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Indication
Uterine fibroids
RAG rating
Amber initiation
Document type
Decision document
Place
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing

Relugolix-estradiol-norethisterone acetate (Ryeqo)


HERTFORDSHIRE AND WEST ESSEX AREA PRESCRIBING COMMITTEE (HWE APC)

Relugolix-estradiol-norethisterone acetate for treating moderate to severe symptoms of uterine fibroids.


AMBER INITIATION

Recommended for initiation by specialists, ongoing prescribing in primary care.

 

Name generic (trade): Relugolix-estradiol-norethisterone (Ryeqo®)

What it is: Non-peptide GnRH receptor antagonist 

Indication: Licensed for treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age

Date decision last revised: June 2025

NICE: NICE TA 832 recommended

 

HWE APC recommendation:

Relugolix–estradiol–norethisterone acetate (relugolix combination therapy, Ryeqo®) is recommended, within its marketing authorisation, as an option for treating moderate to severe symptoms of uterine fibroids in adults of reproductive age, in line with the recommendations in NICE TA832. 


Relugolix–estradiol–norethisterone acetate can be considered when standard non-hormonal (for example tranexamic acid, NSAIDs) and hormonal pharmacologic options (for example levonorgestrel-releasing intrauterine system, combined hormonal contraception, cyclical oral progestogens) as detailed in NICE guidance 88 ‘Heavy menstrual bleeding: assessment and management’ are unsuitable /ineffective and the next treatment options would be injectable gonadotrophin-releasing hormone (GnRH) agonists, uterine artery embolization/surgical interventions.


AMBER INITIATION

Specialists responsibilities include: 

At initiation

  • provide information to the patient relating to the safe and effective use such as, but not limited to, ongoing BMD monitoring requirements and advice on contraception.
  • advise patient on action to take if intolerance/significant side-effects develop prior to next follow up appointment and advise, if required, to contact initiating specialist for further treatment advice. 

This information should be included in the clinic letter to primary care clinicians

 

During follow up care

  • to arrange and review DEXA scan (recommended after one year of treatment) and ongoing BMD monitoring thereafter.
  • to undertake initial and follow up reviews for efficacy and tolerance and advise primary care of the ongoing treatment plan.

During treatment, periodic check-ups must be carried out according to standard clinical practice.

Further information: for latest updates and more detailed information, including contra-indications, cautions and special warnings; please refer to summary of product characteristics SPC)


Relugolix combination therapy is a black Triangle drug ▼ report all suspected adverse reactions at Yellow Card | Making medicines and medical devices safer.



Version number
1.1
Developed by
Pharmacy and Medicines Optimisation Team, Hertfordshire and West Essex (HWE) ICB with relevant HWE ICS stakeholders.
Approved by
Hertfordshire & West Essex Area Prescribing Committee
Date approved / updated
June 2025
Review date
This HWE APC recommendation is based upon the evidence available at the time of publication. This recommendation will be reviewed upon request in the light of new evidence becoming available.
Superseded version
Version 1.0, September 2024
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