Endometriosis
Also known as: chronic pelvic pain
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Diagnosis of Endometriosis: ACOG Clinical Practice Guideline
American College of Obstetricians and Gynecologists (ACOG) · 2026 · Clinical Practice Guideline No. 11
ACOG's clinical practice guideline on the evaluation and diagnosis of endometriosis in reproductive-aged adults and adolescents, covering clinical, imaging and surgical assessment. It is explicitly scoped to diagnosis; ACOG has indicated separate management guidance is being developed. Metadata record only.
- Published in Obstetrics & Gynecology 2026;147(3):432-448 (DOI 10.1097/AOG.0000000000006181). source
- Recommendations were developed with a modified GRADE framework, with ungraded good practice points where formal evidence was insufficient. source
- Target population is reproductive-aged adults and adolescents with symptoms suggestive of endometriosis. source
ESHRE guideline: endometriosis
European Society of Human Reproduction and Embryology (ESHRE) · 2022 · 2022 guideline
ESHRE's comprehensive European guideline on endometriosis, covering diagnosis, treatment of pain and of infertility, recurrent disease, asymptomatic and extrapelvic disease, adolescents, postmenopausal women, prevention, and the relationship with cancer. Published open access in Human Reproduction Open. Metadata record only.
- Contains roughly 109 recommendations spanning diagnosis through long-term management. source
- Revises the earlier ESHRE endometriosis recommendations formulated in 2013/2014, with changed positions on the role of diagnostic laparoscopy and on postoperative hormonal therapy. source
- Adds a dedicated section on endometriosis in adolescence. source
US vs EU key differences
- The guidelines converge on the biggest shift in the field: both ACOG and ESHRE abandon diagnostic laparoscopy as a prerequisite, accepting a clinical or imaging-based diagnosis as sufficient to start empirical medical treatment. source
- Both bodies recommend against biomarkers for diagnosis: ESHRE issues a strong recommendation against blood, menstrual or endometrial-tissue biomarkers, and ACOG likewise advises against blood, urine or endometrial biomarker testing. source
- Imaging guidance is more prescriptive in the US: ACOG specifies transvaginal ultrasonography as the initial modality (transabdominal if unsuitable) with pelvic MRI reserved for characterising deep endometriosis, whereas ESHRE recommends ultrasound or MRI without ranking them. source
- Version currency differs: the ESHRE guideline dates to 2022, while the US clinical practice guideline is a 2026 document developed under a modified GRADE framework. source
What changed recently
- EUESHRE endometriosis guideline (2014) → 2022 guideline2022-01-01
The 2022 ESHRE guideline replaced the 2014 version and demoted diagnostic laparoscopy from a gold standard to an option reserved mainly for symptomatic patients with negative imaging. It also revised medical therapy, positioning GnRH antagonists as a second-line option for endometriosis-associated pain while dropping danazol and antiprogestins, and added new sections on adolescents, menopause and fertility preservation.
source ↗curation confidence 90%
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