How is the diagnosis made?

Discussion and examination

It all starts with a conversation about your symptoms2. Pain can be assessed using a scale3, and you may be asked whether a close female relative has endometriosis4.

An examination of the abdomen and, if possible and if you agree, a gynaecological examination may be offered5. A normal examination does not rule out the disease6. If a gynaecological examination or a transvaginal ultrasound does not suit you, other options exist7.

Imaging

A transvaginal ultrasound, performed by a trained person, is the first-line imaging test; a pelvic MRI may follow, or replace it if a transvaginal ultrasound is not possible8. Normal imaging does not rule out endometriosis, particularly its superficial forms9. At present, no blood test can make the diagnosis10.

Is an operation needed?

Laparoscopy (a procedure under general anaesthetic to look inside the abdomen with a camera) is no longer considered essential: the diagnosis can be based on symptoms, examination and imaging, and treatment can start without surgery11. It is still discussed in some cases, for example when imaging is normal but symptoms persist despite treatment12. Its role varies between sources: the French sources rule out a laparoscopy performed only to confirm the diagnosis, while the European and British guidelines keep it as an option13.

A saliva test, in France

In France, a saliva test has been covered since 2025 on a temporary basis, as part of a study, as a third-line test, when imaging is normal or inconclusive despite highly suggestive symptoms14. According to the HAS in 2024, its clinical usefulness had not yet been demonstrated15. In Switzerland, the CHUV states that these tests are still being evaluated16.

The main treatment options

To date, no treatment makes the disease go away17. Care aims to provide relief and to preserve quality of life18. It is chosen according to each person's symptoms and priorities, rather than according to the “stage” of the disease1. Endometriosis found by chance and causing no symptoms generally does not need treatment19.

Relieving pain

Painkillers are among the options; long-term use of anti-inflammatory drugs is not recommended because of their side effects20. When pain persists, other approaches can be discussed, including the opinion of a specialist pain service21.

Hormonal treatments

Hormonal treatments, which often stop periods, are one of the main options for pain: combined hormonal contraceptives, progestogens (tablets, intrauterine device, implant) and, as second-line treatment, medicines that put the ovaries to rest22. They have no lasting negative effect on fertility, but are generally not suitable while you are trying to conceive23. The choice takes into account side effects, the treatments already tried and your preferences24.

In France, certain progestogens taken over a long period are the subject of a warning (risk of meningioma): if this applies to you, talk to your doctor, and do not stop the treatment on your own25.

Surgery

Surgery, most often by laparoscopy, is an option, particularly when medical treatments are not enough26. Deep forms, which can affect the bowel, the bladder or the ureters, call for a specialist team27. The benefits, the risks, the effects on fertility and the risk of recurrence must be explained before the operation28. Removal of the uterus may be discussed for people who no longer wish to become pregnant, but it does not necessarily make the symptoms go away29.

Plans for pregnancy and fertility

If you have difficulty conceiving, fertility specialists are involved; depending on the situation, surgery, insemination or in vitro fertilisation may be offered30. If the ovaries are affected, egg freezing may be discussed, even though its real benefit remains uncertain31.

Care involving several professionals

Care is often provided by a team: gynaecologist, radiologist, surgeons, fertility and pain specialists, psychologists, sex therapists, physiotherapists32. Physiotherapy, psychological therapies or acupuncture are sometimes offered alongside other care; in the absence of solid evidence, guidelines disagree on their value33.

Depending on the country

In France, regional networks (filières) coordinate care, up to expert teams34, and enhanced coverage as an “off-list” long-term condition (affection de longue durée) is possible, subject to conditions35. In French-speaking Switzerland, the HUG and the CHUV have multidisciplinary teams; the CHUV states that most of its services are covered by insurance, except certain hormonal medicines36.

Preparing for your appointment

Keeping a symptom diary

Writing down your symptoms for a few weeks helps you describe them and makes them visible37. Each day, you can note:

  • where it hurts and how intense the pain is, from 0 (none) to 10 (the worst imaginable);
  • the days of your period and how heavy the bleeding is;
  • digestive and urinary problems, fatigue, mood;
  • the medicines you took, their effect, and what the pain stopped you from doing.

Bring this diary, the list of treatments you have already tried, your test reports and your questions written down in advance.

Your rights during the examination

In France, the 2025 guideline on imaging asks for the ultrasound to be explained to you and for your consent to be obtained, which you can withdraw at any time without any break in your care relationship. It provides for you to be offered the option of inserting the probe yourself and reminds you of your right to be accompanied by a person of your choice38.

Questions to ask

  1. Could my symptoms point to endometriosis? What other causes should be considered?
  2. Which tests do you suggest, in what order, and who carries them out?
  3. If the imaging is normal, what does that mean for me?
  4. What can be done to relieve my pain while I wait for the results?
  5. What are the benefits and side effects of each option?
  6. Is this treatment compatible with plans for pregnancy, now or later?
  7. Should I see other specialists, or a specialist team near where I live?
  8. What is covered by my insurance?
  9. When should I come back, and what should I do if the pain changes?

For the basics about the condition, see our pointers on endometriosis.

Sources for this page

Each number leads to a neutral statement and to the documents that support it. We summarise these sources in our own words; the links open the original documents.

  1. 1

    Guidelines ask for care to be chosen together with the person, according to their symptoms, priorities, preferences and any plans for pregnancy rather than the stage of the disease, taking into account side effects, individual effectiveness, costs and the availability of treatments.

    Recommendation · checked on 18 October 2026

    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.6.1 and 1.9.1. Accessed on 18 October 2026.
    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Sections “Are hormone therapies effective…?” and “Are surgical therapies more effective than medical therapies…?” (good practice points). Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 6, “Traitement médical”. Accessed on 18 October 2026.
    Back to the text
  2. 2

    Diagnosis begins with a detailed discussion of symptoms (pain, periods and bleeding, associated symptoms); it is supplemented by a clinical examination and by imaging.

    Established fact · checked on 18 October 2026

    Back to the text
  3. 3

    The 2017 French guidelines provide for assessing the intensity and impact of pain using a scale, as well as quality of life, and for an interdisciplinary assessment in the case of chronic pain.

    Recommendation · checked on 18 October 2026

    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 3, “Examen clinique”, “Évaluation de la douleur” and “Évaluation de la qualité de vie”. Accessed on 18 October 2026.
    Back to the text
  4. 4

    Having a first-degree female relative with endometriosis increases the likelihood of having it; the British guideline asks healthcare professionals to ask about this.

    Recommendation · checked on 18 October 2026

    This family history does not justify screening in the absence of symptoms (HAS 2017); genetic tests are reserved for research (ESHRE 2022).

    Back to the text
  5. 5

    An examination of the abdomen and, where possible and accepted, a gynaecological examination are offered to look for signs of endometriosis (nodules, tender areas, cysts), even though the accuracy of this examination for diagnosis is low.

    Recommendation · checked on 18 October 2026

    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.3.5. Accessed on 18 October 2026.
    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Does clinical examination of symptomatic women reliably predict…?” (strong recommendation ⊕○○○). Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 3, “Examen clinique”. Accessed on 18 October 2026.
    Back to the text
  6. 6

    A normal clinical examination does not rule out endometriosis; other tests, including imaging, should then still be considered if the symptoms suggest it.

    Recommendation · checked on 18 October 2026

    Back to the text
  7. 7

    If a gynaecological examination or a transvaginal ultrasound is declined or unsuitable, other options exist: abdominal examination alone and transabdominal ultrasound (British guideline), MRI straight away (French imaging guideline); in adolescents, the acceptability of the examination should be discussed beforehand.

    Recommendation · checked on 18 October 2026

    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.3.6 and 1.5.3. Accessed on 18 October 2026.
    • Actualisation de la place des différents examens d'imagerie pour le diagnostic d'endométriose — Recommandations (new tab) — Société d'imagerie de la femme (SIFEM) and Société française de radiologie (SFR), with the CNGOF — guideline awarded the HAS label (France), May 2025; HAS label approved on 15 May 2025, published online on 4 June 2025. Concerns women over 18. (in French). Passage: p. 8, recommendation 2. Accessed on 18 October 2026.
    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Which diagnostic procedures should be applied in adolescents…?” (good practice point). Accessed on 18 October 2026.
    Back to the text
  8. 8

    Transvaginal ultrasound performed by a trained professional is the first-line imaging test; pelvic MRI is recommended as a second-line test (negative or inconclusive ultrasound after medical treatment has failed), or straight away if transvaginal ultrasound is not feasible, and is also used to prepare for possible surgery.

    Recommendation · checked on 18 October 2026

    2025 French guideline (grades A and B), which concerns women over 18; ESHRE and NICE also recommend ultrasound and MRI.

    • Actualisation de la place des différents examens d'imagerie pour le diagnostic d'endométriose — Recommandations (new tab) — Société d'imagerie de la femme (SIFEM) and Société française de radiologie (SFR), with the CNGOF — guideline awarded the HAS label (France), May 2025; HAS label approved on 15 May 2025, published online on 4 June 2025. Concerns women over 18. (in French). Passage: p. 8–9, recommendations 1 to 3. Accessed on 18 October 2026.
    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are medical technologies reliable in diagnosing endometriosis…?” (strong recommendation ⊕⊕○○). Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.5.2 and 1.5.9. Accessed on 18 October 2026.
    • Qu'est-ce que l'endométriose ? (new tab) — Santé.fr — Service public d'information en santé (French Ministry of Health), Article published on 12 February 2026 (in French). Passage: Section “Le diagnostic”. Accessed on 18 October 2026.
    Back to the text
  9. 9

    A normal ultrasound or MRI does not rule out endometriosis, particularly its superficial forms affecting the peritoneum.

    Recommendation · checked on 18 October 2026

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are medical technologies reliable in diagnosing endometriosis…?” (strong recommendation ⊕⊕○○). Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.5.4. Accessed on 18 October 2026.
    • Actualisation de la place des différents examens d'imagerie pour le diagnostic d'endométriose — Recommandations (new tab) — Société d'imagerie de la femme (SIFEM) and Société française de radiologie (SFR), with the CNGOF — guideline awarded the HAS label (France), May 2025; HAS label approved on 15 May 2025, published online on 4 June 2025. Concerns women over 18. (in French). Passage: p. 8, recommendation 1 (grade B). Accessed on 18 October 2026.
    • L'endométriose — Des réponses à vos questions (new tab) — Geneva University Hospitals (HUG), July 2022, reprinted June 2026 (text predates the 2025 HAS update; some statements differ from the 2022 ESHRE guideline) (in French). Passage: p. 8, “Les étapes du diagnostic”. Accessed on 18 October 2026.
    Back to the text
  10. 10

    Guidelines advise against using markers measured in the blood (such as CA-125), in the endometrium or in menstrual blood to diagnose endometriosis.

    Recommendation · checked on 18 October 2026

    Strong ESHRE recommendation (⊕⊕⊕○), which predates the saliva test evaluated in France since 2024–2025 (see en-endo-test-salivaire-france).

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are medical technologies reliable in diagnosing endometriosis…?” (strong recommendation ⊕⊕⊕○). Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.5.8. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 4, figure 2 (“Pas de dosage biologique”). Accessed on 18 October 2026.
    Back to the text
  11. 11

    Recent guidelines no longer regard laparoscopy as the mandatory reference test: a clinical diagnosis can be based on symptoms and imaging, and treatment can be started without prior surgery, alongside the tests.

    Recommendation · checked on 18 October 2026

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Discussion and section “Does diagnostic laparoscopy compared to empirical medical treatment…?” (conclusion). Accessed on 18 October 2026.
    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Section “Diagnosis”, third paragraph. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.5.1. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 6, “Cœlioscopie”. Accessed on 18 October 2026.
    Back to the text
  12. 12

    A laparoscopy may be discussed when imaging is normal or uncertain although the symptoms suggest endometriosis, or when treatments have not been enough; it is then part of a plan to manage pain or infertility and also makes it possible to treat lesions.

    Recommendation · checked on 18 October 2026

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are medical technologies reliable in diagnosing endometriosis…?” (good practice point). Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 5–6, figure 3 and “Indication de la cœlioscopie diagnostique”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.5.11 and 1.9.4. Accessed on 18 October 2026.
    • Traiter l'endométriose — Médecine de la fertilité et endocrinologie gynécologique (new tab) — Lausanne University Hospital (CHUV), No update date displayed (consulted on 18 October 2026) (in French). Passage: Section “Chirurgie”. Accessed on 18 October 2026.
    Back to the text
  13. 13

    The role of diagnostic laparoscopy differs between sources: NICE (2024) considers offering it even after normal imaging; ESHRE (2022) reserves it for negative imaging or treatment failure; the HAS (2017) rules out a laparoscopy performed solely for diagnosis; the Assurance Maladie (2026) states that it should no longer be considered for diagnosis, except in complex cases; the HUG brochure still presents it as the most reliable method.

    Uncertain · checked on 18 October 2026

    Disagreement between guidelines and information documents; to be settled by the specialist.

    Back to the text
  14. 14

    In France, a saliva test for diagnosing endometriosis has been covered since February 2025 on an exceptional and temporary basis (the “forfait innovation” scheme), as part of a study and in certain facilities, as a third-line test, for patients whose imaging is normal or equivocal but whose symptoms are highly suggestive and disabling.

    Established fact · checked on 18 October 2026

    Status described by the HAS, Santé.fr and the Assurance Maladie; the text of the ministerial order on Légifrance could not be consulted (HTTP 403). Performance figures differ between sources and are not reported here.

    Back to the text
  15. 15

    In January 2024, the HAS recognised the innovative nature and the diagnostic performance of the saliva test, but judged its clinical usefulness not demonstrated and ruled out standard reimbursement at that stage; in October 2024, it issued a favourable opinion on exceptional coverage linked to a study, whose results are to inform a decision on lasting reimbursement.

    Established fact · checked on 18 October 2026

    Back to the text
  16. 16

    The CHUV states that saliva tests have been developed but are still being evaluated, and that further studies are needed to validate their effectiveness.

    Established fact · checked on 18 October 2026

    No position from the Federal Office of Public Health (FOPH) or the Swiss Society of Gynaecology and Obstetrics was found.

    Back to the text
  17. 17

    To date, no treatment makes endometriosis go away; treatments aim to control the symptoms, particularly pain, and to limit the impact of the disease.

    Established fact · checked on 18 October 2026

    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Key facts, fifth point; section “Treatment”. Accessed on 18 October 2026.
    • Qu'est-ce que l'endométriose ? (new tab) — Santé.fr — Service public d'information en santé (French Ministry of Health), Article published on 12 February 2026 (in French). Passage: Section “Les traitements”. Accessed on 18 October 2026.
    Back to the text
  18. 18

    Treatment is considered when endometriosis has an impact (pain, infertility) or impairs the function of an organ; it aims to provide relief, to improve quality of life and, where relevant, to address plans for pregnancy.

    Recommendation · checked on 18 October 2026

    Back to the text
  19. 19

    When endometriosis without symptoms is discovered by chance, the European guideline provides for informing the person, but neither medical treatment nor routine surgery.

    Recommendation · checked on 18 October 2026

    Strong recommendations, very low level of evidence (⊕○○○). The Assurance Maladie mentions monitoring in this case.

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Is treatment beneficial for incidental finding of asymptomatic endometriosis?”. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “Le traitement hormonal de l'endométriose”. Accessed on 18 October 2026.
    Back to the text
  20. 20

    Painkillers, including paracetamol and non-steroidal anti-inflammatory drugs, are among the options for pain linked to endometriosis; prolonged use of anti-inflammatory drugs should be avoided because of their digestive and kidney side effects.

    Recommendation · checked on 18 October 2026

    Weak ESHRE recommendation, very low level of evidence (⊕○○○).

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are analgesics effective…?”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.4.1 to 1.4.3. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 8, “Antalgiques”. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “Quels médicaments antalgiques ?”. Accessed on 18 October 2026.
    Back to the text
  21. 21

    Persistent pain can be amplified by sensitisation of the nervous system; treatments for pain of nerve origin and the opinion of a specialist pain service may then be offered.

    Recommendation · checked on 18 October 2026

    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 3, “Évaluation de la douleur”, and p. 8, “Antalgiques”. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Sections “Le processus douloureux dans l'endométriose” and “Quels médicaments antalgiques ?”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.4.3 and 1.4.4. Accessed on 18 October 2026.
    Back to the text
  22. 22

    Hormonal treatments reduce pain linked to endometriosis; guidelines cite combined hormonal contraceptives and progestogens (including the hormonal intrauterine device and the implant), then, as second-line treatment, medicines that block the activity of the ovaries (GnRH agonists or antagonists), combined with add-back hormone therapy to limit their side effects.

    Recommendation · checked on 18 October 2026

    Strong ESHRE recommendation (⊕⊕⊕○). The sources rank some progestogens differently (HAS 2017: hormonal intrauterine device as first-line, implant and oral progestogens as second-line). ESHRE accepts aromatase inhibitors for treatment-resistant pain; HAS 2017 states that “there are no grounds” for prescribing them.

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are hormone therapies effective for painful symptoms associated with endometriosis?”. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 7, “Traitements hormonaux”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.4.5 to 1.4.7. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “Le traitement hormonal de l'endométriose”. Accessed on 18 October 2026.
    Back to the text
  23. 23

    Hormonal treatments have no lasting negative effect on later fertility, but they are generally not suitable while trying to conceive and are not recommended to improve the chances of pregnancy.

    Recommendation · checked on 18 October 2026

    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.4.5 and 1.10.4. Accessed on 18 October 2026.
    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are hormone/medical therapies effective for treatment of endometriosis-associated infertility?” (strong recommendations ⊕⊕○○). Accessed on 18 October 2026.
    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Section “Treatment”. Accessed on 18 October 2026.
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  24. 24

    The choice of hormonal treatment takes into account contraindications, possible side effects, treatments already tried, effectiveness for the person, cost, availability and the person's preferences.

    Recommendation · checked on 18 October 2026

    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 6, “Traitement médical”. Accessed on 18 October 2026.
    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Are hormone therapies effective…?” (good practice point). Accessed on 18 October 2026.
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  25. 25

    In France, the Assurance Maladie relays a warning from the medicines agency (ANSM) about an increased risk of meningioma with certain progestogens, especially with prolonged use; it advises people being treated to talk to their doctor and not to stop a treatment without medical advice.

    Established fact · checked on 18 October 2026

    According to ameli.fr, the warning concerns two specific progestogens; the ANSM publication was not consulted directly.

    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Box on the ANSM warning (section “Un traitement hormonal de troisième intention”). Accessed on 18 October 2026.
    • Endométriose : suivi médical et vie quotidienne (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (in French). Passage: Section “La surveillance médicale de l'endométriose”. Accessed on 18 October 2026.
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  26. 26

    Surgery, preferably by laparoscopy, is one of the options for reducing pain linked to endometriosis; it is discussed in particular when medical treatments are not enough or in the case of infertility.

    Recommendation · checked on 18 October 2026

    Strong ESHRE recommendation, low level of evidence (⊕⊕○○).

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Is surgery effective for treatment of pain associated with endometriosis?”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.9.3. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 8, “Traitement chirurgical”. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “Le traitement chirurgical de l'endométriose”. Accessed on 18 October 2026.
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  27. 27

    For deep endometriosis, which can affect the bowel, bladder or ureters, guidelines provide for referral to a specialist, multidisciplinary centre or team.

    Recommendation · checked on 18 October 2026

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Is surgery effective…?” (good practice point). Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.5.6. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 9. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “Le traitement chirurgical de l'endométriose”. Accessed on 18 October 2026.
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  28. 28

    Before surgery, the expected benefits, the risks, the possible effect on ovarian reserve and fertility, and the risk of recurrence must be explained; recurrence remains possible after surgery.

    Recommendation · checked on 18 October 2026

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Is surgery effective…?” (good practice point). Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.9.2. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 6, “Information de la patiente”, and p. 8, “Endométriome ovarien”. Accessed on 18 October 2026.
    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Section “Treatment”. Accessed on 18 October 2026.
    Back to the text
  29. 29

    Removal of the uterus, together with removal of visible lesions, may be considered for people who no longer wish to become pregnant and for whom other treatments have not been enough; it does not necessarily make the symptoms or the disease go away.

    Recommendation · checked on 18 October 2026

    Weak ESHRE recommendation (⊕⊕○○).

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Is surgery effective…?” (hysterectomy). Accessed on 18 October 2026.
    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Section “Treatment”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendations 1.9.9 to 1.9.11. Accessed on 18 October 2026.
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  30. 30

    When there is difficulty conceiving, care involves fertility specialists; depending on the situation (age, forms and locations of endometriosis, ovarian reserve, other infertility factors, including in the partner), it may involve surgery, intrauterine insemination with stimulation or in vitro fertilisation.

    Recommendation · checked on 18 October 2026

    ESHRE recommendations mostly weak. The Assurance Maladie (2025) describes a long GnRH agonist protocol before IVF as increasing the chances of pregnancy, whereas ESHRE (2022) no longer recommends it; the HAS (2017) advocated pre-treatment.

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Treatment of endometriosis-associated infertility”. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Section 1.10 (introduction). Accessed on 18 October 2026.
    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Section “Treatment”. Accessed on 18 October 2026.
    • Centre de l'endométriose — Service de gynécologie (new tab) — Geneva University Hospitals (HUG), Page updated on 18 June 2026 (in French). Passage: Section “Un objectif pour chacune”. Accessed on 18 October 2026.
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  31. 31

    In the case of extensive ovarian endometriosis or before surgery on the ovaries, egg freezing may be discussed; its real benefit is not known.

    Recommendation · checked on 18 October 2026

    Strong ESHRE recommendation, very low level of evidence (⊕○○○). The Assurance Maladie describes a more systematic offer (assessment of ovarian reserve and egg freezing for women without children at the age of 30).

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “Is endometriosis an indication for fertility preservation…?”. Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 8, “Endométriome ovarien”. Accessed on 18 October 2026.
    • Traiter l'endométriose — Médecine de la fertilité et endocrinologie gynécologique (new tab) — Lausanne University Hospital (CHUV), No update date displayed (consulted on 18 October 2026) (in French). Passage: Section “Préservation de la fertilité”. Accessed on 18 October 2026.
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  32. 32

    Care is often multidisciplinary (gynaecologists, radiologists, gastrointestinal surgeons and urologists, fertility and pain specialists, psychologists, sex therapists, physiotherapists); guidelines provide for access to a multidisciplinary pain management service.

    Recommendation · checked on 18 October 2026

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  33. 33

    Opinions differ on non-drug approaches: the European guideline considers that it cannot recommend any specific intervention (acupuncture, physiotherapy, exercise, nutrition, psychological interventions…) for lack of evidence, while asking for them to be discussed; the 2017 French guidelines and the Assurance Maladie cite acupuncture, osteopathy or yoga as possible complements; the WHO mentions physiotherapy and cognitive behavioural therapies within a multidisciplinary approach to pain.

    Uncertain · checked on 18 October 2026

    Evidence weak or absent for each of these approaches; NICE advises against traditional Chinese medicine and supplements (1.8.1).

    • ESHRE guideline: endometriosis (new tab) — European Society of Human Reproduction and Embryology (ESHRE) — Human Reproduction Open, Hum Reprod Open 2022;2022(2):hoac009, published on 26 February 2022 (full text read via Europe PMC, PMC8951218). Still presented as the current version on the ESHRE website as of 18 October 2026.. Passage: Section “What non-medical management strategies are effective…?” (good practice point). Accessed on 18 October 2026.
    • Prise en charge de l'endométriose — Messages clés destinés au médecin généraliste (new tab) — Haute Autorité de santé (HAS) and Collège national des gynécologues et obstétriciens français (CNGOF), France, Good practice guideline of December 2017, published online on 17 January 2018 (page updated on 6 December 2018). Imaging section updated in 2025 (see en-endo-has-2025-imagerie). (in French). Passage: p. 8, “Options thérapeutiques non médicamenteuses”. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “D'autres approches pour soulager la douleur de l'endométriose”. Accessed on 18 October 2026.
    • Endometriosis (fact sheet) (new tab) — World Health Organization (WHO), Fact sheet dated 15 October 2025. Passage: Section “Treatment”, penultimate paragraph. Accessed on 18 October 2026.
    • Endometriosis: diagnosis and management (NICE guideline NG73) (new tab) — National Institute for Health and Care Excellence (NICE), Published on 6 September 2017, updated on 11 November 2024, last reviewed on 2 September 2025. Passage: Recommendation 1.8.1. Accessed on 18 October 2026.
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  34. 34

    In France, regional networks dedicated to endometriosis (filières), set up under the national strategy presented in February 2022 and in conjunction with the regional health agencies, organise tiered care, from the regular doctor, gynaecologist or midwife up to expert teams.

    Established fact · checked on 18 October 2026

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  35. 35

    In France, endometriosis is not on the list of long-term conditions (affections de longue durée, ALD), but enhanced coverage as an “off-list” ALD (ALD 31) is possible for forms that impair quality of life, if specific criteria are met (drug treatment and at least two of four criteria).

    Established fact · checked on 18 October 2026

    • Endométriose : définition et facteurs favorisants (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (in French). Passage: Sections “Mise en place d'une stratégie nationale…” and “Critères d'admission de l'endométriose en ALD 31”. Accessed on 18 October 2026.
    • Traitement de l'endométriose (new tab) — Assurance Maladie (ameli.fr), France, Page dated 9 April 2026 (mentions brand names, not repeated here) (in French). Passage: Section “Critères d'admission de l'endométriose en ALD 31”. Accessed on 18 October 2026.
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  36. 36

    In French-speaking Switzerland, the HUG have a multidisciplinary endometriosis centre with a reference nurse, and the CHUV a multidisciplinary team; the CHUV states that most of the services it offers are covered by insurance, with the exception of certain hormonal medicines, and suggests asking the doctor.

    Established fact · checked on 18 October 2026

    Information specific to these two hospitals; coverage depends on the insurer and the policy. No federal source (FOPH) or public document from the Swiss Society of Gynaecology and Obstetrics was found.

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  37. 37

    Keeping a diary of pain and symptoms can make discussions during appointments easier: the British guideline asks for patients to be informed about this, and the European guideline recognises its value for objectifying pain, without evidence that it speeds up diagnosis. The HUG diary suggests recording each day the location and intensity of pain (from 0 to 10), digestive and urinary symptoms, bleeding, other symptoms and the treatments taken.

    Recommendation · checked on 18 October 2026

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  38. 38

    The 2025 French imaging guideline asks for the ultrasound to be explained before it begins, for free and informed oral consent to be obtained, for any withdrawal of consent to be accepted immediately without a break in the care relationship, for the patient to be offered the option of inserting the probe themselves, for the results to be explained to them and for them to be reminded of their right to be accompanied by a person of their choice.

    Recommendation · checked on 18 October 2026

    Recommendations at the “expert agreement” level, applicable in France to women over 18.

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