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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Lobster vs Crab – Which is Healthier?
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Our Verdict
When comparing lobster to crab, we picked the crab.
Why?
Generally speaking, most seafood is healthy in moderation (assuming it’s well-prepared, not poisonous, and you don’t have an allergy), and for most people, these two sea creatures are indeed considered a reasonable part of a healthy balanced diet.
In terms of macros, they’re comparable in protein, and technically crab has about 2x the fat, but in both cases it’s next to nothing, so 2x almost nothing is still almost nothing. And, if we break down the lipids profiles, crab has a sufficiently smaller percentage of saturated fat (compared to monounsaturated and polyunsaturated), that crab actually has less saturated fat than lobster. In balance, the category of macros is either a tie or a slight win for crab, depending on your personal priorities.
When it comes to vitamins, crab wins easily with more of vitamins A, B1, B2, B6, B9, B12, and C, in most cases by considerable margins (we’re talking multiples of what lobster has). Lobster, meanwhile, has more of vitamin B3 (tiny margin) and vitamin B5 (pantothenic acid, as in, the vitamin that’s in basically everything edible, and thus almost impossible to be deficient in unless literally starving).
The minerals scene is more balanced; lobster has more calcium, copper, manganese, and selenium, while crab has more iron, magnesium, phosphorus, potassium, and zinc. The margins are comparable from one creature to another, so all in all the 4:5 score means a modest win for crab.
Both of these creatures are good sources of omega-3 fatty acids, but crab is better.
Lobster and crab are both somewhat high in cholesterol, but crab is the relatively lower of the two.
In short: for most people most of the time, both are fine to enjoy in moderation, but if picking one, crab is the healthier by most metrics.
Want to learn more?
You might like to read:
Shrimp vs Caviar – Which is Healthier?
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Yoga for Better Sleep – by Mark Stephens
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The book has, as you might expect:
- postural exercises
- breathing exercises
- meditation exercises
Instructions given in all of the above categories are clear and easy to follow, and there are photographic illustrations too where appropriate.
What sets it apart from many books of this kind is that it also has chapters dedicated to various specific circumstances; the many actual reasons people seriously struggle to sleep; not just “screentime too late”, but for example deprepression, sleep apnea, hyperarousal, or even just aging.
As well as the comprehensive exercises, there are also many tips, tricks, hacks, and workarounds—it’s a practical guidebook with practical advice.
While the book is about yogic practices, the author also does tackle this holistically, acknowledging that there are many factors going on, and that yogic practices should be one more string to our sleep-improving bow—as we continue with other general good advice for good sleep too, have medical tests if it seems appropriate, that kind of thing. Basically, to have one’s assorted approaches work together with synergistic effect.
Bottom line: this book will quite possibly put you to sleep! But only in the best possible way.
Click here to check out Yoga for Better Sleep, and get those valuable Zs in, healthily!
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Hold Me Tight – by Dr. Sue Johnson
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A lot of relationship books are quite wishy-washy. This one isn’t.
This one is evidenced-based (and heavily referenced!), and yet at the same time as being deeply rooted in science, it doesn’t lose the human touch.
Dr. Johnson has spent her career as a clinical psychologist and researcher; she’s the primary developer of Emotionally Focused Therapy (EFT), which has demonstrated its effectiveness in over 35 years of peer-reviewed clinical research. In other words, it works.
EFT—and thus also this book—finds roots in Attachment Theory. As such, topics this book covers include:
- Recognizing and recovering from attachment injury
- How fights in a relationship come up, and how they can be avoided
- How lot of times relationships end, it’s not because of fights, but a loss of emotional connection
- Building a lifetime of love instead, falling in love again each day
This book lays the groundwork for ensuring a strong, secure, ongoing emotional bond, of the kind that makes/keeps a relationship joyful and fulfilling.
Dr. Johnson has been recognized in her field with a Lifetime Achievement Award, and the Order of Canada.
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Federal Panel Prescribes New Mental Health Strategy To Curb Maternal Deaths
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BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.
When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”
Aquino has lots of company.
Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.
Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.
“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.
Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.
Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.
For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.
Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.
The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.
This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.
The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.
Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”
There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.
“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.
Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.
In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.
To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.
Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”
Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.
Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.
Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.
Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.
Without warning, “a dark cloud came over me,” she said.
Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.
In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.
One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.
But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.
The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.
In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.
Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.
About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.
The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.
A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.
Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.
“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.
Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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No More Aches/Tripping When Walking: Strengthen This Oft-Neglected Muscle
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Aches and pains while walking (in the feet, shins, and/or knees), as well as fatigue, are actually mostly about the oft-neglected tibialis anterior muscle.
Fortunately, it’s quite easy to strengthen if you know how:
All about the tib
The tibialis anterior is located at the front of the shin. It lifts the toes when walking, preventing trips and stumbles. Weakness in this muscle can cause fatigue as other muscles compensate, tripping as feet catch the floor, and/or general instability while walking.
Happily, there is an easy exercise to do that gives results quite quickly:
Steps:
- Stand with back and shoulders against a wall, feet 12 inches away.
- Slightly bend knees and keep posture relaxed.
- Lift toes off the ground, hold for a few seconds, then lower.
- Repeat for 10–15 reps.
To increase difficulty:
- Step further away from the wall for more ankle movement.
- Perform a “Tib Plank” by lifting hips off the wall and keeping knees straight.
It’s recommended to do 3 sets per day, with 1-minute rests between.
For more on all of this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
The Secret to Better Squats: Foot, Knee, & Ankle Mobility
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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:
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Want to learn more?
You might also like to read:
Psst… A Word To The Wise About UTIs
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