Two innovative, non-invasive diagnostic technologies could help transform how endometriosis is identified in the NHS, following new draft guidance published by NICE today.
The guidance recommends early use of EndoSure and Endotest in primary care settings, aiming to tackle the long-standing delays that have left many patients waiting years for a confirmed diagnosis. Endometriosis affects approximately one in ten women of reproductive age in the UK, yet the average time to diagnosis remains more than nine years.
A shift towards earlier, less invasive diagnosis
NICE is proposing a three-year evidence generation period during which both technologies can be used in the NHS while further data is gathered on their performance and cost-effectiveness. The move signals a broader strategy to accelerate the adoption of promising health technologies while maintaining robust evaluation standards.
Currently, diagnosing endometriosis can be complex and inconsistent in primary care. Limited access to specialist imaging and variations in clinical expertise often contribute to delays in referral and treatment.
Both EndoSure and Endotest are designed to be used alongside existing clinical pathways, supporting clinicians in decision-making rather than replacing current diagnostic methods.
How the technologies work
- Endotest uses saliva samples to detect microRNAs – tiny biological markers linked to endometriosis. Samples are analysed in a laboratory, with results sent back to the clinician to guide next steps.
- EndoSure works differently, measuring electrical activity in the gut via sensors placed on the abdomen. The 45-minute test requires fasting beforehand, with patients drinking water during the procedure to optimise readings. Results are available immediately.
A third innovation, DotEndo, has not yet been recommended by NICE due to the need for further clinical evidence.
Addressing a major unmet need
The scale of diagnostic delay in endometriosis care is significant. A survey of more than 10,000 women conducted by the All-Party Parliamentary Group (APPG) on endometriosis found that:
- Over half had visited their GP more than ten times before being diagnosed.
- More than half had attended A&E due to their symptoms.
Delays can stem from multiple factors, including late initial presentation, inconsistent ultrasound interpretation, slow referral pathways, and prolonged waits for specialist gynaecology services. These delays often result in worsening symptoms, reduced quality of life, and more complex treatment needs.
At present, a definitive diagnosis typically requires laparoscopy – a surgical procedure carried out under general anaesthetic. While effective, it carries risks, incurs significant cost, and contributes to waiting list pressures.
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.”
Implementation and NHS impact
The guidance specifies that both tests should be used in cases where:
- Endometriosis is still suspected despite a normal clinical examination, and
- Imaging is negative, inconclusive, or unsuitable for the patient.
Importantly, these technologies are not intended as standalone diagnostic tools but as part of a broader clinical pathway supporting referral and treatment decisions.
Early economic modelling suggests both technologies could be cost-effective, with NHS funding provided during the evidence generation phase. Manufacturers will lead data collection activities, with NICE conducting annual reviews.
Wider policy context
The draft guidance aligns with NICE’s ongoing focus on improving women’s health services. Recent updates include:
- Fertility guideline NG257 (March 2026), including recommendations for patients with endometriosis
- New hormonal treatments approved in 2025
- Updated endometriosis guideline NG73 (November 2024), focusing on earlier recognition and improved referral pathways
Together, these initiatives highlight a concerted effort to reduce diagnostic delays, improve patient outcomes, and modernise care pathways across the NHS.
Image credit: iStock
