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If you live with endometriosis, you already know the drill. Debilitating period pain, exhaustion that knocks you sideways, nausea, bloating, heavy bleeding, some days, it feels like your body is actively working against you. And when it comes to treatment? Well, that’s often where the real frustration begins.
Many people spend years, sometimes decades, trying different treatments. Some offer a little relief, others come with side effects just as bad as the symptoms. Hormonal therapies can take months to wear off, while injections and implants often feel like an all-or-nothing gamble(1).
But finally, there’s some long-overdue good news. On March 12, 2025, the National Institute for Health and Care Excellence (NICE) approved Ryeqo for NHS use, the first-ever daily oral tablet for the long-term treatment of endometriosis (2).
That alone is a massive breakthrough, but for those with hypermobility syndromes (HSD/EDS) or fibromyalgia, this could be even more significant. Research shows that:
- 75% of people with EDS/HSD experience chronic pelvic pain, many with undiagnosed endometriosis (3).
- Endometriosis is 2-3 times more common in people with fibromyalgia compared to the general population, likely due to central sensitization (where the nervous system amplifies danger signals), (4).
- Women with hypermobility or fibromyalgia often experience longer diagnosis delays—sometimes beyond 10 years (5).
The fact that this condition has been ignored and underfunded for so long is unacceptable, but with Ryeqo’s approval, we’re finally seeing progress.
Endometriosis: A Chronic Condition That’s Often Overlooked
Endometriosis affects 1 in 10 women worldwide! around 176 million people, yet remains underdiagnosed, underfunded, and widely dismissed (6).
It’s not just a “bad period”—it’s a full-body inflammatory disease. When tissue similar to the uterine lining grows outside the womb, it triggers inflammation, scarring, and adhesions. In severe cases, it can spread to organs like the bladder, bowel, and even the lungs (7).
For many, it’s a lifelong battle with:
- Chronic pelvic pain
- Painful periods (dysmenorrhoea)
- Pain during sex, bowel movements, or urination
- Severe bloating (“endo belly”)
- Heavy menstrual bleeding
- Exhaustion, brain fog, nausea
- Fertility issues (8)
Why Does Diagnosis Take So Long?
The average diagnosis time is 7-10 years a staggering delay for such a life-altering condition (9).
- Medical Gaslighting: Many are told to “just take painkillers” or “try getting pregnant” as a solution (10).
- Lack of Awareness: Doctors often misdiagnose endometriosis as IBS, pelvic floor dysfunction, or stress (11).
- Surgical Diagnosis Required: The only way to confirm endometriosis is laparoscopy (keyhole surgery), meaning many struggle for years before getting the care they need (12).
Treatment options have been limited and frustrating, hormonal suppression, painkillers, or surgery, none of which offer a true long-term solution (13).
This is why Ryeqo’s approval is so significant. Instead of another temporary fix, it represents a real step forward in giving people better, more sustainable relief (14).
What Is Ryeqo and How Does It Work?
Ryeqo is a once-daily tablet designed for long-term symptom management offering relief without injections, implants, or irreversible hormone suppression.
Unlike older treatments, it can be stopped and restarted easily, giving people far more control over their treatment.
What Makes Ryeqo Different?
Ryeqo contains three active ingredients, designed to suppress symptoms while minimizing side effects:
- Relugolix (40mg): A GnRH receptor antagonist that blocks estrogen and progesterone production, slowing endometriosis progression.
- Estradiol (1mg): A low-dose estrogen that prevents menopause-like symptoms such as hot flashes, mood swings, and bone loss.
- Norethisterone acetate (0.5mg): A progestin that protects the uterus, preventing endometrial thickening.
Unlike some hormonal treatments that take months to wear off, Ryeqo is easily reversible, hormone levels normalize quickly after stopping treatment, making it an ideal option for those considering pregnancy or adjusting their approach to symptom management, especially for those getting older with EDS.
For too long, endometriosis treatments have been rigid, slow, and filled with trade-offs. Ryeqo finally acknowledges the need for flexibility something that those with chronic illnesses rarely get to experience.
Why Ryeqo Is a Game-Changer
Most hormonal treatments completely shut down estrogen, which causes severe side effects like bone loss, joint pain, and mood swings. Ryeqo, however, moderately suppresses estrogen—allowing for symptom relief without throwing the body into hormonal chaos.
It’s also one of the few treatments designed with reversibility in mind. While injections and implants can linger in the system for months, Ryeqo can be stopped at any time, with hormones returning to normal quickly.
For people with hypermobile EDS, fibromyalgia, or central sensitization, this more balanced hormonal approachmay be particularly useful. Many treatments over-suppress estrogen, worsening pain, fatigue, and joint instability, Ryeqo may offer a more tolerable alternative.
Most importantly, Ryeqo represents progress. It’s the first of its kind, proving that endometriosis treatment doesn’t have to be all or nothing.
What Does the Research Say? (SPIRIT Clinical Trials)
New treatments always come with big claims, but the real question is, does Ryeqo actually work?
Unlike many endometriosis treatments that were originally repurposed from other conditions, Ryeqo was specifically developed for endometriosis-related pain. And crucially, it’s backed by solid clinical research.
The approval of Ryeqo was based on two large-scale Phase III trials, SPIRIT 1 and SPIRIT 2, which studied over 1,200 women with moderate to severe endometriosis pain (15).
- 75% of patients taking Ryeqo saw significant relief from dysmenorrhoea (painful periods), compared to 27-30% in the placebo group (16).
- 59-66% of patients experienced reductions in non-menstrual pelvic pain (NMPP), compared to 40-43% with placebo (17).
These aren’t just modest improvements, they’re clinically significant reductions in pain.
Long-Term Effectiveness & Safety
An 80-week extension study followed patients beyond the initial trial period to see if Ryeqo’s benefits lasted. The results? Pain relief was sustained over two years, proving that Ryeqo isn’t just a short-term fix (18).
Beyond pain relief, Ryeqo also had a strong safety profile. Reported side effects were mostly mild to moderate, including hot flashes, headaches, and nausea (19). Importantly, the inclusion of low-dose estradiol helped prevent bone density loss, a major issue with older hormonal treatments.
So, the clinical evidence is clear. Ryeqo works, and it works well. But how does it compare to existing treatments?
How Does Ryeqo Compare to Existing Treatments?
For decades, managing endometriosis has meant choosing between limited options, none of which are ideal. The usual lineup includes NSAIDs, hormonal treatments (the pill, Mirena coil, progestins), GnRH agonists, and surgery.
While some of these options work, they all come with drawbacks that make long-term use difficult.
- GnRH agonists (e.g., Zoladex, Prostap) force the body into temporary menopause, stopping estrogen production entirely, which often leads to bone loss, hot flashes, and severe joint pain.
- The combined pill or progestin-only therapies help some, but don’t always suppress symptoms enough and can increase clotting risks in certain individuals.
- Surgery (excision or ablation) is considered the gold standard, but it’s not a cure—many experience recurrence within a few years.
Where Does Ryeqo Fit In?
Unlike GnRH agonists, Ryeqo doesn’t shut down estrogen completely, instead, it moderately suppresses it, allowing for symptom relief without throwing the body into full-blown menopause.
It’s also more flexible. While injections or implants linger in the body for months, Ryeqo can be stopped or adjusted as needed, a major advantage for those who want more control over their treatment.
For people with hypermobility, fibromyalgia, or chronic pain syndromes, this balanced hormonal approach may be particularly beneficial. Aggressive estrogen suppression can worsen fatigue, pain, and joint instability, Ryeqo offers a more tolerable alternative.
| Feature | Ryeqo | Traditional Hormonal Treatments |
| Administration | Once-daily pill | Monthly injections / implants |
| Hormone suppression | Adjustable & reversible | More prolonged suppression |
| Onset of action | Faster | Gradual |
| Side effect management | Includes estradiol to prevent menopause-like symptoms | Can cause bone density loss, hot flashes, joint pain |
| Fertility considerations | Hormones normalize quickly after stopping | Some treatments delay fertility return |
Of course, no treatment is perfect, and Ryeqo won’t work for everyone. Some people may still experience side effects. But compared to existing options, it represents a real step forward.
Who Can Benefit from Ryeqo?
Ryeqo is designed for people with moderate to severe endometriosis symptoms who haven’t responded to other treatments or need a more tolerable long-term option.
It could be particularly helpful for:
- Those who struggled with GnRH agonists due to severe side effects like hot flashes, bone loss, or joint pain.
- People who want a flexible, reversible treatment that doesn’t require months of waiting for hormones to normalize after stopping.
- Individuals planning future pregnancies who want symptom relief without prolonged hormonal suppression.
- People with HSD, EDS, or fibromyalgia, whose pain may worsen with aggressive estrogen suppression.
- Those who haven’t responded to the combined pill, progestin-only treatments, or Mirena coil.
Ryeqo isn’t for everyone: it’s still a hormonal treatment, so it may not be suitable for those with a history of blood clots, cardiovascular disease, or hormone-sensitive cancers.
But for those who have been left with few viable options, Ryeqo represents a long-overdue alternative.
What’s Next? The Future of Endometriosis Treatment
Ryeqo is a milestone, but it’s not the final answer.
Endometriosis treatment has barely progressed in decades, and the fact that a daily pill is considered groundbreaking, says a lot about how neglected this condition is.
The next phase of endometriosis research needs to focus on Non-Hormonal Approaches
Since hormones aren’t the only factor in endometriosis, new treatments are targeting inflammation, immune dysfunction, and nerve pain:
- JNK Inhibitors: Drugs that block inflammatory pathways involved in pain and lesion growth.
- Cannabinoid-Based Treatments: Research into CBD and THC for neuropathic pain and inflammation.
- Immune Modulators: Therapies that reprogram the immune system to prevent lesion growth.
Better Diagnostic Tools
Right now, the only way to definitively diagnose endometriosis is through surgery. Future diagnostic tools in development include:
- Blood-based Biomarkers – Detecting inflammation markers in blood tests.
- Menstrual Fluid Testing – Identifying endometriosis-related inflammation in menstrual blood.
- Advanced Imaging Techniques – New MRI contrast agents designed to detect deep-infiltrating endometriosis without surgery.
The Fight for Better Treatment Is Far from Over
Endometriosis still takes years to diagnose. Patients are still gaslighted by medical professionals. And most treatments still focus on symptom suppression rather than the root cause.
The next decade must focus on faster diagnosis, better treatments, and an overhaul of how endometriosis is managed in healthcare.
References
- synapse.patsnap.com/article/mhra-approves-new-endometriosis-treatment
- theconversation.com/what-is-ryeqo-the-recently-approved-medicine-for-endometriosis-224237
- pmlive.com/pharma_news/mhra-authorises-first-in-new-class-of-treatment-for-endometriosis-symptoms/
- medicinetoday.com.au/mt/2024/jan-feb/something-borrowed/what-is-ryeqo-the-recently-approved-medicine-for-endometriosis
- pf-media.co.uk/news/mhra-licenses-endometriosis-treatment-for-patients-in-the-uk/
- ema.europa.eu/en/medicines/human/EPAR/ryeqo
- gedeonrichter.com/en/news/221025
- pharmaceutical-technology.com/news/ec-gedeon-richter-sumitomo-ryeqo/
- abuhb.nhs.wales/files/patient-information-leaflets1/womens-health/ryeqo-for-treatment-of-symptomatic-fibroids-and-endometriosis
- healthed.com.au/clinical_articles/what-is-ryeqo-the-recently-approved-medicine-for-endometriosis/
- iconplc.com/insights/blog/2025/03/04/endometriosis-research-and-development-call-action
- europeanpharmaceuticalreview.com/news/232956/first-in-class-combination-therapy-authorised-for-endometriosis
- news.sky.com/story/first-of-a-kind-endometriosis-tablet-approved-for-use-on-nhs-13327054
- news.us.sumitomo-pharma.com/2023-11-02-European-Commission-Approves-the-Commercialisation-of-RYEQO-R-for-the-Symptomatic-Treatment-of-Endometriosis
- pubmed.ncbi.nlm.nih.gov/37223761/
- prnewswire.com/news-releases/european-commission-approves-the-commercialisation-of-ryeqo-for-the-symptomatic-treatment-of-endometriosis-301975945.html
- guernseypress.com/news/uk-news/2025/03/13/new-pill-to-transform-treatment-of-endometriosis-approved-on-the-nhs/
- uk.news.yahoo.com/pill-transform-treatment-endometriosis-approved-000100426.html
- pmc.ncbi.nlm.nih.gov/articles/PMC10905503/
