A living atlas about endometriosis · updated 10.07.2026
For people who live with endometriosis, support someone, treat it, or want to understand it. Reviewed medical information, practical guidance, and the limits of evidence in plain sight.
Start with the answer that is useful to you now. Everything else remains within reach.
Understand
The map of lesions and the map of pain do not always overlap. Symptom intensity does not reliably indicate the visible extent of disease.
Signature interaction
Move the slider. An investigation may show part of the disease, while pain may also be influenced by inflammation, adhesions, and nervous-system processing.
Conceptual diagram. The slider position does not measure disease severity.
Important A normal examination or ultrasound does not rule out endometriosis, particularly superficial disease. Surgery is not required before treatment can begin in every case.
Diagnosis
Endometriosis may appear as superficial lesions on the , of the ovary, that infiltrates tissue, or disease outside the pelvis. Location, stage and symptom intensity do not reliably match. Treatment is guided by symptoms, priorities and impact, rather than stage alone.
Underlined terms are explained by tap, keyboard, or when you move the pointer over them.
Sources: NICE NG73opens in a new tab and NICE · consultation 7 Jul 2026opens in a new tab.
When there is suspected or confirmed:
This is the pathway recommended by NICE. Romanian access and referral rules may differ. Source: NICE NG73opens in a new tab.
Options
The plan depends on symptoms, priorities, side effects, access and pregnancy goals. Compare questions, not promises.
Choose up to three options to compare:
| Compare | Hormonal treatment | Surgery | Multidisciplinary care |
|---|---|---|---|
| Can help | May reduce pain and bleeding or suppress periods. It is a common first-line option when pregnancy is not being pursued. | May remove lesions, restore anatomy and improve symptoms in carefully selected cases. | Pelvic-floor physiotherapy, psychological support and pain management may help function, sleep, movement and coping with pain. |
| Limits | Response and adverse effects vary. Contraindications may apply, and ovarian hormonal suppression does not improve fertility. | Pain or lesions may persist or recur. Surgery has risks, and ovarian surgery may affect ovarian reserve. | This is adjunct care and does not remove lesions. The quality of evidence varies between interventions and individuals. |
| Ask | Which option fits my risks and priorities? How long should we try it, and when should we review the plan? | What is the aim of surgery, what experience does the team have, and who treats bowel, bladder or ureter involvement? | Which discipline addresses my symptoms, and which concrete outcomes will we use to measure progress? |
3 options selected.
Combined hormonal contraceptives and treatment with a are common options for pain when pregnancy is not being pursued. are generally later options.
It may be indicated for symptoms, anatomy, an endometrioma or deep disease. Hysterectomy does not guarantee a cure and does not always eliminate pain.
does not improve fertility. or surgery should be discussed individually, with attention to .
Fertility
The plan starts with your current goal. It may remain stable or change over time.
Hormonal options may reduce symptoms, and the goal can be reviewed if priorities change.
Hormonal suppression does not improve fertility. Surgery before assisted reproduction is not an automatic step.
You can discuss options without making an immediate decision about pregnancy or fertility preservation.
Sources: ESHRE 2022opens in a new tab and NICE NG73opens in a new tab.
Real life
A good plan includes life between appointments: work, relationships, your body, your energy and whether you are believed.
A valid goal may be to sleep, go to work, experience intimacy without fear or be able to make plans.
Describe the practical limitation: absences, a need for breaks, toilet access, flexible hours, working from home or modified exertion. Keep a simple record of affected days.
Pain during sex should not be normalised. You can discuss pace, positions, stopping without guilt and pelvic-floor assessment. Consent remains present at every moment.
Persistent pain can affect mood and a sense of safety. Psychological support does not mean the pain is ‘in your head’; it can help the nervous system, coping and quality of life.
Evidence is limited. No diet cures endometriosis. may be discussed for selected digestive symptoms with guidance from a qualified professional; avoid broad restrictions and ‘detox’ promises.
For partners, family, and friends
Good support keeps the affected person in control and turns care into practical help.
You can continue with: ‘What would help you right now?’ Validation does not require an immediate solution.
Ask whether the person wants to be heard, receive practical help, or prepare questions for an appointment.
Attend an appointment only when invited, take notes if asked, and share tasks on difficult days.
Do not pressure decisions about treatment, surgery, pregnancy, food, or sex. Do not compare pain or demand visible proof.
Source: NICE NG73opens in a new tab, sections 1.2 and 1.3.
Support now
You do not have to reconstruct your entire history alone. Choose the next possible step today, then prepare a clearer picture for your appointment.
Reduce today's demands to what is strictly necessary. Use only medication you know you can take safely and ask a trusted person for help.
Note when the pain appears, how long it lasts, which functions it affects, and any connection with periods, sex, urination, bowel movements or exertion.
‘I cannot go to work’, ‘it wakes me at night’ or ‘I avoid sex’ gives the clinician more useful information than an isolated number.
Resources for counselling, community, and a practical next step. Links and contact details were checked on 10 July 2026.
Provides counselling, support, and assistance to people with endometriosis.
Visit the association's websiteopens in a new tabContact and community page, including an email address for enquiries.
See the contact pageopens in a new tabListen without minimising, offer practical help, and ask what is useful before acting.
See the guide for supportersChecked on 10 July 2026. The TelVerde schedule was confirmed by the service on 12 May 2026.
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Research
We label each development by its distance from medical practice. An interesting mechanism is not automatically a test or treatment.
This is a curated selection rather than a systematic review of the entire literature. It includes guidelines, independent assessments, and primary studies selected for clinical relevance, including negative results. The last search date shows when the evidence set was checked; it does not guarantee that every published study is included.
Clinical assessment and imaging can support diagnosis. Laparoscopy remains a diagnostic and treatment option in selected cases and does not have to precede treatment in every case.
The NICE draft dated 7 July 2026 proposes early use of EndoSure and Endotest in the NHS (England's public health service) for 3 years while evidence is generated. DotEndo requires further research. Final guidance is scheduled for 8 October 2026.
In a multicentre case-control study, HerResolve was evaluated as a blood test using a model. The independent retrospective validation included 80 women, 40 with endometriosis and 40 controls. It identified 80% of endometriosis cases and produced false-positive results in 2.5% of controls.
A very large study identified 80 associated genetic regions and possible directions for drug repurposing. The results generate hypotheses, not a clinical test.
A research atlas analysed 466,371 cells from 60 people. Without external validation, the findings describe possible mechanisms, not a clinical test or treatment.
Studies report conflicting results. There is no basis for antibiotics or probiotics as routine treatment for endometriosis.
În studiul de fază 2, nu a demonstrat superioritate față de pentru rezultatul principal. Problemele posibile de limitează interpretarea.
Clinical data are at an early stage. It is too soon to draw conclusions about efficacy, long-term safety, or routine use.
A phase 2 study is interesting for carefully selected patients, but too small to support a routine recommendation.
tailored to endometriosis was evaluated in a 2026 randomised trial that suggests improvements in quality of life and pain. It is complementary support, not a substitute for medical care.
Risk, without alarmism ESHRE estimates lifetime ovarian cancer risk at approximately 1.3% in the general population and 2.5% among people with endometriosis. The absolute increase remains small; the guideline does not recommend additional routine cancer screening solely because of the diagnosis. The cardiovascular association is observational and does not establish causality.
Romania
What the national programme covers, what it leaves out, and what to prepare before contacting a centre.
National programme
The programme introduced in 2023 officially covers patients with deep endometriosis with bowel involvement, documented through medical history, clinical examination, and ultrasound and/or MRI.
The 2026 figures (209 patients per year and an average cost of 6,119 lei per patient per year) are budget-planning indicators, not an amount guaranteed to each patient.
Comunicat CNAS opens in a new tabProviders named in the programme rules
Materna Care SRL in Timișoara and Memorial Healthcare International in Bucharest are named as providers in the National Endometriosis Programme rules. They are not a general list of recommended clinics.
The programme covers minimally invasive interventions for eligible people with deep endometriosis involving the bowel. Being named does not automatically confirm eligibility, an appointment or coverage of every cost.
CNAS announcementopens in a new tab and CNAS regulatory update from 2025opens in a new tab.
The official Romanian guideline dates from 2019. More recent international guidelines also inform the clinical content.
Every term explained on this page, in one place. Each definition matches the one in the text.
Sources
We prioritise guidelines, independent assessments, and primary research. Each date identifies the version reviewed; sources may change later.
Prevalence, symptoms, diagnosis, treatment, and global impact.
Diagnosis, imaging, referral, treatment, and communication.
Guideline from the European Society of Human Reproduction and Embryology (ESHRE): pain, fertility, diagnosis, surgery, and long-term risks.
Living guideline from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), including physiotherapy and nutrition.
Cochrane systematic review: 33 studies and 5,059 participants; certainty varies across comparisons.
The draft proposes early use of EndoSure and Endotest in the NHS (England's public health service) for 3 years while evidence is generated. DotEndo requires further research; final guidance is scheduled for 8 October 2026.
Multicentre case-control study, peer reviewed: 298 participants; the independent retrospective validation included 80 women. Prospective validation is ongoing.
European Medicines Agency (EMA): authorisation status, indication, and safety information for relugolix combination therapy.
European authorisation status and indication for linzagolix.
Romania's National Health Insurance House (CNAS): launch and scope of the programme for deep endometriosis with bowel involvement.
Rules and budget indicators valid through 31 December 2026.
Nearly 1.4 million women, including 105,869 cases; 80 associated regions. Genetic research, not a clinical test.
466,371 cells from 60 people, analysed with methods including AI; an atlas without external validation.
A synthesis of microbiome research; differences in methods and cohorts limit clinical conclusions.
A second study included to keep conflicting findings visible; it does not validate a treatment.
Negative clinical result: gefapixant did not improve pain compared with placebo.
Early data, insufficient for conclusions about routine use.
A small study for selected pelvic spasm; clinical research, not a routine recommendation.
A randomised trial of complementary psychological support and quality of life.
A systematic review of benefits and adverse effects for endometriosis-associated pain.
Official criteria for the programme covering deep endometriosis with bowel involvement.
The official list of devices and medical supplies funded for minimally invasive surgery.
The 2019 Romanian guideline; for current practice, it is read alongside newer international guidelines.
Verified resource for counselling, support, and assistance for people with endometriosis.
Verified contact and community page, including an email address.
Updated aggregator entry for a general emotional-crisis service: 0800 801 200, Friday–Sunday, 16:00–04:00, and sos@antisuicid.ro by email 24/7. The schedule was confirmed by the service on 12 May 2026. It is not an endometriosis-specific resource.
Editorial review of sources: 10 July 2026. Next scheduled review: October 2026, or earlier if a major guideline is published.