For millions of women living with unexplained pelvic pain, getting an endometriosis diagnosis can take nearly a decade. Now, two emerging non-invasive technologies, one that analyzes a saliva sample and another that measures electrical activity in the gut, could help change that.
The U.K.'s National Institute for Health and Care Excellence (NICE) has issued draft guidance recommending the early use of Endotest and EndoSure in England's National Health Service (NHS) while additional evidence is gathered over the next three years.
The technologies are designed to help primary care clinicians identify endometriosis earlier, potentially reducing the need for invasive procedures and accelerating referrals for treatment.
The move comes as experts continue searching for better ways to diagnose a condition that affects an estimated 1 in 10 women of reproductive age, yet often goes undetected for years.
According to Endometriosis UK, the average time to diagnosis in the U.K. is more than nine years, with even longer delays reported among women from ethnically diverse communities.
Why Endometriosis Is So Difficult to Diagnose
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus, commonly affecting the ovaries, fallopian tubes, and other pelvic organs. The condition can cause chronic pelvic pain, painful periods, pain during sex, bowel and bladder symptoms, and infertility.
Despite its prevalence, diagnosis remains notoriously challenging because symptoms often overlap with other conditions, including irritable bowel syndrome (IBS) and pelvic inflammatory disease. Many patients are initially told their pain is "normal" or attributed to gastrointestinal disorders before receiving the correct diagnosis.
According to an All-Party Parliamentary Group (APPG) on Endometriosis survey of more than 10,000 women, more than half reported visiting their general practitioner at least 10 times before receiving a diagnosis, while more than half also sought emergency care because of their symptoms.
Currently, the only way to definitively confirm endometriosis is through diagnostic laparoscopy, a surgical procedure performed under general anesthesia in which a surgeon inserts a small camera into the abdomen to look for endometrial lesions. Although effective, the procedure is invasive, costly, and carries the risks associated with surgery.
How a Saliva Sample Could Detect Endometriosis
One of the new technologies, Endotest, relies on a simple saliva sample to detect biological markers associated with endometriosis.
After the sample is collected, it is sent to a laboratory where researchers analyze microRNAs, small, non-coding RNA molecules that regulate gene expression. Certain microRNA patterns have been linked to endometriosis, enabling the test to estimate the likelihood of disease presence.
The results are then returned to the treating clinician to support decisions about further evaluation, referral, or treatment.
Unlike surgery, the test can be completed without anesthesia or invasive procedures, offering a less burdensome option for patients whose symptoms remain unexplained after a clinical examination or imaging.
EndoSure Takes a Different Approach
The second technology, EndoSure, does not rely on laboratory analysis.
Instead, patients fast for six to eight hours before undergoing a 45-minute test during which adhesive sensor pads placed on the abdomen measure electrical activity in the gastrointestinal tract. During the examination, patients drink water until they feel full, enabling the device to record gut signals that may reflect changes associated with endometriosis.
Results are available immediately after the test is completed, allowing clinicians to incorporate the findings into decisions about additional diagnostic work-up or specialist referral.
Like Endotest, EndoSure is intended to complement, not replace, existing clinical assessments.
According to NICE, both technologies should be used only in women who continue to have suspected endometriosis despite a normal physical examination and either negative, inconclusive, or unavailable imaging results.
Earlier Answers Could Mean Earlier Treatment
Health experts say one of the greatest potential benefits of these technologies is reducing the prolonged uncertainty many patients experience before receiving treatment.
Delayed diagnosis has been linked to worsening symptoms, disease progression and reduced quality of life. Many women endure years of chronic pain, repeated medical appointments, and unnecessary investigations before being referred to a gynecologist.
In announcing the draft guidance, NICE said the technologies could help primary care professionals identify patients who may benefit from earlier specialist referral while decreasing reliance on operator-dependent imaging and unnecessary invasive investigations.
The organization also noted that preliminary economic analyses suggest both tests could be cost-effective if their performance is confirmed through ongoing evidence collection.
The Technology Isn't Replacing Surgery—Yet
Despite the excitement surrounding these innovations, experts caution that neither Endotest nor EndoSure is a standalone diagnostic tool.
Instead, the tests are designed to support clinical decision-making and should be interpreted alongside symptoms, medical history, physical examination, and imaging findings.
Additional research conducted during the NHS's three-year evidence-generation period will determine how accurately the technologies identify endometriosis across different patient populations and whether they should be incorporated into routine clinical care.
For now, specialists say the promise lies in helping patients reach the right diagnosis sooner rather than replacing existing diagnostic standards altogether.
