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The National Institute for Health and Care Excellence (NICE) has recommended the first daily pill to treat endometriosis for use on the NHS in England and Wales.
In final draft guidance, published on 13 March 2025, NICE approved the pill, known as relugolix combination therapy or Ryeqo (Gedeon Richter), which contains relugolix — a non-peptide gonadotrophin-releasing hormone (GnRH) receptor antagonist — with estradiol and norethisterone.
NICE said that around 1,000 women each year could benefit from relugolix combination therapy. It added that the advantages of the treatment are that it can be taken at home rather than in a clinic, starts working more quickly than injectable treatments and combines all required hormones in one pill.
The treatment was initially rejected in draft guidance issued in March 2024. However, NICE said that “[Gedeon Richter] provided new evidence that addressed NICE’s initial questions about the treatment’s effectiveness and value for money”.
In final draft guidance, NICE said relugolix combination therapy can be considered as an option for patients who have already tried medical or surgical treatment for endometriosis.
Current first-line treatments for endometriosis are a short-term trial of analgesics — including paracetamol or non-steroidal anti-inflammatory drugs, either together or alone — neuromodulators or hormonal treatments, the guidance said.
However, it noted that “all current hormonal treatments are contraceptive, so are not suitable for those wishing to conceive”.
NICE added that if these first-line treatments are ineffective, patients can be offered GnRH agonists or surgical treatment via excision or ablation.
Endometriosis is a long-term condition where endometrium, which usually grows inside and lines the uterus, grows elsewhere in the body. It affects around 1.5 million women in the UK and can cause chronic pain, painful and heavy periods and fatigue.
Helen Knight, director of medicines evaluation at NICE, said the combined pill “marks a potential step-change in how we manage endometriosis, putting control back in patients’ hands while ensuring value for the taxpayer”.
“Instead of travelling to clinics for injections, there is now a daily tablet that can be taken at home. The treatment can also be stopped and started more easily, which is particularly important for those planning to have children and for managing side effects. This convenience not only benefits patients but reduces pressure on NHS services,” she added.
A spokesperson for Endometriosis UK said that the charity welcomes the approval of relugolix combination therapy and “hopes this medication is accepted for use across the whole of the UK”.
However, the spokesperson added that “we note that [relugolix combination therapy] may be suitable for only a small proportion of the 1.5 million [women] with the disease”.
