NICE recommends two technologies for endometriosis diagnosis

The National Institute for Health and Care Excellence (NICE) has said that two new non-invasive technologies can be used in the NHS to speed up the diagnosis of endometriosis in primary care.

The condition affects around one in ten women of reproductive age in the UK, yet the average time to diagnosis is more than nine years.

NICE’s draft early use guidance recommends two technologies, EndoSure and Endotest, that can be used in the NHS during a three-year period while additional evidence is collected on how well they work.

The tests are intended to support the diagnosis of endometriosis in primary care, where accurate diagnosis can be limited by the availability of other tests and variation in expertise.

Under NICE’s early use programme, promising technologies can be introduced into the NHS while further evidence is gathered before decisions are made on routine adoption.

Dr Anastasia Chalkidou, healthtech programme director at NICE, said: “A diagnosis of endometriosis can for some women take the best part of a decade, with the UK average standing at 9 years and 4 months, and rising to 11 years for those from ethnically diverse communities.

“That delay means 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.

“Our draft guidance reflects our commitment to getting promising innovations to patients quickly, while making sure the evidence to support their wider use is built in a rigorous way.”

Endotest analyses a saliva sample for tiny biological markers called microRNAs, which can indicate whether endometriosis is likely present, with results sent to the treating clinician.

EndoSure detects endometriosis by measuring electrical signals in the gut using sensor pads on the abdomen, after the patient fasts and drinks water during the 45-minute test.

A third technology, DotEndo, requires more research before NICE can recommend that the NHS fund its early use.

The technologies could provide a less invasive and potentially faster way of diagnosing endometriosis without relying on ultrasound operator expertise, potentially enabling earlier decision-making and reducing the need for unnecessary invasive investigations.

Currently, the only way to definitively confirm an endometriosis diagnosis is through diagnostic laparoscopy, but it is invasive, costly, and carries surgical risks.

This surgical procedure is carried out under general anaesthetic, where a surgeon inserts a small camera through a tiny cut in the abdomen to look directly inside the pelvis for signs of endometriosis.

Emma Cox, CEO of Endometriosis UK, said: “For too long, those with endometriosis have faced unacceptable delays in accessing a diagnosis, especially if from ethnically diverse communities, and diagnosis times have been going up, not down, in the last decade.”

“Speeding up diagnosis times is much needed and would be a major step forward in reducing disease impact and supporting those with endometriosis to live well with the disease.

“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.

“This is the perfect opportunity to support Primary Care colleagues with improved understanding of endometriosis, adenomyosis and menstrual health conditions and their symptoms,” she added.