The American College of Obstetricians and Gynecologists (ACOG) issued new guidelines in March 2026, Clinical Practice Guideline No. 11 on the diagnosis of endometriosis, which replace the older protocols from 2010 and 2018.[3][5][6] These guidelines recognize a clinical diagnosis based on history, symptoms, and physical examination as sufficient to initiate treatment, without the need for surgical confirmation.[3][5] Endometriosis is suspected in cyclical or non-cyclical symptoms such as chronic pelvic pain, dysmenorrhea, deep dyspareunia, dysuria, or dyschezia.[3] As the first imaging method, they recommend transvaginal ultrasound for high specificity in endometriomas and moderate sensitivity in deep endometriosis; magnetic resonance imaging is used for further characterization.[3] Guidelines do not recommend biomarkers such as CA 125 due to their low accuracy compared to clinical examination.[3] The average delay in the diagnosis of endometriosis is 4 to 11 years from the onset of symptoms, which leads to disease progression and deterioration of quality of life.[3][5] A clinical diagnosis allows empiric drug therapy during further investigation, thereby speeding up pain relief.[5]