Endometriosis: Navigating the Path to Diagnosis and Care

The American College of Obstetricians and Gynecologists (ACOG) has released new clinical guidance aimed at reducing the significant delays associated with the diagnosis of endometriosis. Clinical Practice Guideline 11, titled Diagnosis of Endometriosis, provides comprehensive recommendations to improve the evaluation of adolescent and adult patients experiencing endometriosis-like symptoms.

Endometriosis is a chronic inflammatory disorder characterized by the presence of endometrial-like tissue lesions located outside the uterus. This condition can lead to severe and debilitating pain, infertility, and a decreased health-related quality of life for women and girls.

Addressing Diagnostic Delays

A primary goal of the new ACOG guidance is to shorten the time between the onset of symptoms and a formal diagnosis. According to ACOG, diagnostic delay is a critical issue in patient care, with individuals waiting an average of four to 11 years to receive a diagnosis after symptoms first appear.

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With this expanded clinical guidance, we are hopeful that more clinicians will feel comfortable following the evidence to diagnose endometriosis clinically and initiate treatment more quickly when appropriate. Earlier diagnosis can help patients access needed clinical care faster and find help and support through patient education resources and support groups.

Steven J. Fleischman, MD, MBA, FACOG, ACOG President

The guidelines were developed using an a priori protocol and a writing team comprising specialists in obstetrics, gynecology, and reproductive endocrinology and infertility. The evidence base for these clinical considerations included a comprehensive literature search of PubMed, MEDLINE, EMBASE, and the Cochrane Library, as well as an evidence review from the National Institute for Health and Care Excellence (NICE).

Clinical Evaluation and Diagnosis

The updated guidelines provide recommendations for clinical, imaging, and surgical evaluation. While diagnosis has traditionally been achieved through the visualization of lesions, most commonly via laparoscopy, the new guidance encourages clinicians to use evidence to diagnose the condition clinically to initiate treatment more rapidly.

The guidelines utilize a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework to translate evidence into recommendation statements. In cases where formal recommendations could not be made due to nonexistent or inadequate evidence, the document includes Ungraded Good Practice Points.

Understanding the Condition

Endometriosis involves tissue similar to the uterine lining growing in areas where it does not belong. Common locations for these lesions include:

• The ovaries
• The fallopian tubes
• The peritoneum
• The space behind the uterus
• The myometrium (a layer of the uterine wall)

Less common sites for the growth of this tissue include the bladder and the rectum. The presence of this tissue can cause heavy periods, pelvic pain, and fertility issues, sometimes resulting from fallopian tube blockage or scarring.

Management and Treatment Path

Once diagnosed, treatment for endometriosis typically involves medication, surgery, or a combination of both. ACOG is currently developing additional guidance specifically focused on the management of the disorder to complement the diagnostic recommendations released in February 2026.

The release of Clinical Practice Guideline 11 was timed to precede Endometriosis Awareness Month in March, highlighting the urgency of improving access to care for those suffering from the burdensome symptoms of this chronic inflammatory disorder.