Advancements in Early Diagnostics for Endometriosis
Reviewed by: HU Medical Review Board | Last reviewed: December 2025 | Last updated: December 2025
Key Takeaways:
- Salivary microRNA testing yields >90 percent diagnostic accuracy, reducing reliance on diagnostic laparoscopy.
- Advanced transvaginal ultrasound protocols now effectively characterize deep infiltrating endometriosis and pouch of Douglas obliteration.
- Emerging "liquid biopsies" using menstrual effluent and plasma proteins promise rapid, non-invasive screening.
The average time to diagnose endometriosis ranges from 7 to 9 years. This delay results in prolonged patient suffering, disease progression, and increased healthcare costs.1
The gold standard for diagnosis has long been laparoscopic visualization with histological confirmation. However, reliance on surgery creates significant barriers to care. Recent advancements now allow clinicians to diagnose endometriosis with high accuracy using non-invasive methods. This shift from surgical to clinical diagnosis represents a fundamental change in gynecologic practice.2,3
Salivary microRNA signatures
A breakthrough in non-invasive diagnostics is the identification of salivary microRNA (miRNA) signatures. MicroRNAs are small non-coding RNA molecules that regulate gene expression. They are stable in body fluids and reflect the pathophysiological state of the disease.3
The Ziwig Endotest represents the first commercially available saliva-based diagnostic tool. It analyzes a signature of 109 specific miRNAs combined with artificial intelligence modeling. However, it is not yet approved by the US Food and Drug Administration (FDA).4
Recent multicenter validation studies demonstrate high diagnostic performance. A 2025 validation study reported a sensitivity of 97.3 percent and a specificity of 94.1 percent for detecting endometriosis. This exceeds the diagnostic accuracy of conventional imaging for early-stage disease.4
The test can differentiate between patients with endometriosis and those with other pelvic pathologies. This tool allows for earlier intervention without the risks associated with laparoscopy.4
Advanced imaging protocols
Transvaginal ultrasound (TVUS) is now the first-line imaging modality for endometriosis. Historically, ultrasound was thought to only detect ovarian endometriomas. Updated protocols allow sonographers to identify deep infiltrating endometriosis and superficial markers.1,5
Recent data confirms that TVUS performed by an experienced clinician has a sensitivity of 79 to 94 percent for rectosigmoid lesions. This is comparable to magnetic resonance imaging (MRI). MRI remains useful for mapping complex deep lesions and assessing lateral compartments before surgery. However, TVUS offers a cost-effective and accessible alternative for initial assessment.5
Menstrual effluent analysis
Menstrual blood testing is an emerging frontier in diagnostics. Menstrual effluent contains endometrial tissue and immune cells that flow retrograde into the peritoneal cavity. This fluid provides a "liquid biopsy" of the uterus.6
Additionally, research focuses on stromal fibroblast cells in menstrual effluent. These cells in patients with endometriosis show impaired decidualization compared to healthy controls. This phenotypic difference serves as another potential diagnostic marker.6
Emerging blood biomarkers
Serum biomarkers have historically lacked the sensitivity required for clinical use. New proteomic approaches are identifying more robust panels. A 2025 study identified and validated a novel panel of 10 plasma protein biomarkers that demonstrated strong predictive accuracy for diagnosing the condition.7
A rapidly evolving diagnostic landscape
The diagnostic landscape for endometriosis is rapidly evolving. The reliance on diagnostic laparoscopy is diminishing in favor of molecular and imaging-based techniques.
Salivary miRNA testing and advanced TVUS protocols now offer high sensitivity and specificity. Emerging technologies like menstrual effluent analysis may offer even faster point-of-care options. Clinicians may be focusing on advanced transvaginal ultrasound protocols now, but the near future promises more non-invasive tools for early identification of endometriosis.1,4-7