Endometriosis & Pelvic Pain
PelvPelvic pain can have a significant effect on daily life, exercise, work, relationships and sexual health. It may occur mainly around periods or be present throughout the month.
Endometriosis is an important cause of pelvic pain, although it is not the only possibility. Other causes can include adenomyosis, ovarian cysts, fibroids and conditions affecting the bladder, bowel or pelvic floor.
I am a specialist endometriosis surgeon and a named consultant gynaecologist at the BSGE-accredited Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG) at Ashford & St Peter’s NHS Foundation Trust. My practice includes the assessment and surgical treatment of complex endometriosis as well as the wider investigation of pelvic pain.
My approach is to understand the pattern of your symptoms, investigate appropriately and then discuss treatment based on the likely cause, the impact on your life and your priorities
Investigating Endometriosis and Pelvic Pain
Assessment starts with a detailed history, including the relationship of pain to periods, pain during or after sex, bowel or bladder symptoms, previous treatments and whether fertility is a current or future priority.
Examination may also be helpful, although the findings can be completely normal even when endometriosis is present.
Contrary to popular belief, Endometriosis CAN be diagnosed in the outpatient clinic and does not always require a laparoscopy.
Ultrasound
Transvaginal ultrasound is usually the first imaging investigation when endometriosis is suspected. It can identify ovarian endometriomas, some forms of deep endometriosis and other possible causes of pelvic pain such as fibroids, adenomyosis or ovarian cysts.
A normal ultrasound does not exclude endometriosis.
MRI
MRI scanning can provide additional information where deep endometriosis is suspected or when more detailed mapping is helpful before treatment or surgery.
Specialist pelvic ultrasound and MRI are particularly useful for assessing disease involving areas such as the bowel, bladder, ureters or tissues behind the uterus.
My preference is to not rely on MRI for diagnosing or excluding endometriosis but this will be discussed in detail during your consultation.
Laparoscopy
A laparoscopy is no longer required simply to establish a diagnosis in every patient. Treatment can often be started on the basis of symptoms and imaging.
Laparoscopy may still be appropriate when symptoms persist despite treatment, when imaging is inconclusive, or when surgical treatment is being considered. Endometriosis can normally be treated during the same procedure.
Newer non-invasive diagnostic tests
There is considerable interest in developing non-invasive tests that could help diagnose endometriosis without surgery. Two newer technologies that patients may encounter online are EndoSure and the Ziwig Endotest.
These tests are at different stages of clinical evaluation. Neither replaces a careful clinical assessment or appropriate specialist imaging, and their results need to be interpreted in the context of an individual patient's symptoms and investigations.
EndoSure
EndoSure is a non-invasive test that uses sensors placed on the abdomen to measure patterns of gastrointestinal electrical activity. The developers report that particular electrical patterns may be associated with endometriosis. A published prospective study of 154 women reported high sensitivity and specificity.
Potential advantages
The test is non-invasive, does not require a blood or tissue sample and can produce a result relatively quickly. The initial published results are encouraging, and the concept represents an interesting area of research into non-invasive endometriosis diagnosis.
Current limitations
The evidence supporting EndoSure remains relatively limited. The Royal College of Obstetricians and Gynaecologists has highlighted that the strongest diagnostic performance results currently come mainly from relatively small studies involving the test's developers, rather than large independent studies in routine clinical populations. RCOG currently considers EndoSure an experimental test and recommends cautious interpretation.
In September 2026, after reviewing consultation responses and the available evidence, NICE revised its draft recommendations. EndoSure was not retained among the technologies recommended for NHS use during the proposed evidence-generation programme; NICE concluded that further research is required before it could be considered for NHS funding.
My current approach
For these reasons, I do not currently offer EndoSure as part of my diagnostic pathway. I will continue to review the evidence as independent validation studies become available. I recommend significant caution before considering EndoSure outside of a research project
Ziwig Endotest
Ziwig Endotest is a non-invasive test that analyses a panel of microRNAs in a saliva sample using next-generation sequencing and an algorithm designed to identify a molecular signature associated with endometriosis. It is intended for women aged 18–43 with symptoms suggestive of endometriosis.
Potential advantages
Published studies have reported high diagnostic accuracy, and the test requires only a saliva sample. It may be particularly useful when symptoms remain suggestive of endometriosis despite normal or inconclusive examination and ultrasound findings.
Unlike EndoSure, Ziwig Endotest has now been retained in NICE's September 2026 draft recommendations for use in the NHS during a four-year evidence-generation period in selected patients. NICE specifically proposes its use alongside usual care rather than as a replacement for clinical judgement.
Current limitations
The evidence is promising rather than definitive. RCOG notes that much of the published evidence comes from specialist populations in whom the likelihood of endometriosis was already high, and that further independent validation is needed in broader populations and routine clinical practice.
The test also does not tell us where endometriosis is located or how extensive it is. Specialist ultrasound or MRI may therefore still be required, particularly when deep endometriosis or an endometrioma is suspected and when surgery is being considered.
My current approach
I consider Endotest a potentially useful additional investigation for selected patients — particularly when symptoms remain suggestive of endometriosis despite normal or inconclusive imaging. It should not be used as a substitute for specialist clinical assessment or appropriate imaging.
Please contact me directly to arrange Endotest
Specialist Endometriosis Excision Surgery
Mr Erritty is a specialist endometriosis surgeon and a named consultant gynaecologist at the BSGE-accredited CEMIG Endometriosis Centre at Ashford & St Peter’s NHS Foundation Trust. His surgical practice uses laparoscopic excision techniques rather than ablation of endometriosis.
Medical Treatments
Hormonal Treatments
Options may include the combined contraceptive pill, progestogen treatment or a Mirena® intrauterine system. These treatments aim to suppress or modify the menstrual cycle and reduce endometriosis-associated pain.
The most appropriate option depends on your symptoms, medical history, previous treatment and whether you are currently trying to conceive.
Newer GnRH antagonist treatments
Newer oral GnRH antagonist treatments are now available for selected patients whose symptoms have persisted despite previous medical or surgical treatment.
These include Ryeqo (relugolix combined with estradiol and norethisterone)and Yselty (linzagolix). They can reduce endometriosis-associated pain while avoiding some of the limitations of older injectable GnRH treatments.
Suitability needs to be considered individually, including previous treatment, side effects, contraception and other medical factors.
Laparoscopic Excision of Endometriosis
Surgery may be considered when symptoms remain troublesome despite medical treatment or if there is a preference to avoid hormonal treatment altogether. It is also remains an important option for women where there is an uncertainty regarding the underlying cause of pelvic pain.
Endometriosis surgery is performed laparoscopically using keyhole techniques. Excision techniques are the gold standard and is a routine part of your endometriosis surgery.
Ovarian Endometriosis
Endometriosis affecting the ovary can form cysts known as endometriomas. Management depends on their size, symptoms, previous surgery and fertility considerations. Where surgery is appropriate, ovarian reserve is an important part of decision-making. Ovarian cystectomy, ovarian sclerotherapy and ovarian removal are all valid options but individualised to your circumstances.
Deep or Severe Endometriosis
Deep endometriosis can involve structures including the bowel, bladder or ureters. When this is suspected, careful imaging and surgical planning are particularly important.
Complex cases may benefit from multidisciplinary treatment involving other specialist surgeons where appropriate.
My NHS endometriosis practice is based within a BSGE-accredited specialist centre, where complex endometriosis surgery is undertaken within this multidisciplinary framework
Hysterectomy
Hysterectomy is not itself an excision treatment for endometriosis.
It may nevertheless be appropriate for selected patients where adenomyosis, heavy bleeding or pain arising from the uterus is an important part of the overall problem and future pregnancy is not desired.
Where hysterectomy is undertaken in a patient with endometriosis, any endometriosis requiring surgical treatment is assessed separately and treated using excisional techniques where appropriate.
Endometriosis and Fertility
Endometriosis can sometimes affect fertility, although many patients with endometriosis conceive without difficulty.
If fertility is an immediate priority, this can influence decisions about hormonal treatment, ovarian surgery and whether referral for fertility advice is appropriate.
Finding the right approach
Endometriosis and chronic pelvic pain are not the same for every patient. Treatment may involve medication, hormonal suppression, surgery, management of associated conditions or a combination of approaches.
My aim is to identify the most likely causes of your symptoms and discuss the options in a way that reflects their impact on your life and your priorities for treatment.
A patient perspective
British Vogue contributor Lisa Potter-Dixon has written about her experience of severe endometriosis, complex surgery and hysterectomy.