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Published in on Oct 23rd 2026

Why Is Endometriosis So Hard to Diagnose?

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterus, often affecting the ovaries, fallopian tubes, and other structures within the pelvis. It affects approximately 11% of people of reproductive age in the U.S. and can cause significant pelvic pain, painful periods, and difficulty getting pregnant.

Despite how common endometriosis is, receiving a diagnosis can be surprisingly difficult. In fact, patients can wait up to 11 years before they are confirmed to have endometriosis. Fortunately, advances in diagnostic approaches and updated medical guidelines are helping make it possible to identify and manage the condition sooner.

Why Does Endometriosis Often Go Undiagnosed?

Diagnostic delays stem from several factors.

Symptoms Overlap With Other Conditions

Endometriosis can cause pelvic pain, bloating, nausea, lower back pain, and pain with bowel movements or urination. Many of these symptoms are also shared by other conditions, such as irritable bowel syndrome (IBS), bladder pain syndrome, pelvic inflammatory disease, or ovarian cysts. As a result, patients may undergo multiple evaluations or receive treatment for other suspected conditions before endometriosis is considered.

Severe Period Pain Is Often Normalized

Because menstrual cramps are common, severe period pain is sometimes dismissed as normal. Patients may hear from friends, family, and even health care providers that painful periods are simply something they have to tolerate or manage. Over time, many people learn to downplay their pain or stop mentioning it. This can lead to delays in further evaluation, allowing symptoms to continue affecting a patient's health and quality of life. Although some discomfort during menstruation is normal, period pain that regularly interferes with daily activities should not be ignored.

Diagnosis Has Traditionally Relied on Surgery

For many years, the standard way to diagnose endometriosis was through a surgical procedure called laparoscopy. During this minimally invasive surgery, a physician inserts a small camera through an incision in the abdomen to examine the pelvic organs for endometriosis lesions. Tissue samples may also be collected for examination.

While laparoscopy remains an important diagnostic and treatment option, requiring surgery to confirm endometriosis creates a significant barrier to diagnosis. Due to surgical risks, costs, and recovery time, laparoscopy may be deferred while patients pursue other treatment options. However, the traditional reliance on surgical confirmation has contributed to diagnostic delays and uncertainty for many patients.

How Are Diagnostic Practices for Endometriosis Improving?

In February 2026, the American College of Obstetricians and Gynecologists (ACOG) released updated clinical guidance emphasizing that physicians can make a clinical diagnosis of endometriosis based on a patient's medical history, symptoms, physical examination, and imaging findings. This approach can help patients receive an earlier diagnosis and begin treatment without first undergoing surgery.

The updated recommendations also encourage a more individualized approach to care, allowing patients and their physicians to make treatment decisions together rather than relying on a single diagnostic pathway.

Finding the Right Care for Your Symptoms

If you’ve been living with unexplained pelvic pain or other persistent symptoms, you don’t have to wait years for answers. At Pacific Women's OB/GYN Medical Group, our experienced providers can help you understand what’s causing your symptoms and walk you through your options. We believe in working closely with patients to understand their concerns and build treatment plans tailored to their needs.

If you're experiencing symptoms that may be associated with endometriosis, contact us to schedule an appointment.