New Endometriosis Guidelines Could End Years of Delayed Diagnosis

New endometriosis guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) focus on earlier clinical diagnosis and treatment without surgery, giving hope to the thousands of women who suffer for years without a firm diagnosis.

The old guidelines, dating back to 2010 and 2018, required surgical confirmation – a laparoscopy followed by a biopsy – to diagnose the condition.

The guidelines issued this year support a clinical diagnosis based on a patient’s medical history, symptoms, and physical examination. This will help women receive a diagnosis earlier and, perhaps more important, speed up their access to care.

Stephanie Delgado, M.D., a gynecologist with the University of Miami Health System who specializes in endometriosis, says the changes are welcomed by both clinicians and patients.

 “By the time they come to me, many of my patients have been tormented by pain for years,” she says. “On average, patients wait nine years for a diagnosis, which means nine years without access to care that can alleviate their symptoms.”

That’s one of the reasons why people with endometriosis experience higher rates of mental health issues, including anxiety, depression and trauma‑related symptoms, she adds. One 2025 study, for example, found that 42.5% of the endometriosis patients had clinically significant depression and 51% had anxiety, both strongly linked to inflammatory markers and pain severity.

What is endometriosis?

Endometriosis is a chronic inflammatory disorder that affects the uterus and surrounding areas. It is characterized by endometrial-like tissue lesions that grow outside the uterus.  Though the severity of symptoms can vary, the lesions can lead to scarring, inflammation and pain. The most common symptoms include cramping during periods, painful intercourse, urinary or bowel issues, heavy menstrual flow, unusual fatigue and bloating, and difficulty getting pregnant. There is currently no cure for the condition.

The U.S. Office on Women’s Health estimates that at least 11% of American women, or more than 6.5 million people, have the condition.

International health organizations estimate that about 50% to 80% of women with endometriosis suffer from chronic, long-term pelvic pain that disrupts their lives. In addition, 90% of patients experience gastrointestinal symptoms, including bloating, constipation, diarrhea or nausea during their periods, and almost 68% report having to miss work or school or other function because of the pain.

For women who want to have children, early diagnosis and early treatment also will help them deal with fertility issues. Though many women with endometriosis do conceive, research shows up to 50% of those experiencing infertility actually have the condition. “The longer we wait for treatment, the more damage to the reproductive organs,” Dr. Delgado explains.

Highlights from the 2026 ACOG endometriosis guidelines include:

• Diagnosis. Rather than wait for laparoscopy surgery and biopsy to diagnose the condition, now a clinical diagnosis based on symptoms, physical examination and patient’s history is enough for the start of treatment.
• Imaging. While imaging was once considered secondary to surgery, now a transvaginal ultrasound is considered to be a first-line tool to confirm cases of endometriosis. When deep endometriosis — the most severe form that has burrowed into nearby organs — is suspected, a pelvic MRI is recommended.

Imaging, says Dr. Delgado, is important to rule out other causes for severe menstrual pain and other symptoms. “Historically, ultrasounds have not been good at picking up endometriosis lesions. But it helps us eliminate the possibility of fibroids or a cyst.”

• Treatment. Perhaps the most important (and welcomed) recommendation is the ACOG’s emphasis on starting treatment without waiting for surgery to confirm clinical diagnostic.  In the old guidelines, laparoscopy was considered the diagnostic tool, but now the emphasis has shifted to its effectiveness as treatment. If a patient is undergoing laparoscopy, clinicians are encouraged to treat the lesions immediately during surgery, with no further confirmation of a biopsy.

 It’s important to note, however, that the first-line of treatment is birth control pills, but one-third of patients don’t respond to this therapy, Dr. Delgado says. If this hormonal therapy is not effective, the next step is surgery.

Surgery is not a cure and recurrence of the lesions is common.

Dr. Delgado says that about 50% of younger patients (in their 20s) will experience a return of their lesions.

A hysterectomy is considered a “last-resort” treatment and only under very specific circumstances. Typically, it is when a patient with endometriosis also has adenomyosis, a condition in which endometrial tissue grows on the muscle walls of the uterus. (Removal of the uterus will cure adenomyosis.)

The new guidelines underscore the importance of including patients into the decision-making process of endometriosis care. 

It’s a method Dr. Delgado has always used because “every patient is at a different point in their reproductive journey. If they want children, a hysterectomy is not something they will probably want. But if they don’t want them or already have them, they may have different goals and priorities.”

By directly addressing the obstacles marginalized populations face in receiving diagnoses and accessing care, the 2026 guidelines recommend enhancing medical education and training and continuing the expansion of ob/gyn care to all groups.

Dr. Delgado is hopeful that the new guidelines will bring increased awareness of endometriosis both to the general public and the medical community, particularly doctors who are outside the ob-gyn specialty.

When family doctors are knowledgeable about the condition, they can quickly refer a patient to a specialist.

Seeking prompt help for symptoms is essential for effective and pain-relieving treatment.

“As women, we have to learn to advocate for ourselves. The more knowledge we have, the more power we have.”

Written by Ana Veciana Suarez. Reviewed by Stephanie Delgado, M.D.

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Tags: Dr. Stephanie Delgado, early diagnosis of endometriosis, endometriosis specialist, pelvic pain in women