> ## Content Index > Fetch the complete content index at: https://www.mikebakerhq.com/llms.txt > Use this file to discover other available public pages before exploring further. # The Rule Changed in March. Most Clinics Have Not. - URL: https://www.mikebakerhq.com/endometriosis/acog-2026-diagnosis-guidance/ - Published: 2026-09-23T10:18:32.000Z - Updated: 2026-10-03T06:30:23.000Z - Description: In March, ACOG said a doctor no longer has to confirm endometriosis surgically before treating it. That moves the work into primary care, in a state short on specialists. A health center CEO and endo dad on what the change actually asks of a clinic. - Author: Mike Baker - Tags: Endometriosis, Human First In March, the American College of Obstetricians and Gynecologists published new clinical guidance on diagnosing endometriosis. The headline is short enough to fit in a sentence. A doctor no longer has to cut a woman open to confirm the disease before treating her. A clinical diagnosis is now enough to begin management. For anyone who has watched a woman in their own family wait years for an answer, that sentence is worth reading twice. I run community health centers in North Idaho. I have been in community health since 1999\. My wife has endometriosis. My daughter has endometriosis, and it took two years from the time she first said something was wrong to the time anyone wrote the word down. I want to be precise about what that means, because it is the part people skip. I am not describing a family that could not get in the door. I am describing a family with a health center CEO in it. So when I say the new guidance matters, I am not saying it because it is new. I am saying it because I know exactly where the two years went, and the guidance lands on that spot. The EndoDad Letter · From a dad who believes you Every week, one useful thing for living with endometriosis, plus a short piece to pass on to the people around you. Free, and it opens the Resource Library. Email address Send me the next one You’re in. Check your inbox to confirm. ## Where the delay actually happens The World Health Organization puts the average time to a diagnosis at somewhere between four and twelve years, for a disease affecting roughly ten percent of women of reproductive age, about 190 million people. A French cohort of nearly seven thousand patients, published in the Journal of Women's Health earlier this year, found an average delay of ten years. A UK survey of more than three thousand women, published in March, found an average of nine years and four months, and noted that the number has been getting worse rather than better. Those are the numbers people quote. Here is the one that almost nobody quotes. The largest multi-country study of this question, across sixteen centers in ten countries, found the delay concentrated in primary care. Not in the operating room. Not in the specialist's schedule. In the exam room where a woman first says the words out loud. That is my building. That is my staff. I am not pointing at somebody else's failure here. Under the old pathway, a family physician who suspected endometriosis was in an awkward position. The definitive answer required surgery, surgery required a referral, and the referral required a gynecologist. Idaho has been losing OB-GYNs for years, which pushes more and more gynecologic care onto family medicine physicians who were trained to refer it out. So the clinician suspects, cannot confirm, does not want to commit to a diagnosis they cannot prove, and writes something softer in the chart. Try this birth control. Let's see how you do. Come back in six months. Six months, six more times, is three years. ## What the change actually asks of us The new guidance removes the excuse. If the history and the exam point at endometriosis, treatment can start. The surgical question becomes a separate question, asked later, for its own reasons. Tissue confirmation still requires a biopsy taken at surgery, and that has not changed. What has changed is that confirmation is no longer the gate a woman has to walk through before anyone will help her. This is a good change. It is also a transfer of work. It moves the diagnostic burden from the specialist to the primary care clinician, which is to say it moves it onto the people I employ, in a state that is short on the specialists they used to lean on. A guideline does not do that work by itself. A guideline published in a journal changes nothing in a clinic in Bonners Ferry unless somebody carries it there. That is an operational problem, not a medical one, and it is the kind of problem health center leadership exists to solve. What it looks like in practice is unglamorous. Whether your intake forms ask about pain with periods at all. Whether a sixteen-year-old who says her cramps make her miss school gets that written in the chart as a symptom or as a note about school attendance. Whether your clinicians know the guidance changed. Most of them do not yet. It came out six months ago and it did not make the news. ## The thing I cannot stop thinking about Buried in that UK report is a line from a woman describing how she finally got taken seriously. She said doctors only really listened when she mentioned the effect her pain was having on her male partner's life, and that they only really listened once she started bringing him to appointments. I have read that sentence probably thirty times now. It is a damning thing to know about your own profession. It is also, if you are a husband or a father, a job description. If your presence in that room changes what happens in that room, then you should be in that room, and you should understand that your only useful function there is to make her harder to dismiss. Not to speak for her. Not to translate. To sit there and be one more person who does not think she is exaggerating. I would rather the system did not work this way. It does. My daughter waited two years inside a system I help run, and I did not know enough to shorten it. ## What I would ask of the people who read this If you are a clinician, look up the March guidance. It is short. Then look at your own intake process and ask whether a woman with this disease would be found by it or missed by it. If you are a health center leader, this is a training item and a workflow item, and it will not happen because the journal published it. Somebody has to put it on an agenda. If you are a husband or a father, go to the appointment. Know the timeline, in dates, because she has told it so many times to so many people that it has worn smooth. And if she is told to wait and see, ask what specifically you are waiting to see, and how long, and what happens if it does not change. That one question, asked out loud by somebody who is not the patient, does more than it should have to. I wrote out [exactly what to do in that room](https://www.mikebakerhq.com/endometriosis/at-the-appointment/), because nobody had. Believe her the first time. The cost of being wrong in that direction is almost nothing. The cost of being wrong in the other direction is my daughter's twenties. Mike Baker is the chief executive of a community health center organization in North Idaho and has worked in community health since 1999\. He is the author of [Believe Her the First Time: A Father's Guide to Endometriosis](https://www.mikebakerhq.com/endometriosis/fathers-guide/) and hosts the podcast [Still Here, Still Trying](https://www.mikebakerhq.com/podcast/). His earlier piece for clinicians, [Women's Health in Primary Care Needs Continuity, Not Visits](https://kevinmd.com/2026/09/womens-health-in-primary-care-needs-continuity-not-visits.html), ran in KevinMD. Sources for the figures on this page American College of Obstetricians and Gynecologists, Clinical Practice Guideline No. 11, "Diagnosis of Endometriosis," Obstetrics & Gynecology, March 2026 (announced February 2026): clinical diagnosis is sufficient to initiate empiric medical treatment; histopathologic confirmation still requires biopsy at surgery. World Health Organization, Endometriosis fact sheet, 15 October 2025: 4 to 12 years; about 10%, 190 million. Breton Z et al., ComPaRe-Endometriosis cohort (about 6,950 participants), Journal of Women's Health, February 2026: 10 years for endometriosis, 11 for adenomyosis. Endometriosis UK, "The State of Endometriosis Care in the UK," 2 March 2026, 3,075 respondents: 9 years 4 months, worsening; partner quote on page 5\. Nnoaham KE et al., WERF Global Study of Women's Health, Fertility and Sterility 96(2):366-373, 2011, 1,418 women across 16 centers in 10 countries: 6.7-year delay, principally in primary care. Idaho OB-GYN losses: JAMA Network Open study reported by Boise State Public Radio, 5 August 2025 (268 to 174, 35%); Wyoming Public Media, 8 August 2025.