The diagnosis of endometriosis still relies on the findings of laparoscopic surgery. Although non-invasive biomarkers could diminish both the time to initial diagnoosis as well as the burden of symptomatic patients to the healthcare system, as well as allow earlier treatment and avoid the risk associated with the invasive procedure, the reliability of proposed biomarkers remains modest. To date, there is neither a single biomarker nor a panel of biomarkers that can be used in the clinical setting. According to international clinical practice guidelines, it is recommended to use transvaginal ultrasound and bimanual vaginal examination as the first line approach for examination of patients with endometriosis-like symptoms, without considering any biomarkers.
Most likely, reliable biomarkers have not been found owing to the insufficient size of study groups and differences in the study design, patients’ characteristics, study methods and data analysis. Also, it is very likely that incomplete knowledge about the nature of the disease and molecular changes occurring inside endometriotic lesions may hinder finding novel biomarkers. Only a detailed understanding about the disease pathogenesis would open up new possibilities to uncover reliable disease-specific biomarkers.