Endometriosis affects about one in ten women, causing intense pain and potentially lowering fertility. Unfortunately, it can take years for a diagnosis, with some women enduring nearly a decade before it’s correctly identified.
This delay largely stems from the fact that the most effective way to diagnose endometriosis is through a laparoscopy—a minor surgical procedure where a camera is inserted to examine the pelvic area and take biopsies. Christine Metz, a professor at the Institute of Molecular Medicine, notes that this method prolongs the diagnosis. Many patients, particularly younger women, might be hesitant to undergo such invasive surgery, not to mention the costs and the missed diagnoses in 10 to 20 percent of cases.
However, there’s hope for change. Research teams, including Metz’s, are working on simpler diagnostic methods. Recently, scientists at the University of Oxford showcased results from a clinical trial involving a potentially groundbreaking test. In this trial, a patient receives an injection that highlights endometriosis during a SPECT-CT scan, a common imaging method used in hospitals.
The injected agent, 99mTc-maraciclatide, attaches to a protein that appears when new blood vessels form—a process that endometrial tissue uses to survive and proliferate. This agent emits radioactive rays detectable by the SPECT-CT, allowing for the identification of endometriosis and its exact location.
Presenting their findings at the World Congress on Endometriosis in Sydney last month, researchers indicated that this light-up dye performs on par with laparoscopy in detecting endometriosis. A spokesperson from Serac Healthcare, the maker of the dye, mentioned that it could illuminate early stages of endometriosis—showing its extent, location, and progression, which are currently only observable during surgery. This advancement could drastically reduce the typical nine-year wait for a diagnosis and even help bypass surgery entirely, potentially rolling out within three years.
Additionally, there’s another innovative test on the horizon: PromarkerEndo, which is a blood test that detects ten proteins related to endometriosis. A study conducted in 2024 involving 805 women showed it could identify severe endometriosis with over 99 percent accuracy and early-stage cases with about 85 percent accuracy. This test is expected to launch in Australia soon, priced between £455 and £720, although its introduction in the UK is still uncertain.
Meanwhile, Professor Metz and her team are investigating menstrual fluid—essentially, the period blood—that includes shed endometrial tissue from women with and without endometriosis. They hope to identify unique differences for a diagnostic test. The great part is this sample can be collected easily and affordably at home, beneficial for both diagnosis and monitoring treatment responses.
Initial studies have already shown that menstrual fluid from women with endometriosis contains distinct stromal cells and increased inflammation. The US team is set to recruit women experiencing endometriosis symptoms who are considering surgery for diagnosis. Metz is optimistic that this test could be widely available in about five years.
The need for improved diagnostic tests couldn’t be clearer. Delayed diagnoses lead to postponed treatments, heightening the risk of disease progression, worsening symptoms, and even permanent damage to organs, as highlighted by Faye Farthing from Endometriosis UK. This delay can significantly impact mental health and affect personal relationships, careers, and education.
In terms of treatment, mild to moderate endometriosis might be managed with anti-inflammatory medications like ibuprofen or contraceptives to suppress estrogen—hormones that promote tissue growth. For more severe cases, surgery to excise the tissue might be an option, but it’s noted that symptoms can return in about 50 percent of cases within five years. Currently, there isn’t a cure.
Recently, the National Institute for Care Excellence approved a daily pill, relugolix-estradiol-norethisterone (brand name: Ryeqo), for patients who haven’t found relief through other methods. This medication targets hormones contributing to endometriosis while providing hormone replacement therapy to preserve bone density and mitigate other effects, essentially inducing a temporary menopause.
Moreover, a second daily pill, linzagolix (brand name: Yselty), was approved in May. It acts by blocking specific hormones to halt the progression of endometriosis, but patients will also need to be on a separate hormone replacement therapy.
