Endometriosis Should Not Remain Hidden for Years – Ziwig Endotest Brings the Diagnosis to Light

1. Dr. Chapanova, endometriosis often remains undiagnosed for years. Why does this happen, and what are the consequences for patients?

Endometriosis is a chronic condition that can present with a variety of symptoms—dysmenorrhea (severe menstrual pain), chronic pelvic pain, dyspareunia (pain during intercourse), or infertility (difficulty conceiving). Unfortunately, many women accept these symptoms as “normal” for a long time and do not seek specialized care.

Due to its highly non-specific symptoms, the diagnosis is often delayed. Worldwide, the average time to receive the correct diagnosis is between 7 and 10 years.

During this period, the disease may progress rapidly and is often discovered only after the onset of chronic pain, reduced quality of life, and in many cases, compromised fertility.

That is why medicine is actively seeking new, revolutionary, and earlier diagnostic solutions. Ziwig Endotest is one of the most innovative developments in this field because it enables detection of the disease at a very early stage—and in a non-invasive way.

At “Nadezhda” Hospital, we always strive to stay aligned with the latest medical innovations and to provide our patients with the most advanced diagnostic opportunities. That is precisely why, for the first time in Bulgaria, this test is being offered here. Our focus is on early non-invasive diagnosis and reducing the years of suffering many patients endure before receiving an accurate diagnosis.

2. Tell us more about Ziwig Endotest. What exactly is this test?

Ziwig Endotest is an innovative molecular test developed for the non-invasive diagnosis of endometriosis.

Unlike conventional methods, which rely on imaging studies or surgical procedures such as laparoscopy, this test uses a saliva sample to analyze specific molecular markers associated with the disease.

Through advanced genomic technologies, characteristic molecular “signatures” linked to endometriosis can be identified.

The method was developed based on the analysis of 109 microRNAs in the saliva of patients, and with the help of artificial intelligence, a specific disease “signature” is detected.

The reliability of the test has been established through a series of multicenter prospective blinded studies, confirming its specificity.

3. How does this test differ from standard diagnostic methods?

Its greatest and most important advantage is that it is non-invasive and can diagnose endometriosis at a very early stage.

Imaging methods such as ultrasound or MRI are extremely valuable, but in some cases—especially in early stages or when lesions are smaller than 1 mm—they may become less reliable.

In certain situations, the final diagnosis is established through laparoscopy, which is still a surgical procedure and has long been considered the “gold standard.”

Endotest makes it possible to perform a molecular analysis at the first suspicion of disease, supporting the diagnostic process without invasive intervention.

This approach is truly groundbreaking because it shifts the paradigm from “surgery for diagnosis” to “molecular diagnostics for diagnosis.”

4. How does the procedure work for patients who wish to take the test?

The procedure itself is extremely simple.

The patient provides a saliva sample, which is then sent for specialized laboratory analysis.

This means there is no pain, no surgical intervention, and no recovery period.

That is what makes the test highly convenient, fast, and gentle for patients.

5. How reliable is the test?

Clinical studies show very high diagnostic accuracy—sensitivity >97% and specificity >93%—which is why Endotest has attracted serious interest in scientific circles and is regarded as one of the most promising innovations in endometriosis diagnostics.

Of course, results are always interpreted in the context of the clinical examination and the patient’s symptoms.

Every result should be discussed with the attending obstetrician-gynecologist in order to determine a personalized approach.

6. For which women would you recommend this test?

The test is particularly useful for women between 18 and 43 years of age who experience symptoms suggestive of endometriosis, such as:

• severe menstrual pain;
• chronic pelvic pain;
• pain during intercourse;
• difficulty conceiving;
• pain during bowel movements;
• long-term complaints without a clear diagnosis;
• unexplained infertility;
• lower back pain;
• leg pain;
• fatigue;
• endo belly (abdominal bloating).

7. How can early diagnosis change treatment outcomes?

The earlier the disease is identified, the sooner adequate treatment and symptom control can begin.

This means better pain management, lower risk of disease progression, and improved chances of preserving fertility.

Modern pharmacology now offers oral medications for endometriosis treatment that improve quality of life and help control pain syndrome.

It is also important to highlight the significance of early diagnosis in adolescence.

Studies show that up to 38% of girls with severe pelvic pain and dysmenorrhea are later diagnosed with endometriosis.

Introducing this test can simplify the diagnostic process, prevent complications, and preserve fertility in many young patients.

It is important to note that its use is approved for women aged 18 and above.

8. What are the risks to fertility when endometriosis remains undiagnosed for years?

When endometriosis remains undiagnosed for years, it can seriously affect a woman’s fertility.

Chronic pelvic inflammation can lead to adhesions between the ovaries, fallopian tubes, and other organs, making egg transport and fertilization more difficult.

Even when the fallopian tubes remain open, endometriosis can alter their peristalsis and impair normal function.

In more severe cases, ovarian reserve may decline, egg quality may worsen, and ovulation may be disrupted.

Endometriosis also affects the body’s immune balance, reducing the chances of successful implantation and pregnancy.

Chronic pain and hormonal imbalance further reduce quality of life and may interfere with normal sexual activity during reproductive years.

All of this increases the risk of difficulty conceiving, miscarriage, and reproductive complications.

That is why early diagnosis through the non-invasive Endotest is extremely important—it allows timely treatment, protects ovarian reserve, and significantly improves the chances of a successful pregnancy later on.

9. What would you say to women who have lived with pain for years but still do not have a diagnosis?

It is important for women to know that severe pain is not a normal part of the menstrual cycle and should not be accepted as something they simply have to live with.

Today, medicine offers new diagnostic opportunities that can significantly shorten the path to diagnosis.

At “Nadezhda” Hospital, we believe that access to modern diagnostic technologies is key to better patient care.

That is why we introduced this test for the first time in Bulgaria—with the clear goal of helping more women receive a timely diagnosis and breaking the years of pain and uncertainty experienced by so many patients with endometriosis.

Do not accept pain as normal—you have the right to know.