Latest ACOG Guidelines Aim to Accelerate Endometriosis Diagnosis
The American College of Obstetricians & Gynecologists (ACOG) released updated clinical guidance on endometriosis in February 2026, including for the first time comprehensive recommendations on diagnosis. The condition, a chronic inflammatory disorder, affects an estimated 190 million reproductive-age women worldwide 1. Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, leading to pain, infertility, and decreased quality of life 2.
Understanding Endometriosis
Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus. This tissue can cause pain, bleeding, and scarring when it responds to hormonal changes during the menstrual cycle 2. Symptoms commonly include cyclic pelvic pain around the time of menstruation, heavier periods, and cramping 2. Scarring in the fallopian tubes can also lead to infertility and an increased risk of ectopic pregnancies.
Why Diagnosis is Often Delayed
Historically, diagnosing endometriosis has been challenging due to overlapping symptoms with other conditions like irritable bowel syndrome (IBS), ovarian cysts, and pelvic inflammatory disease 3. The definitive diagnosis traditionally required laparoscopic surgery, a barrier that contributed to significant delays – sometimes years – in receiving a diagnosis 3. A majority of endometriosis cases are initially misdiagnosed with other physical or mental health issues 3.
ACOG’s New Guidance: A Shift Towards Earlier Diagnosis
The new ACOG guidance aims to address these delays by recommending initiating treatment based on symptoms consistent with endometriosis, even without immediate confirmation through laparoscopic surgery 4. The guideline emphasizes the use of improved ultrasound modalities for diagnosis as a quicker and less invasive first step 4. The guidance was developed by specialists in obstetrics and gynecology and reproductive endocrinology and infertility appointed by ACOG’s Committee on Clinical Practice Guidelines-Gynecology 5.
Treatment Options
Hormonal contraception is typically the first-line treatment for endometriosis, working to suppress ovarian and endometrial activity and reduce symptoms 2. In some cases, hormonal contraception can even lead to regression of endometriosis. GnRH agonists, another class of medications, can also shut down estrogen production and alleviate symptoms 2.
The Role of Primary Care Physicians
The new recommendations highlight the crucial role of primary care physicians in early recognition of endometriosis. Performing an ultrasound when a patient presents with cyclic pelvic pain is a recommended first step 4. Starting a birth control regimen to manage symptoms is also considered a reasonable approach based on the new guidelines 4.
Looking Ahead
ACOG is developing additional guidance on the management of endometriosis, building on this initial focus on diagnosis 2. These updated guidelines represent a significant step towards reducing the diagnostic delays and improving care for individuals with endometriosis.
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