8 Years. That's How Long Women Wait for an Endometriosis Diagnosis. Here's What to Do About It.

Key insights from our webinar with Bal Sagoo, Gynaecologist at Dr Morton's Women's Health Service

— Bal Sagoo, Gynaecologist, Dr Morton's Women's Health Service.

1 in 10 women. 1.5 million in the UK. 176,000 GP appointments made every year by women seeking answers. And still — an average wait of 8 years from first symptoms to diagnosis.

Endometriosis is one of the most common gynaecological conditions in the world, and one of the most misunderstood. This March, for Endometriosis Awareness Month, we hosted a webinar with Bal Sagoo, specialist gynaecologist at Dr Morton's Women's Health service, to give women the knowledge they need to advocate for themselves. Here's what came out of that conversation.

What is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside it — on the ovaries, fallopian tubes, bowel, or elsewhere in the pelvic area, and indeed beyond! Each month, this tissue responds to hormonal changes just as the uterine lining does: it thickens, breaks down, and bleeds. But with nowhere to leave the body, this causes inflammation, scar tissue, and in some cases significant damage to surrounding organs.

It affects women very differently — some experience debilitating symptoms from adolescence, whilst others have few obvious signs. This variability is why it is so frequently misunderstood and misdiagnosed. Many women suffer in silence, believing severe pain is simply part of menstruation. It isn't.

Recognising the Symptoms

The symptoms of endometriosis extend well beyond painful periods, though that is often the starting point. Bal outlined the most common signs to be aware of:

• Chronic pelvic pain — persistent pain in the lower abdomen and pelvis, often worsening before and during menstruation, and sometimes radiating to the lower back and legs

• Painful periods (dysmenorrhoea) — severe menstrual cramps that interfere with daily activities, often accompanied by heavy bleeding and clotting

• Pain during intimacy (dyspareunia) — deep pain during or after sexual intercourse, which can significantly impact relationships and quality of life

• Pain when opening the bowel or emptying the bladder (pooing or weeing), especially during a period

• Persistent fatigue

• Bloating and nausea

• Difficulty conceiving

— Bal Sagoo, Gynaecologist, Dr Morton's Women's Health Service

The Road to Diagnosis

The average diagnostic delay in the UK is 8 years — the result of symptoms that overlap with conditions like IBS or pelvic inflammatory disease, the cultural normalisation of menstrual pain, and historically limited awareness among patients and clinicians alike.

What to Expect at Your Appointment

Bal outlined a typical diagnostic pathway, which usually progresses through four stages:

1. History — A detailed discussion of your menstrual history and pain patterns. A detailed medical history is often all that's needed to start treatment.

2. Symptoms — Questions about how symptoms are affecting your daily life, work, and fertility

3. Examination — A physical examination, including a pelvic exam if appropriate

4. Referral — If initial treatment isn't working, your GP can refer you to a gynaecologist for further investigation

Advanced Diagnostics

For more complex cases, Bal outlined three key investigative tools:

• Transvaginal ultrasound — Helps visualise ovarian endometriomas (sometimes called 'chocolate cysts') and deep infiltrating endometriosis. Non-invasive and readily available.

• MRI scanning — Provides detailed images of soft tissues and can detect endometriosis in areas difficult to see on ultrasound. Particularly useful for surgical planning.

• Laparoscopy (the gold standard) — A keyhole surgical procedure using a small camera to directly visualise and biopsy endometrial tissue. Tissue samples taken during this procedure confirm the diagnosis.

— Bal Sagoo, Gynaecologist, Dr Morton's Women's Health Service

It is entirely reasonable to ask for a referral to a gynaecologist if your symptoms are not being adequately addressed. Advocating for yourself can make a significant difference to the speed of diagnosis.

Understanding Your Management Options

There is no cure for endometriosis, but a wide range of approaches can significantly improve quality of life. Bal emphasised that management should always be tailored to the individual.

Pain Management

• NSAIDs (such as ibuprofen) — anti-inflammatory medications for pain relief

• Paracetamol — regular pain relief for mild to moderate pain

• Prescription painkillers — stronger options for severe pain episodes

• TENS machines — transcutaneous electrical nerve stimulation for drug-free pain relief

  
  

Hormonal Therapies

The guiding principle Bal shared here is simple: stop the bleed, stop the pain.

• The combined contraceptive pill — regulates or stops periods, reducing endometrial tissue growth and inflammation

• Progestogens — available as pills, injections, or intrauterine systems (IUS) such as the Mirena, Levosert, or Benilexa. These thin the endometrium and may stop periods entirely. Dienogest is a progestogen specifically licensed for endometriosis.

• GnRH analogues — create a temporary menopause-like state by suppressing oestrogen production. Typically used short-term. Newer options include Ryeqo (relugolix combined with estradiol and norethisterone) and Yselty (linzagolix).

  
  

Surgical Treatment

• Conservative laparoscopic surgery — removes endometrial tissue whilst preserving reproductive organs. Aims to relieve pain and improve fertility. Recovery typically takes 2–6 weeks depending on the extent of disease.

• Excision vs ablation — excision (cutting out tissue) is generally more effective than ablation (burning), as it removes disease from its root and reduces recurrence rates significantly.

• Hysterectomy — removal of the uterus, sometimes with the ovaries, considered only when other treatments have failed and the patient's family is complete. It is not a guaranteed cure, as endometriosis tissue may remain elsewhere.

  
  

Surgery is most effective when performed by specialist endometriosis surgeons at accredited centres.

Fertility Support

For those whose fertility has been affected, a range of assisted conception options are available and should be discussed with a specialist.

Living Well: Lifestyle and Self-Care

Alongside medical and surgical management, self-care plays a meaningful supporting role for many women. Bal highlighted the following:

• Anti-inflammatory diet — focusing on whole foods, omega-3 fatty acids, fruits, vegetables, and fibre. Limiting red meat, processed foods, caffeine, and alcohol may help reduce inflammation and symptoms.

• Gentle exercise — regular low-impact activities such as walking, swimming, yoga, and pilates. Exercise releases endorphins, reduces stress, and can help manage pain without overexertion.

• Heat therapy — hot water bottles, heating pads, and warm baths provide natural pain relief by relaxing pelvic muscles and improving blood flow.

• Stress management — mindfulness, meditation, and cognitive behavioural therapy (CBT) help manage chronic pain and improve mental wellbeing. Acupuncture may also provide relief for some women.

Looking Forward

Research is advancing, awareness is growing, and diagnosis times are improving. As Bal's closing message put it:

Where to Get Support

If you have symptoms that concern you, or have recently been diagnosed, you do not have to navigate this alone. Bal Sagoo is a specialist gynaecologist at Dr Morton's Women's Health Service — designed to give women fast, expert access to clinical support without the usual barriers.

Take the next step. If you have access to the Adora app:

• Watch the webinar recording: Catch up on the full session with Bal Sagoo.

• Visit Dr Morton's Women's Health Service: Access specialist gynaecology support.

  
  

For further information:

• Further support: Endometriosis UK offers information, helpline support and local networks — endometriosis-uk.org

This article was produced by Adora Digital Health in partnership with Dr Morton's Women's Health Service.

Dr Bal Sagoo is a highly respected Consultant Obstetrician and Gynaecologist, with a specialised focus on general gynaecology, exercise in pregnancy, perinatal mental health, and especially managing problems of the vulvar-vaginal area. Her expertise extends to offering bespoke coaching for women, including pregnant athletes and those seeking to optimise their health during two pivotal life stages—pregnancy and menopause. Dr Sagoo also provides comprehensive management of a wide range of women’s health including pelvic pain and abnormal periods, ensuring personalised care for each of her patients.