Endometriosis as a systemic disease, with Hugh Taylor, MD

ACOG's new guidance permitting a clinical, nonsurgical diagnosis of endometriosis represents an important advance that can shorten diagnostic delays and get patients treated sooner, according to Hugh Taylor, MD, Chair, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine.

Per ACOG, Clinical Practice Guideline No. 11, “Diagnosis of Endometriosis,” published February 2026, includes for the first time comprehensive recommendations on diagnosis, recommending a symptom-based assessment, physical examination, or both to establish a presumptive diagnosis rather than relying solely on surgical findings. Diagnostic delay is a longstanding problem, with patients waiting an average of 4 to 11 years from symptom onset to diagnosis. Endometriosis affects an estimated 10% of women of reproductive age.

Taylor framed the change as overdue.

“This is a disease that historically has taken a long time to diagnose. Often, it's 7 to 10 years between the time someone has endometriosis-related pain and when it's actually diagnosed,” he said, attributing much of the delay to the prior requirement for surgical proof.

Listening to patients

Taylor said clinical judgment is often sufficient to identify the disease.

“If we simply listen to our patients, they will tell us that they have endometriosis, maybe not use that term, but describe the classic cyclic pelvic pain that progresses over time, which is most commonly endometriosis,” he said.

Because first-line treatment is typically an accessible option, earlier diagnosis can be transformative, Taylor noted.

“Since the first-line treatment is usually a birth control pill, something very easy, simple, and inexpensive, to diagnose it clinically and start treatment earlier will really help turn around the lives of a lot of these young women,” he said, adding that cyclic, progressive pelvic pain first presenting as dysmenorrhea likely indicates endometriosis.

A systemic disease

Taylor emphasized that endometriosis extends well beyond pelvic pain, affecting multiple organ systems including the brain.

“Women with endometriosis are much more likely to have bowel symptoms and bladder symptoms, but also mental health symptoms as well,” he said, noting depression and anxiety are more common in this population.

He described a direct biological mechanism rather than a purely reactive one. “There is a direct effect of endometriosis on the brain, that the inflammation and other ways that endometriosis signals the brain lead to changes in the brain that can cause depression and anxiety,” Taylor said. “This is not patients who are anxious and depressed and complaining. This is actually a consequence of this disease.”

He characterized endometriosis as systemic, affecting the brain, liver, adipose tissue, and blood vessels. “This is not just a disease of the pelvis,” Taylor said.

Reference:

1. Committee on Clinical Practice Guidelines–Gynecology. Diagnosis of endometriosis: ACOG clinical practice guideline no. 11. Obstet Gynecol. Published online February 19, 2026. Accessed September 11, 2026. doi:10.1097/AOG.0000000000006181