NICE recommends new tests for endometriosis in primary care
NICE has conditionally approved the use of two technologies in primary care to speed up the diagnosis of endometriosis, under new draft guidance.
The committee said Endosure and Endotest should be made available in primary care during a three-year period while additional evidence is collected on their effectiveness.
Endotest analyses a saliva sample for microRNAs biomarkers that indicate whether endometriosis is likely to be present.
And EndoSure is a 45-min test which measures electrical signals in the gut using sensor pads on the abdomen.
Both should only be used in primary care where endometriosis is suspected but abdominal and pelvic exams are normal and transvaginal or transabdominal ultrasound is either negative for endometriosis or inconclusive, is declined or not suitable.
They should be used alongside standard clinical practice to support diagnosis, referral and management, and not as standalone diagnostic tests, the committee said.
It currently takes between four to 10 years for a diagnosis of endometriosis with a survey from the All-Party Parliamentary Group on endometriosis finding more than half of women visited their GP more than ten times before receiving a diagnosis, NICE noted.
Delays are associated with late initial presentation, variation in the expertise of traditional diagnostic transvaginal ultrasound in primary care, issues with referral pathways, and long waiting times for gynaecology services, the committee added.
The new approved technologies provide a less invasive, faster approach to receiving a diagnosis without relying on ultrasound operator expertise and could reduce the need for unnecessary invasive investigations such as laparoscopy.
A third technology, a blood test called DotEndo, requires more research before it can be recommended on the NHS, the draft guidance said.
The tests will be funded by the NHS but the companies who developed them will be responsible for organising further evidence collection, and NICE will review progress annually.
Dr Anastasia Chalkidou, healthtech programme director at NICE, said delays in diagnosis leave individuals 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.’
Professor Tom Clutton-Brock, chair of NICE’s diagnostics advisory committee, said the committee had 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.’
Dr Gail Busby, consultant gynaecologist at Manchester University NHS Foundation Trust, said: ‘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.’
Emma Cox, CEO of Endometriosis UK, welcomed the recommendation but added: ‘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.’
A consultation on the guidance is open until 27 July 2026.
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