The average time to clinical diagnosis of endometriosis is nine years. Definitive diagnosis of the disease is difficult, and until recently, has relied on laparoscopic surgery.
Now, as Medscape recently reported, novel clinical recommendations, advanced diagnostic tools and research into inflammation and immune responses, are bringing promise that women with endometriosis will find relief sooner and without surgery, according to experts, including Katie Burns, PhD, University of Cincinnati College of Medicine associate professor.
Endometriosis can develop when endometrial cells escape the uterus and cause lesions to form outside of it, leading to chronic pelvic inflammation. This can result in pain, infertility and decreased quality of life. The World Health Organization estimates that globally 190 million women of reproductive age — nearly 11% of all women — are affected by endometriosis.
Earlier this year, the American College of Obstetricians & Gynecologists (ACOG) released updated clinical guidance, including comprehensive recommendations for the diagnosis of endometriosis. The first-line recommendation replaces laparoscopy for obtaining a clinical diagnosis with “a symptom-based assessment, physical examination or both.” This recommendation is listed as strongly recommended but with low-quality evidence.
The goal of the new guidance is to speed diagnosis, so that endometriosis sufferers can more quickly access treatment and other resources. The guideline also highlights the need for further research into the pathogenesis and pathophysiology of endometriosis to facilitate the development of noninvasive methods that can accurately diagnose it without surgery.
At UC, Burns, a faculty member in the Division of Environmental Genetics and Molecular Toxicology in the Department of Environmental and Public Health Sciences, published work in 2018 showing in an animal model that it is an immune response that actually causes the endometrial lesions to begin. The lesions are driven by estrogen after the initial immune response.
In a follow-up study, Burns and colleagues used samples of menstrual effluent to study neutrophils (the white blood cells that initiate an immune response) in women with and without endometriosis.
Burns said the findings, published in 2025, “indicate that neutrophils are signaling incorrectly in endometriosis and may not be clearing debris as they should be doing.” Morphological changes in white blood cells in menstrual effluent may be a noninvasive endometriosis diagnostic tool, she said.
Burns has a patent pending for a noninvasive endometriosis diagnostic tool.