather, what it is: a guide to get better sleep in the near future (six weeks).
The way it delivers this is primarily Cognitive Behavioral Therapy for Insomnia (CBT-I), in 6 weekly lessons, each divided into 3 activities:
- Reflection
- Education
- Setting goals
Now, all parts are important, but we’d say the biggest value here is in the education segment, in part because it helps the reader understand why the reflection is important, and how to usefully set the goals.
“Reflection” may sound quite wishy-washy, but in fact it is very science-based, with questions as prompts, which effectively amount to the “gathering data” part of science.
“Setting goals”, for its part, is intended to be a progressive, step-by-step approach to get you to where you want to be with your sleep.
The style is instructional pop-science, with everything made easy to understand. There are an abundance of scientific references for those who wish to delve further, and sometimes he does go into more neurological detail than a book written by a psychologist might (Dr. Peters being a medical doctor, board-certified in neurology and sleep medicine, and with extensive training in CBT-I).
Bottom line: if you’d like to sleep better and you have the will to commit to a 6-week program (which will not ask anything arduous of you, but you will need to show up for it and do the things), then this book can give you a much better long-term fix than telling you to change your sheets and put your phone away.
Click here to check out Sleep Through Insomnia, and sleep easy!
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Pelvic Floor Exercises (Not Kegels!) To Prevent Urinary Incontinence
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It’s a common threat, and if you think it couldn’t happen to you, then well, just wait. Happily, Dr. Christine Pieton, PT, DPT, a sport & women’s health physical therapist, has advice:
On the ball!
Or rather, we’re going to be doing ball-squeezing here, if you’ll pardon the expression. You will need a soccer-ball sized ball to squeeze.
Ball-squeeze breathing: lie on your back, ball between your knees, and inhale deeply, expanding your torso. Exhale, pressing your knees into the ball, engaging your abdominal muscles from lower to upper. Try to keep your spine long and avoid your pelvis tucking under during the exhalation.
Ball-squeeze bridge: lie on your back, ball between your knees, inhale to prepare, and then exhale, pressing up into a bridge, maintaining a firm pressure on the ball. Inhale as you lower yourself back down.
Ball-squeeze side plank: lie on your side this time, ball between your knees, supporting forearm under your shoulder, as in the video thumbnail. Inhale to prepare, and then exhale, lifting your hip a few inches off the mat. Inhale as you lower yourself back down.
Ball-squeeze bear plank: get on your hands and knees, ball between your thighs. Lengthen your spine, inhale to prepare, and exhale as you bring your knees just a little off the floor. Inhale as you lower yourself back down.
For more details and tips on each of these, plus a visual demonstration, plus an optional part 2 video with more exercises that aren’t ball-squeezes this time, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Psst… A Word To The Wise About UTIs
Take care!
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Build Strong Feet: Exercises To Strengthen Your Foot & Ankle
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A lot depends on the health of our feet, especially when it comes to their strength and stability. But they often get quite neglected, when it comes to maintenance. Here’s how to help your feet keep the rest of your body in good condition:
On a good footing
The foot-specific exercises recommended here include:
- Active toe flexion/extension: curl and extend your toes
- Active toe adduction/abduction: use a towel for feedback this time as you spread your toes
- “Short foot” exercise: create an arch by bringing the base of your big toe towards your heel
- Resisted big toe flexion: use resistance bands; flex your big toe while controlling the others.
- Standing big toe flexion (isometric): press your big toe against an inclined surface as forcefully as you can
- Foot bridge exercise: hold your position with the front part of your feet on an elevated surface, to strengthen the arch.
- Heel raises: which can be progressed from basic to more advanced variations, increasing difficulty
- Ankle movements: dorsiflexion, inversion, etc, to increase mobility
It’s important to also look after your general lower body strength and stability, including (for example) single-leg deadlifts, step-downs, and lunges
Balance and proprioceptive exercises are good too, such as a static or dynamic one-leg balances, progressing to doing them with your eyes closed and/or on unstable surfaces (be careful, of course, and progress to this only when confident).
For more on all of these, an explanation of the anatomy, some other exercises too, and visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Steps For Keeping Your Feet A Healthy Foundation
Take care!
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What Happens Every Day When You Quit Sugar For 30 Days
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We all know that sugar isn’t exactly a health food, but it can be hard to quit. How long can cravings be expected to last, and when can we expect to see benefits? Today’s video covers the timeline in a realistic yet inspiring fashion:
What to expect on…
Day 1: expect cravings and withdrawal symptoms including headaches, fatigue, mood swings, and irritability—as well as tiredness, without the crutch of sugar.
Days 2 & 3: more of the same, plus likely objections from the gut, since your Candida albicans content will not be enjoying being starved of its main food source.
Days 4–7: reduction of the above symptoms, better energy levels, improved sleep, and likely the gut will be adapting or have adapted.
Days 8–14: beginning of weight loss, clearer skin, improved complexion; taste buds adapt too, making foods taste sweeter. Continued improvement in energy and focus, as well.
Days 15–21: more of the same improvements, plus the immune system will start getting stronger around now. But watch out, because there may still be some cravings from time to time.
Days 22–30: all of the above positive things, few or no cravings now, and enhanced metabolic health as a whole.
For more specificity on each of these stages, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Not-So-Sweet Science Of Sugar Addiction
Take care!
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