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Science

The science behind Emenla.

What the published evidence says about endometriosis, the years it takes to be believed, and what a record kept in your own words can do. Every claim on this page has a source.

What the evidence says · Sources at the end of the page

A common disease, a long wait, and a diagnosis that no longer needs surgery.

Endometriosis affects roughly one in ten women and girls of reproductive age, around 190 million people worldwide.[1] The lesions can sit on the ovaries, the peritoneum, the bowel or the bladder, and the pain they cause does not track their size.[10][11]

The wait for a name is long. Studies across Europe and the United Kingdom put the delay between first symptoms and a diagnosis at several years, commonly between four and eleven,[5][7][8] and a large part of that delay is symptoms being treated as normal, by the person and by the clinician in front of her.[6][15]

The diagnosis itself has changed. The European guideline of 2022 no longer treats laparoscopy as the required first step,[2] a position specialists had argued for as a call to action in 2019,[13] and in 2026 the American College of Obstetricians and Gynecologists said a clinical diagnosis made from symptoms, history and an examination is enough to begin treatment.[4] The history is the evidence. That is what a record is for.

10%

of women and girls of reproductive age are affected worldwide, by the World Health Organization's estimate. [1]

190 million

people living with endometriosis, the same estimate. [1]

4 to 11 years

the delay between first symptoms and a diagnosis that studies commonly report. [5][7][8]

No surgery

is required first: a clinical diagnosis from symptoms, history and examination is enough to begin treatment. [2][4]

What that means for a record.

Your words first.

People with endometriosis struggle to make their pain understood in the clinic; the language available to describe it fails them, and the failure costs time.[14][15] Emenla keeps the sentence you actually wrote and prints the clinical term beside it, with its source, so the match can be checked at a glance.

Counted, never predicted.

The guidelines describe endometriosis pain by its pattern over time: cyclical, chronic, with periods, with sex, with the bowel.[2][3] Emenla counts what you logged against the periods you logged and reports the count. It forecasts nothing.

Honest by design.

Emenla is a record-keeping app, not a medical device. It has not been studied in a trial and no clinician has reviewed its term list yet. This page cites the evidence about the disease and about what helps a diagnosis. It makes no claim about what the app does for your health.

Beyond the record: what we have not done.

Where a device company would show you its validation study, we can only show you the standard we hold ourselves to. The clinical terms in Emenla come from three published guidelines, each cited inside the app.[2][3][4] The quality-of-life and cost burden of the disease is documented in large multicentre studies.[9][17] Health data is special category data under GDPR, which is why nothing you write leaves your phone.[21]

Read the sources

Emenla has not been studied in a clinical trial. No clinician has reviewed it. It does not diagnose, treat or predict anything, and nothing on this page is a claim about the app's effect on your health. If any of that changes, this page will say so, with a source.

Guidelines we follow

Three guidelines, cited in the app.

Every clinical term Emenla prints comes from one of these, with the source shown beside it.

ESHRE · 2022

European guideline on endometriosis

The European Society of Human Reproduction and Embryology's guideline: diagnosis, treatment, and the shift away from laparoscopy as the required first step.

Read the guideline

NICE · NG73

Endometriosis: diagnosis and management

The UK guideline that tells clinicians to suspect endometriosis when someone reports chronic pelvic pain, period pain that affects daily life, or pain during or after sex.

Read the guideline

ACOG · 2026

Clinical Practice Guideline No. 11

The American guideline: a clinical diagnosis from symptoms, history and a physical examination is enough for a clinician to begin treatment.

Read the guideline

Why this page exists

Emenla is built on published guidelines and on how people with endometriosis describe their pain. This is what we record, what we never say, and why.

References.

Featured · Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009 (The guideline the app's terms are built on.)

  1. World Health Organization. Endometriosis, fact sheet. who.int/news-room/fact-sheets/detail/endometriosis
  2. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009
  3. National Institute for Health and Care Excellence. Endometriosis: diagnosis and management. NICE guideline NG73, 2017, updated 2024. nice.org.uk/guidance/ng73
  4. American College of Obstetricians and Gynecologists. Diagnosis of Endometriosis. Clinical Practice Guideline No. 11, March 2026. acog.org
  5. Scoping review of diagnostic delay in endometriosis, 2024. PubMed Central, PMC11633989. ncbi.nlm.nih.gov/pmc/articles/PMC11633989
  6. Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006;86(5):1296-1301. https://doi.org/10.1016/j.fertnstert.2006.04.054
  7. Hudelist G, Fritzer N, Thomas A, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27(12):3412-3416. https://doi.org/10.1093/humrep/des316
  8. Ghai V, Jan H, Shakir F, Haines P, Kent A. Diagnostic delay for superficial and deep endometriosis in the United Kingdom. J Obstet Gynaecol. 2020;40(1):83-89. https://doi.org/10.1080/01443615.2019.1603217
  9. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.e8. https://doi.org/10.1016/j.fertnstert.2011.05.090
  10. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. https://doi.org/10.1056/NEJMra1810764
  11. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852. https://doi.org/10.1016/S0140-6736(21)00389-5
  12. Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022;379:e070750. https://doi.org/10.1136/bmj-2022-070750
  13. Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1-354.e12. https://doi.org/10.1016/j.ajog.2018.12.039
  14. Bullo S. "I feel like I'm being stabbed by a thousand tiny men": the challenges of communicating endometriosis pain. Health (London). 2020;24(5):476-492. https://doi.org/10.1177/1363459318817943
  15. Denny E. Women's experience of endometriosis. J Adv Nurs. 2004;46(6):641-648. https://doi.org/10.1111/j.1365-2648.2004.03055.x
  16. Jones G, Kennedy S, Barnard A, Wong J, Jenkinson C. Development of an endometriosis quality-of-life instrument: the Endometriosis Health Profile-30. Obstet Gynecol. 2001;98(2):258-264. https://doi.org/10.1016/S0029-7844(01)01433-8
  17. Simoens S, Dunselman G, Dirksen C, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod. 2012;27(5):1292-1299. https://doi.org/10.1093/humrep/des073
  18. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261-275. https://doi.org/10.1038/nrendo.2013.255
  19. Nezhat C, Nezhat F, Nezhat C. Endometriosis: ancient disease, ancient treatments. Fertil Steril. 2012;98(6 Suppl):S1-S62. https://doi.org/10.1016/j.fertnstert.2012.08.001
  20. Sampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1927;14(4):422-469.
  21. Regulation (EU) 2016/679 (General Data Protection Regulation), Article 9: processing of special categories of personal data. eur-lex.europa.eu/eli/reg/2016/679/oj

Reference wording and page numbers were checked against the publishers' records on 2026-08-28. If you find an error, write to hello@emenla.com and it will be corrected.