NONINVASIVE DIAGNOSIS AND PRECISION MANAGEMENT OF ENDOMETRIOSIS IN 2026: ADVANCED ULTRASOUND, MRI ARTIFICIAL INTELLIGENCE, MICRORNA BIOMARKERS, AND FERTILITY-PRESERVING THERAPY

Abstract

Background. Endometriosis is a chronic estrogen-dependent inflammatory and fibrotic disorder associated with dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, bowel and urinary symptoms, infertility, fatigue, and reduced quality of life. Contemporary practice is shifting from routine diagnostic laparoscopy toward a clinical–imaging diagnosis supported by expert transvaginal ultrasound, magnetic resonance imaging, molecular biomarkers, and individualized therapeutic response.

Materials and methods. A structured narrative review was conducted using international guidelines, consensus statements, prospective diagnostic studies, randomized trials, biomarker investigations, and fertility-preservation reviews published through July 2026. Evidence was organized by clinical phenotype, imaging performance, artificial-intelligence support, microRNA testing, hormonal therapy, surgery, ovarian reserve, fertility planning, safety, and implementation.

Results. Expert transvaginal ultrasound and pelvic MRI can diagnose ovarian and deep endometriosis and provide preoperative anatomical mapping, although superficial peritoneal lesions remain difficult to detect. A 2026 MRI artificial-intelligence program improved radiologists’ recall for subtle posterior pelvic plaques from 0.73 to 0.91 in a preliminary reader study, but external prospective validation is still required. A 2025 multicenter study externally validated a saliva-based microRNA signature, supporting the feasibility of noninvasive molecular triage, while heterogeneity among biomarker platforms prevents routine universal adoption. Oral gonadotropin-releasing hormone antagonists reduce dysmenorrhea and nonmenstrual pelvic pain, but hypoestrogenic effects require dose selection and add-back therapy. Surgical decisions should integrate pain, anatomy, fertility goals, ovarian reserve, prior surgery, and procedural risk.

Conclusion. Endometriosis management is moving toward a multimodal precision pathway. Imaging, biomarkers, hormonal response, fertility assessment, and multidisciplinary decision-making should complement rather than automatically replace one another.