Endometriosis can cause painful, heavy periods, but it has been hard to diagnose without a surgical exam.
Connecticut Post file
New commercially available blood tests can help diagnose endometriosis without requiring surgery or ultrasound. EndomTest and HerResolve can help some women finally have a definitive diagnosis.
Neither test has been approved by the U.S. Food and Drug Administration, but some gynecologists or fertility specialists might offer them for a patient who has unexplained infertility or does not want exploratory surgery. It’s similar to how some doctors might recommend a commercial genetic ancestry test as a first step toward understanding a patient’s risk factors for certain diseases.
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Endometriosis has been a difficult disease to diagnose, said Dr. Shaun Williams, a reproductive endocrinologist at Illume Fertility in Austin.
“You have to either see endometriosis lesions within the pelvis at the time of a surgery, or biopsy those lesions and send them to the pathology lab, and they say, ‘yes, that’s endometriosis,'” he said.
Endometriosis occurs when cells from the uterus lining escape to other areas of the abdomen through the space between the fallopian tubes and the ovaries. About 10% of women have or have had endometriosis.
Doctors might suspect endometriosis if a woman reports pain during periods, sex or bowel movements, or heavy clotting during her period, but many women who have endometriosis have none of these symptoms.
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A blood test can look for micro RNA that could signify a person has endometriosis.
Jay Janner/American-Statesman
The disease is sometimes only discovered when a woman is having trouble getting pregnant. As many as half of the women who have trouble getting pregnant have endometriosis. Endometriosis causes inflammation that can reduce the egg’s ability to move into the fallopian tube and can lower egg quality. It also can cause scarring in the uterus that makes implantation of a fertilized egg more difficult.
For some women, the new blood tests could help achieve a definitive diagnosis, Williams said.
The new blood tests are looking for two or three types of micro ribonucleic acids (RNA) that are most commonly found in endometriosis, but more than 200 microRNAs can be expressed by endometriosis cells, Williams said.
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Insurance does not yet cover the tests, which means patients would have to pay about $600 to have a blood test done.
Diagnostic surgery is often covered by insurance and it can turn into treatment because a doctor can remove the endometriosis lesions at the same time, Williams said.
For some women, the symptoms don’t require any testing, Williams said. Doctors will prescribe hormones such as birth control to help suppress periods and thin the lining of the uterus. If the symptoms improve, then endometriosis is suspected and is being treated.
“Our professional society, the American College of Obstetricians and Gynecologists, still doesn’t recommend the use of these tests because they don’t provide any better treatment options apart from what we can determine based on exam and history and testing that we have available,” he said.
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Ziwig Endotest, a saliva test being used in Europe, can look for 109 microRNAs, but that test has yet to come to the United States. If the FDA approved that saliva test or an improved blood test that picks up more microRNAs, professional practice guidelines might be changed by the association. That might shorten the average 6.6 years it takes to get an endometriosis diagnosis, according to a 2025 study in the journal PLOS One.