diagnosis; endometriosis; gynecology; laparoscopy; magnetic resonance imaging; radiography; sonography; ultrasound
Abstract :
[en] Endometriosis affects 1 in 10 women globally. We aimed to determine health provider involvement and preferred methods of obtaining an endometriosis diagnosis across international jurisdictions. A global cross-sectional survey, distributed through formal and informal FIGO Reproductive Medicine, Endocrinology, and Infertility (REI) committee networks from September through October 2024. A total of 445 respondents from 76 countries began the survey, with 360 completions. Of the respondents, 63.9% were female, with most being gynecologists. Academics and/or researchers comprised 6.7%, with 39.2% involved in research in some capacity. Endometriosis was largely diagnosed by gynecologists (95.0%), with most respondents overall describing ultrasound as the most common method of diagnosis (77.8%). Of those surveyed, 93.6% stated clinicians in their country used non-invasive imaging (predominantly ultrasound) to diagnose endometriosis before surgery. One third of respondents did not feel confident distinguishing between routine gynecological scans and specialist endometriosis imaging. Significant barriers for uptake of imaging diagnostics included access to training, cost, and geographical accessibility. Regarding adoption of non-invasive imaging in clinical care, "game-changing" effects were described, including improvements in surgical preoperative mapping, and patient-centered care, with concerns that it could increase clinical workloads. Significantly, shifts in endometriosis diagnosis, from visualization of lesions at laparoscopy to non-invasive imaging diagnostics, were observed internationally. Policies should aim to overcome barriers to uptake of imaging-based diagnostics by supporting training initiatives, reducing associated costs, and improving geographical accessibility. Respondents predicted transformative changes in endometriosis care once non-invasive endometriosis diagnostics are effectively adopted.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Avery, Jodie C ; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
Fragkoudi, Anna ; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
Deslandes, Alison ; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia ; Specialist Imaging Partners, Adelaide, South Australia, Australia
Nelson, Scott M ; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
Henry, Laurie ; Université de Liège - ULiège > Département des sciences cliniques
Bhardwaj, Ajey; Avni Health Foundation, Seattle, WA, USA
Topcu, Elif G ; Department of Obstetrics and Gynaecology, Sisli Kolan International Hospital, Istanbul, Turkiye
Tulandi, Togas ; Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
Malhotra, Jaideep ; Rainbow IVF, Agra, India
Feldberg, Dov ; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
Barnea, Eytan ; Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
Purandare, Nikhil ; Department of Obstetrics and Gynaecology, Galway University Hospital, Galway, Ireland
Mocanu, Edgar ; Rotunda Hospital and RCSI, Dublin, Ireland
Leonardi, Mathew ; Specialized Ultrasound for Gynecology and Ultrasound (SUGO), Hamilton, Ontario, Canada ; McMaster University, Hamilton, Ontario, Canada
Hull, M Louise ; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia ; Embrace Fertility, Adelaide, South Australia, Australia ; Women's and Children's Hospital, Adelaide, South Australia, Australia
FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility
Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256.
Fryer J, Mason-Jones AJ, Woodward A. Understanding diagnostic delay for endometriosis: a scoping review using the social-ecological framework. Health Care Women Int. 2025;46(3):335-351.
Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. Br J Gen Pract. 2007;57(539):470-476.
Armour M, Lawson K, Wood A, Smith CA, Abbott J. The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: a national online survey. PLoS One. 2019;14(10):e0223316.
Pascoal E, Wessels JM, Aas-Eng MK, et al. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. Ultrasound Obstet Gynecol. 2022;60(3):309-327.
Chapron C, Cravello L, Chopin N, Kreiker G, Blanc B, Dubuisson JB. Complications during set-up procedures for laparoscopy in gynecology: open laparoscopy does not reduce the risk of major complications. Acta Obstet Gynecol Scand. 2003;82(12):1125-1129.
Frishman GN, Salak JR. Conservative surgical management of endometriosis in women with pelvic pain. J Minim Invasive Gynecol. 2006;13(6):546-558.
Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;26(2):CD009591.
Mohammadi SD, Moeini A, Rastegar T, et al. Diagnostic accuracy of plasma microRNA as a potential biomarker for detection of endometriosis. Syst Biol Reprod Med. 2025;71(1):61-75.
Bendifallah S, Dabi Y, Suisse S, et al. Saliva-based microRNA diagnostic signature for the superficial peritoneal endometriosis phenotype. Eur J Obstet Gynecol Reprod Biol. 2024;297:187-196.
Schoeman EM, Bringans S, Peters K, et al. Identification of plasma protein biomarkers for endometriosis and the development of statistical models for disease diagnosis. Hum Reprod. 2025;40(2):270-279.
Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the international deep endometriosis analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-332.
Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2:hoac009.
RANZCOG. Australian Living Evidence Guideline: Endometriosis The Royal Australian and New Zealand College of Obstetrics and Gynaecology. 2025 https://ranzcog.edu.au/wp-content/uploads/Endometriosis-Clinical-Practice-Guideline.pdf
Singh SS, Allaire C, Al-Nourhji O, et al. Guideline No. 449: diagnosis and impact of endometriosis – a Canadian guideline. J Obstet Gynaecol Can. 2024;46(5):102450.
Wild M, Pandhi S, Rendle J, Swift I, Ofuasia E. MRI for the diagnosis and staging of deeply infiltrating endometriosis: a national survey of BSGE accredited endometriosis centres and review of the literature. Br J Radiol. 2020;93(1114):20200690.
Grigoriadis G, Roman H, Kalaitzopoulos DR, Christoforidis N, Pados G, Daniilidis A. Diagnosis of endometriosis by transvaginal ultrasound: an online survey of gynecologists Practising in Greece. Cureus. 2023;15(4):e37950.
Crivellaro PS, Rehman I, Chang S, et al. Current practice patterns, challenges, and need for education in performing and reporting advanced pelvic US and MRI to investigate endometriosis: a survey by the Canadian Association of Radiologists Endometriosis Working Group. Can Assoc Radiol J. 2024;75(1):38-46.
Menakaya UA, Hannedege B, Infante F, Lanzarone V, Adno A, Johnson NP. Awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women planning surgery for endometriosis: a survey of RANZCOG fellows and trainees. Aust N Z J Obstet Gynaecol. 2021;61(4):563-568.
Leonardi M, Robledo KP, Goldstein SR, Benacerraf BR, Condous G. International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis. Ultrasound Obstet Gynecol. 2020;56(3):324-328.
Leonardi M, Rocha R, Tun-Ismail AN, Robledo KP, Armour M, Condous G. Assessing the knowledge of endometriosis diagnostic tools in a large, international lay population: an online survey. BJOG. 2021;128(13):2084-2090.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.
Sharma A, Minh Duc NT, Luu Lam Thang T, et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med. 2021;36(10):3179-3187.
Avery JC, Deslandes A, Freger SM, et al. Non-invasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging and artificial intelligence. Fertil Steril. 2023;121(2):164-188.
Condous G, Gerges B, Thomassin-Naggara I, et al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an international consensus statement. Ultrasound Obstet Gynecol. 2024;64(1):129-144.
Guerriero S, Condous G, Rolla M, et al. Addendum to consensus opinion from international deep endometriosis analysis (IDEA) group: sonographic evaluation of the parametrium. Ultrasound Obstet Gynecol. 2024;64(2):275-280.
Deslandes APC, Avery J, Condous G, et al. Are sonographers the future ‘gold standard’ in the diagnosis of endometriosis? Sonography. 2024;11:278-286.
Avery JC, Knox S, Deslandes A, et al. Non-invasive diagnostic imaging for endometriosis part 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography. Fertil Steril. 2023;121(2):189-211.
Shakeri BNB, Reid S, Mongelli M, Condous G. EP27.04: cost-benefit analysis for the use of transvaginal ultrasound to avoid laparoscopy in women with minimal endometriosis disease. Ultrasound Obstet Gynecol. 2016;48(51):378-379.