Relugolix

How it works

It competitively blocks pituitary GnRH receptors, rapidly suppressing the release of LH and FSH and thereby lowering ovarian oestradiol production, with the added oestradiol/progestogen offsetting hypo-oestrogenic effects.

Prescribing in practice

• Even with add-back hormones, treatment can reduce bone mineral density, so duration should be limited and bone health considered, particularly with risk factors for osteoporosis.
• Because it can restore ovulation and is contraindicated in pregnancy, effective non-hormonal contraception is needed during use.
• It is contraindicated in undiagnosed abnormal uterine bleeding and in known or suspected hormone-sensitive malignancy.

Monitoring

Assess bone mineral density where prolonged use or osteoporosis risk applies, and reassess the need for continued treatment periodically.

Counselling the patient

• Take the tablet once daily at about the same time each day.
• Use a non-hormonal method of contraception while taking this medicine.
• Report any unexpected or worsening vaginal bleeding.

Evidence & guidelines

Recommended by NICE for heavy menstrual bleeding due to uterine fibroids and for symptomatic endometriosis on the basis of randomised controlled trials.