The first daily pill for treating endometriosis symptoms has been approved for use on the NHS in England – but only for patients who have tried all other options.

Endometriosis affects 1.5 million women in the UK, causing pain and extreme tiredness as a result of tissue similar to the womb lining growing elsewhere in the body.

The new tablet, known as relugolix combination therapy, has been approved by drug assessment body the National Institute for Health and Care Excellence (NICE) and, unlike current injectable treatments, it can be taken at home.

The charity Endometriosis UK said the pill gives patients more choice, but will help only a relatively small number of people.

• severe period pain that stops you from doing normal activities
• very heavy periods
• pain when you poo or pee
• other symptoms can include pain in your lower tummy, pain after sex, fatigue, shortness of breath, low mood, anxiety
• difficulty getting pregnant

The new combination therapy pill will cost £72 for a 28-day supply, NICE said.

It works by blocking specific hormones that contribute to the condition, while also providing replacement hormones that are needed.

It will only be available on the NHS for people who have already tried all other medical and surgical treatments and found they did not help, NICE said – equivalent to 1,000 women a year.

This includes treatments such as hormonal contraceptives and intrauterine delivery systems.

Helen Knight, director of medicines evaluation at NICE, said it marked “a potential step-change in how we manage endometriosis, putting control back in patients’ hands while ensuring value for the taxpayer”.

She said the treatment could be stopped and started more easily than other treatments, which is important for those planning to have children and for managing side effects.

That could also reduce pressure on NHS services, she added.

NICE initially rejected the drug, but new evidence was provided by the manufacturer on its effectiveness and value for money.

Ami Clarke, 27, from St. Albans, started experiencing endometriosis symptoms after her very first period, aged 13.

She was not diagnosed until 10 years later – by then she had tried six different contraceptive pills to find a way of helping her pain, but nothing seemed to work.

“I came off the pill and that’s when my periods became absolutely, completely unmanageable. They took over my life. I wasn’t going to university, I wasn’t going to work,” Ami says.

“If I was going to work, I was collapsing in pain consistently every single month.”

Ami kept going back to her GP because the pain was “completely unbearable”.

“I was just so desperate, my mental health was on the floor. I don’t even know how I survived. It was like 20 to 25 days out of the month where I was just completely bed-bound,” she told the BBC.

Ami had her first surgery in October 2021, which reduced the pain for seven or eight months, but then it gradually came back. A second operation in April 2024 was not as successful. She is now trying to raise enough money to have a third surgery, privately.

Ami says it is good to hear that further treatment is being developed for endometriosis because “a lot of the time it feels like you’re being left in the dark”.

Usually, the first treatments for endometriosis, after pain relievers, are hormone injections which temporarily shut down the body’s production of estrogen. This is the hormone that causes endometriosis tissue to grow and cause pain.

However, patients often need to travel to hospitals to have the injections, which last for up to three months.

With the new all-in-one tablet, there is no need for patients to remember to take hormone replacement therapy as a separate tablet.

It can be stopped quickly if side effects are difficult and taken up until the menopause.

“It’s a step forward and will give patients more choice, but it will impact a relatively small number of people,” says Emma Cox, chief executive of Endometriosis UK.

“We need to see more investment in other research and treatments,” she added.