Saliva test could end years-long endometriosis diagnosis delays for women

By Blaise Cloran

A new "game-changing" saliva test will be used in the NHS to help diagnose endometriosis - offering hope to women who face an average nine-year wait.

NICE - the independent body that advises the NHS on treatment - has recommended two new noninvasive diagnostic tests for early NHS use.

The draft guidance issued today (7), says doctors can now use Endotest which analyzes a saliva sample for tiny biological markers called microRNAs, which can indicate whether endometriosis is likely present.

And a second newly recommended test, 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.

The tests will be used and funded by the NHS while researchers collect more data on their effectiveness.

Endometriosis, a painful condition where cells like those in the womb grow in other parts of the body, affects around one in 10 women of reproductive age in the U.K. and the average time to diagnosis is more than nine years.

Currently, it is diagnosed by using a laparoscopy which is carried out under general anesthesia and involves the insertion of a small camera through a tiny cut in the abdomen to look inside the pelvis for signs of the condition.

Announcing the new tests, NICE healthtech program director Dr. Anastasia Chalkidou said: "A diagnosis of endometriosis can for some women take the best part of a decade, with the U.K. average standing at nine years and four 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 noninvasive 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"Our draft guidance reflects our commitment to getting promising innovations to patients quickly, while making sure the evidence to support their wider use is built in a rigorous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."

Ami Robertson, 23, experienced symptoms of endometriosis age 16 but was repeatedly told she had irritable bowel syndrome.

She was finally diagnosed using the noninvasive tests, enabling her to access treatment for the first time.

The Pilates instructor from Glasgow, said: "I spent years being told my pain was something else entirely.

"I started to doubt myself, wondering if it was all in my head. When I finally had the test, it took less than an hour and gave me something I'd never had before: concrete evidence I could take to my doctor.

"For the first time, I was believed, and I could finally get the help I needed. Today my quality of life is night and day compared to before. No one should have to wait years to be believed."

Simran Chavda, 15, began experiencing severe pelvic pain at 13, but repeated GP visits and A&E attendances failed to identify the cause.

Her mother Sharan Uppal, a GP, said having the noninvasive test finally gave them the evidence they needed to push for a referral and, ultimately, a diagnosis of widespread endometriosis.

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Simran from Huddersfield, said: "Getting my diagnosis honestly felt like the best thing in the world.

"The test itself was easy, it wasn't painful at all - just drinking water and being monitored. Really simple. And I'm already starting to feel better after my surgery. I know it's never going to go away completely, but I know I'm not going to be in pain all the time, and that means everything."

Mom Sharan, 46, added: "We were hitting roadblocks everywhere.

"I lost count of how many times I took Simran to the GP. We ended up in A&E three or four times, spending over 10 hours on one occasion, and nobody would take ownership. When the test came back strongly positive, it gave me the empowerment to go back to our GP and push for a referral.

"That test opened doors for us to get Simran the help she needed at a time when NHS waiting times meant we couldn't afford to wait. I would recommend it to anyone."

Symptoms of endometriosis include heavy menstrual bleeding, fatigue, pain when urinating, pelvic pain, difficulty getting pregnant and painful bowel movements.

For Ebony Dowdell, 20, who had periods that lasted as long as four months, it took eight years for her to get a diagnosis and treatment for her endometriosis.

She had a laparoscopy procedure in July 2024 but was still not officially diagnosed until she saw further professionals.

Ebony, from Southampton, had robotic assisted endometriosis excision laparoscopy surgery to remove her endometriosis in April 2025, which cost over £20,000 ($26,800).

She said: "If I had a quicker diagnosis I don't think it would have got to that point.

"If I had been seen quicker and I had a diagnosis, I would have not felt as alone. It is so lonely.

"Having a diagnosis makes you feel human, you know it is not in my head and you are not crazy.

"I think a quicker diagnosis system would make a huge difference to people, younger people would be getting diagnosed earlier too."

Endotest works by analyzing a saliva sample to look for biological markers associated with endometriosis.

The sample is collected and sent to a laboratory for analysis, before the result is then returned to the health care professional to help inform next steps in diagnosis and care.

EndoSure detects endometriosis by measuring electrical signals in the gut using sensor pads placed on the abdomen. Patients fast for six to eight hours beforehand, and during the 45-minute test are asked to drink water until full, helping the device record gut activity accurately. Results are available as soon as the test is complete.

Dr. Gail Busby, consultant gynecologist 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. An earlier diagnosis doesn't just change one person's life, it frees up appointments and surgical slots for everyone waiting for care."

In a survey of over 10,000 women with the condition, over half reported visiting their GP more than 10 times before receiving a diagnosis, according to the All-Party Parliamentary Group.

Both new tests are intended to be used to support diagnosis, referral and management, and are not standalone diagnostic tests.

They should also only be used in women where endometriosis is still suspected despite a normal clinical examination and carried out by a health care professional.