New advances in endometriosis diagnosis and care

Ziwig Biotech has developed a new saliva test to determine if a patient has endometriosis and it's 97% accurate.

Close-up view of a medical professional examining an ultrasound image

For millions of women with endometriosis, getting a diagnosis can take years. The disease can be difficult to detect, symptoms can overlap with other conditions and, in some cases, surgery is needed to confirm it. Now, researchers have found that a simple saliva sample could help change that.

Dr. Norbert Nabet, a medical doctor and public health expert who works with Ziwig Biotech, based in France, said the company’s saliva-based test is designed to identify endometriosis by looking at tiny molecules called microRNAs.

MicroRNAs help regulate how genes are expressed. Ziwig’s scientists analyzed the full spectrum of microRNAs found in saliva and used next-generation sequencing, or NGS, combined with artificial intelligence to identify patterns associated with endometriosis, according to Nabet.

“MicroRNA is very robust,” Nabet said, explaining that the molecules are stable and easier to handle than DNA and longer RNA molecules.

The company initially explored samples of blood and other bodily secretions before determining that saliva contained enough information to make the test precise, he said.

Ziwig studied about 2,600 microRNAs in saliva and used samples from roughly 1,000 people in its validation work, according to Nabet. The study included people with confirmed endometriosis as well as control groups, with surgery used to establish whether participants actually had the disease.

The test currently has a reported performance of about 97%, Nabet said, meaning there is still room for false-positive or false-negative results. But he stressed that the test is not intended to replace every other diagnostic tool.

In France, where the test has been used by physicians for more than a year, Nabet said it is considered a diagnostic tool for patients who already have symptoms — not a screening test for the general population.

Doctors can use imaging, and when appropriate, the saliva test to gather more information before deciding what comes next.

That could be particularly important for patients struggling with infertility, Nabet said. Endometriosis can sometimes involve lesions that are difficult to detect, and a noninvasive test could provide doctors with another piece of information without immediately turning to surgery.

The challenge now is access

Ziwig is a relatively small company, and bringing a new diagnostic technology into a market as large as the United States requires significant funding, regulatory work and logistical infrastructure. Nabet said the company has pursued necessary accreditations and hopes the test will become available in the U.S. before the end of 2026. Initially he said it would be available as an out-of-pocket expense.

For now, the test provides a yes-or-no answer about whether the molecular signature associated with endometriosis is present. But Nabet believes the technology could eventually do much more.

Researchers are studying whether the same biological signals could help determine disease severity, track patients over time or even help physicians personalize treatment.