New technologies could help cut years-long wait for endometriosis diagnosis, says NICE

Two new non-invasive diagnostic technologies can be used in the NHS to speed up the diagnosis of endometriosis in primary care, NICE said in draft guidance today (Tuesday 7 July).

Endometriosis affects around one in ten women of reproductive age in the UK, yet the average time to diagnosis is more than nine years.

NICE's draft early use healthtech guidance recommends two technologies, Endosure and Endotest, that can be used in the NHS during a three-year period while additional evidence is collected on how well they work. The tests can be used to diagnose endometriosis in primary care, where current diagnostic accuracy can be limited by the availability of other tests and variation in expertise.

Endotest analyses a saliva sample for tiny biological markers called microRNAs, which can indicate whether endometriosis is likely present, with results sent to the treating clinician. EndoSure detects endometriosis by measuring electrical signals in the gut using sensor pads on the abdomen, after the patient fasts and drinks water during the 45-minute test.

A third technology, DotEndo, requires more research before NICE can recommend the NHS to fund early use of it.

In a survey of over 10,000 women conducted by the All-Party Parliamentary Group on endometriosis, over half reported visiting their GP more than ten times before receiving a diagnosis. In the same APPG survey, over half of respondents reported attending an emergency department because of their symptoms.

Delays result from late initial presentation, variation in the expertise of traditional diagnostic transvaginal ultrasound in primary care, delays in referral pathways, and long waiting times for gynaecology services. People with endometriosis have described diagnostic delays as contributing to increased suffering, prolonged ill health, and disease progression that can be more challenging to treat.

The new technologies offer a less invasive, faster approach to receiving a diagnosis that does not rely on ultrasound operator expertise, potentially enabling earlier decision-making and reducing the need for unnecessary invasive investigations.

Currently the only way to definitively confirm an endometriosis diagnosis is by using a diagnostic laparoscopy, but it is invasive, costly, and carries surgical risks. This surgical procedure is carried out under general anaesthetic, where a surgeon inserts a small camera through a tiny cut in the abdomen to look directly inside the pelvis for signs of endometriosis.

Dr Anastasia Chalkidou, healthtech programme director at NICE, said: A diagnosis of endometriosis can for some women take the best part of a decade, with the UK average standing at 9 years and 4 months, and rising to 11 years for those from ethnically diverse communities. That delay means living with chronic pelvic pain that affects daily life, relationships and work. These technologies have the potential to change that by giving primary care professionals better non-invasive tools to identify endometriosis earlier allowing earlier and better treatment. Our draft guidance reflects our commitment to getting promising innovations to patients quickly, while making sure the evidence to support their wider use is built in a rigorous way.

How the technologies work

Endotest works by analysing a saliva sample to look for biological markers associated with endometriosis. The sample is collected and sent to a laboratory for analysis. The laboratory examines specific molecules called microRNAs, which are tiny biological signals that can indicate whether endometriosis is likely to be present. The result is then returned to the healthcare professional to help inform next steps in diagnosis and care.

EndoSure is a non-invasive test that detects endometriosis by measuring electrical signals in the gut using sensor pads placed on the abdomen. Patients fast for six to eight hours beforehand, and during the 45-minute test are asked to drink water until full, helping the device record gut activity accurately. Results are available as soon as the test is complete.

Both are intended to be used alongside standard clinical practice to support diagnosis, referral and management, and are not standalone diagnostic tests. They should only be used in women where endometriosis is still suspected even though they have a normal clinical examination and either negative or inconclusive imaging results for endometriosis, or no imaging results because imaging is unacceptable or not suitable for them. The tests should only be used by a healthcare professional.

Early economic modelling suggests that both technologies could be cost effective. During the evidence generation period, they will be funded through core NHS funding. Companies are responsible for organising the evidence generation activities, and NICE will review progress annually.

Using the technologies to diagnose endometriosis

Ami Robertson experienced symptoms of endometriosis from the age of 16 but was repeatedly told she had irritable bowel syndrome. A non-invasive diagnostic test finally confirmed her condition, enabling her to access treatment for the first time.

Ami, 23, a Pilates instructor from Glasgow, said: I spent years being told my pain was something else entirely. I started to doubt myself, wondering if it was all in my head. When I finally had the test, it took less than an hour and gave me something I'd never had before: concrete evidence I could take to my doctor. For the first time, I was believed, and I could finally get the help I needed. Today my quality of life is night and day compared to before. No one should have to wait years to be believed.

Simran Chavda began experiencing severe pelvic pain at 13, but repeated GP visits and A&E attendances failed to identify the cause. Her mother Sharan Uppal, a GP, said having the non-invasive test finally gave them the evidence they needed to push for a referral and, ultimately, a diagnosis of widespread endometriosis.

Simran, 15, from Huddersfield, said: "Getting my diagnosis honestly felt like the best thing in the world. Everyone kept saying it might be irritable bowel syndrome. I was sent to hospital multiple times and sent back home. When I finally found out what it was, I was so relieved because now I knew what the next step was. The test itself was easy, it wasn't painful at all. Just drinking water and being monitored. Really simple. And I'm already starting to feel better after my surgery. I know it's never going to go away completely, but I know I'm not going to be in pain all the time, and that means everything."

Sharan Uppal, 46, mother of Simran, said: "We were hitting roadblocks everywhere. I lost count of how many times I took Simran to the GP. We ended up in A&E three or four times, spending over ten hours on one occasion, and nobody would take ownership. When the test came back strongly positive, it gave me the empowerment to go back to our GP and push for a referral. That test opened doors for us to get Simran the help she needed at a time when NHS waiting times meant we couldn't afford to wait. I would recommend it to anyone. It's a quick, straightforward test that doesn't hurt, and if it means someone finally gets the attention they need to start getting better, that's a massive thing. Early diagnosis and management of endometriosis can change the trajectory and improve the quality of someone's life.

Dr Gail Busby, consultant gynaecologist at Manchester University NHS Foundation Trust, said: "As a gynaecologist working with both adults and adolescents, I've seen first-hand how endometriosis can devastate young people's lives, causing them to miss school, struggle through GCSEs and miss out on the experiences that matter most during those formative years. Too many o my patients have spent years being told their pain is normal when it isn't. These tests are a game-changer because they give us answers much earlier, without the need for invasive surgery, and that means we can start the right treatment sooner. An earlier diagnosis doesn't just change one person's life, it frees up appointments and surgical slots for everyone waiting for care."

Emma Cox, CEO of Endometriosis UK, said: For too long, those with endometriosis have faced unacceptable delays in accessing a diagnosis, especially if from ethnically diverse communities, and diagnosis times have been going up, not down, in the last decade. Endometriosis UK welcomes NICE's announcement that two new non-invasive diagnostic technologies can now be used in the NHS to speed up diagnosis in primary care, whilst further evidence of their accuracy is collected. Speeding up diagnosis times is much needed and would be a major step forward in reducing disease impact and supporting those with endometriosis to live well with the disease.  Availability of these new tests needs to go hand in hand with education of GPs and Practice Nurses to ensure prompt access to those that need them, and an end to pain and symptoms not being recognised. This is the perfect opportunity to support Primary Care colleagues with improved understanding of endometriosis, adenomyosis and menstrual health conditions and their symptoms.

Women's Health at NICE

Women's health is a priority area for NICE. In March 2026, NICE published an updated fertility guideline (NG257) with dedicated recommendations for people with endometriosis seeking to conceive, covering expectant management, surgical treatment and assisted reproduction options including IVF. NICE has also recommended two hormonal treatments for endometriosis symptoms: relugolix-estradiol-norethisterone (April 2025) and linzagolix with hormonal add-back therapy (June 2025), for adults of reproductive age after medical or surgical treatment. In November 2024, NICE updated its endometriosis guideline (NG73) with new and revised recommendations to help healthcare professionals recognise symptoms earlier, alongside clearer referral pathways and a range of treatment options across community, gynaecology and specialist services.

NICE is inviting comments from stakeholders and the public on its draft guidance. The closing date for comments is 27 July 2026. A second committee meeting is scheduled for 12 August 2026. The recommendations may change following consultation.

ENDS

1. Lucy Common, clinical nursing advisor at NICE, said: Nurses in primary care are often the first point of contact for women experiencing the painful and distressing symptoms of endometriosis. Having access to these new diagnostic tools could make a significant difference, helping clinicians act sooner and giving patients answers more quickly. It is also worth noting that people who find transvaginal ultrasound unacceptable may particularly benefit from having access to these less invasive tests.
2. Professor Tom Clutton-Brock MBE, chair of NICE's diagnostics advisory committee, said: The committee carefully considered the available evidence and the significant unmet need that exists for people with suspected endometriosis. While the evidence base is still developing and most studies have been conducted in secondary or tertiary care settings outside the UK, we believe the potential benefits of earlier diagnosis in primary care justify a conditional recommendation while further evidence is gathered.