A new NHS North West pathway aims to improve treatment and cut waits for people with endometriosis.

The pathway, launched in Cheshire and Merseyside, brings together primary care, secondary care and public health to reduce waiting times and recognise the condition earlier.

Endometriosis affects one in 10 women aged 15 to 45 and currently takes an average of eight years to diagnose.

The programme includes new learning resources for healthcare professionals and a renewed focus on raising public awareness of the condition.

Charlotte Martindale, 30, has had debilitating pain, heavy bleeding, nausea, bowel issues and fatigue for years, but her symptoms were attributed to anxiety and depression.

She said: “When I got to university the pain became unmanageable. I really felt as if I wasn’t being listened to and was made to feel like it was all in my head.”

Charlotte was incorrectly diagnosed with polycystic ovary syndrome (PCOS) before eventually being referred to gynaecology.

She says she was told a laparoscopy, the only definitive diagnostic procedure, would not be offered because she was not trying to conceive.

After 14 years of symptoms, an internal ultrasound finally revealed multiple endometriomas.

She was referred to the endometriosis centre in Preston and underwent surgery in 2025, where deep infiltrating endometriosis was found on her bladder, bowel and appendix, and had stuck her ovaries to her pelvic wall.

Although the surgery was successful, Charlotte has been told it is likely further surgery will be needed as the endometriosis regrows.

Data from the NHS Confederation showed that 84 per cent of women reported being dismissed by medical professionals.

Millie Campbell, 20, is still waiting for a formal diagnosis.

She has had heavy, erratic bleeding, pain and severe bloating since she was 12, but she was told she was “too young” to have endometriosis.

“I’ve been on several different contraceptive pills, but none of them have worked,” she said.

“The pain feels like a ball of barbed wire, and regular pain relief just doesn’t touch it.”

After an MRI last year, she is still waiting to find out whether she will be offered a laparoscopy.

Dr Paula Cowan, NHS England North West’s medical director for primary care and national specialty adviser with the women’s team, says the new approach marks an important step forward, but warns that significant challenges remain.

She said: “Early consideration and recognition of endometriosis is key, both in general practice and in the community. The earlier endometriosis is recognised and diagnosed, the better the care the NHS can give.”

“In this new pathway, we’ve looked closely at how engaging with patients and GPs, workforce planning and better use of data can help reduce waiting lists and ensure people get the help they need.”

“Too many women feel that they have not been listened to regarding their heavy, painful periods are normal.”

“From the very first contact with a patient presenting with heavy painful periods, we need to be thinking could this be endometriosis.”

Dr Cowan says the new pathway is part of a wider commitment to improving women’s health across the region.

NICE has updated fertility guidance with a new endometriosis section for people struggling to conceive.

This follows feedback received during public consultation, recognising for the first time that the condition requires its own tailored approach to fertility care, separate from other causes of infertility.

Emma Cox, chief executive of Endometriosis UK, said: “This year’s Endometriosis Action Month theme is ‘Endometriosis Doesn’t Wait’ and our new State of Endometriosis Care report shows just how urgently change is needed.

“With average diagnosis times now standing at 9 years and 4 months, and 11 years for those from ethnically diverse communities, many have already waited far too long by the time they reach fertility services.

Today’s guidance marks a step change in the fertility support that anyone with endometriosis should receive.

“For years, those with endometriosis have told us they felt invisible within the fertility system, grouped with unexplained infertility despite having a diagnosed condition.

“We welcome NICE’s decision to listen to patient voices during consultation, to create a dedicated pathway, and to remove misleading labels like ‘mild’ and ‘severe’ endometriosis.”

“Endometriosis doesn’t wait. And now, at last, neither will the guidance.”

Endometriosis UK and others told NICE during consultation that endometriosis was being grouped with unexplained infertility, despite it being a diagnosed condition.

The committee agreed this was inappropriate and that endometriosis requires a distinct fertility pathway.

Respondents also told NICE that terms such as “mild” and “severe” endometriosis were clinically ambiguous and did not reflect the complexity of the condition or its impact on fertility.

The committee agreed and those terms have been removed from the final guideline.

Under the new recommendations, clinicians will discuss a range of options with patients with endometriosis who are trying to conceive, taking into account individual factors including how long they have been trying to conceive, the severity of their symptoms, their age, their ovarian reserve, which is a measure of remaining egg supply, and any male fertility factors.

The guideline sets out a treatment pathway. Where appropriate, expectant management, meaning time to try to conceive naturally, may be offered, or surgical treatment to address endometriosis, in line with NICE’s existing endometriosis guideline (NG73).

If neither approach is suitable or successful after 2 years, fertility treatment options including intrauterine insemination (IUI), where sperm is placed directly into the womb, or IVF will be discussed.

The new guidance supports the ambitions set out in the NHS 10 Year Health Plan, which commits to shifting care closer to home and empowering patients and professionals to make the best choices about treatment.

Setting out a clear, personalised pathway in the guideline for endometriosis helps ensure fertility services are better tailored to individual need, reducing variation in care and supporting equitable access across England.

Eric Power, interim director of the Centre for Guidelines at NICE, said: “We listened carefully to what patients, clinicians and patient groups told us during consultation.

“They described how complex endometriosis is, how they felt existing labels were misleading, and that the condition needed its own pathway. The committee agreed and acted on that feedback.”

“By creating a dedicated section for endometriosis, we are giving clinicians a clear, evidence-based framework to have better, more personalised conversations with their patients, ensuring that everyone, regardless of the cause of their fertility problems, has access to the right care at the right time.”

Public health minister Sharon Hodgson said: “Every woman with endometriosis deserves fertility care that recognises the complexity of her condition.

“This landmark guidance will ensure women can access a clear, personalised pathway to fertility care that leads to clearer conversations with clinicians and fewer barriers.

“We’re committed to giving every woman the support she deserves, and today’s guidance is a significant step towards ending the inconsistency that has let down too many, for too long.”

Hull landmarks are being lit yellow to raise endometriosis awareness, campaigners say.

Hull City Hall, Hull Minster and Bridlington Spa are among the buildings being lit in yellow from 18:30 GMT on Friday to mark Endometriosis Awareness Month.

Hull-based Hey Endo has called on local businesses, shops and homes to join in by turning their outdoor lighting yellow.

Helen Brewster from the charity said: “If you have any kind of outdoor lighting that can change colour, we’re asking that from the 20th to the 22nd on a night, they can be changed to the colour yellow for endometriosis awareness.”

Brewster was diagnosed with the condition at 17.

“I started my periods when I was nine years old and, ever since, I was struggling with a lot of pain, and a lot of irregularities with them,” she said.

“I am 34 this year, so I’ve been living with endometriosis for a long time.”

“It has a really, really negative effect on my social life, my daily life, and it can be really debilitating and hard to handle.”

She added: “At worst, the condition can leave people unable to even get out of bed some mornings and cause lot of brain fog and confusion.”

A Hull City Council spokesperson said: “We’re proud to light Hull City Hall yellow in support of Endometriosis Awareness Month and to stand alongside those living with this condition.

“Raising awareness is so important in helping people recognise symptoms earlier, access support and feel less alone.

“By working with groups like Hey Endo, we can help shine a light on the experiences of those affected and show our support as a city.”