NICE's Updated Draft Guidance Recommends Ziwig Endotest® While Evidence Is Gathered
Oct 14, 2026
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Published on
13/10/2026
The LivingCare Group
LivingCare has introduced Ziwig Endotest, a saliva test that can detect endometriosis without surgery. It is available privately at our Canon Medical Arena clinic in Sheffield, with no GP referral needed and self-pay or insurance both welcome. For women who have spent years being told their symptoms are normal, it offers a different starting point.
Around 1 in 10 women of reproductive age in the UK have endometriosis [1], and confirming it has traditionally meant a laparoscopy - keyhole surgery under general anaesthetic to look inside. That is a lot to ask of someone who is still trying to find out what is wrong, and in the UK the average wait for a diagnosis now stands at 9 years and 4 months [2]. A saliva sample is a very different place to start.
Ziwig Endotest is a non-invasive test that looks for endometriosis in a saliva sample. It analyses 109 microRNA markers - molecules that occur naturally in saliva - and it is a CE-marked in vitro diagnostic medical device, meaning it is certified for diagnostic use in Europe under the CE mark [3]. Your clinician confirms the test is suitable for you, the sample is collected in clinic or at home as part of a clinician-led pathway, and results are typically returned within a few weeks.
It is worth being clear about what it is not. It is not a screening test for the general population, and it is not intended to replace diagnosis by pelvic imaging. It is a test for women whose symptoms already point towards endometriosis, used alongside a clinical assessment rather than in place of one.
Ziwig Endotest is a brand new test. So far it has only been validated in specialist clinics, and more research is being done to explore how it performs in a general population.
In a multicentre, manufacturer-funded study of 971 women, the saliva signature correctly identified endometriosis in 97.3% of the women who had it [4]. That study was carried out in a population where endometriosis was already strongly suspected, which is the same population the test is intended for.
A negative result indicates endometriosis is not present. If your symptoms continue despite a negative result, your clinician may recommend other investigations.
Ziwig Endotest is designed for women aged 18 to 43 in whom endometriosis is suspected but not yet confirmed. It is not suitable if you are pregnant, have HIV, or are unwell or have an infection at the time of testing. Your clinician will confirm whether it is right for you before anything is booked.
The symptoms that most often lead to a test are:
These symptoms have several possible causes, and endometriosis is only one of them. That is why the test sits inside a consultation rather than standing on its own.
The value of a non-invasive test is not only speed. It changes what has to happen before a woman can be taken seriously: an answer no longer has to be worth an operation.
"I listen to far too many women living for years with life impacting symptoms and no answers. We hope we can bring new innovations in diagnosis to those who need them most. Hopefully EndoTest is the beginning of a change in the way we diagnose endometriosis which had previously been through invasive surgery."
Dr Becky Mawson, General Practitioner with Special Interest in Women's Health at LivingCare
NICE has also been looking at where tests like this one belong in NHS primary care, and has set out its position in updated draft guidance [5]. Our article NICE's Updated Draft Guidance Recommends Ziwig Endotest® While Evidence Is Gathered covers what that draft says, the conditions that come with it, and what it means if you are still waiting.
Endometriosis also has effects well beyond pain, including on fertility, which we cover in our article on understanding endometriosis and its impact on fertility.
Ziwig Endotest costs £1,180 and is available at Canon Medical Arena in Sheffield, as part of our women's health service. There is no GP referral needed and no NHS waiting list to join.
If you are not sure whether the test is the right next step, a women's health consultation is the place to start, and your clinician will talk you through the options.
Full details of the test are on our Endometriosis Saliva Test (Ziwig Endotest®) page, and you can book your appointment online.
Do I need a GP referral for Ziwig Endotest?
No - you can book directly with LivingCare, with no GP referral needed. Self-pay or insurance are both welcome, and a clinician will confirm the test is suitable for you before it goes ahead.
Does the saliva test replace a laparoscopy?
No. Ziwig Endotest is a non-invasive route to a diagnosis, not a replacement for pelvic imaging or surgical diagnosis. What happens after your result is a clinical decision your clinician will discuss with you.
Does Ziwig Endotest tell me how severe my endometriosis is?
No. Ziwig Endotest won't tell you how severe your endometriosis is or where it is. There are different types of endometriosis, including superficial and deep infiltrating. This can only really be assessed with MRI or advanced ultrasound, or with surgery [6]. Dr Mawson adds that the type or severity of endometriosis doesn't always fit with the severity of symptoms - this depends on where the inflammation is and what nerves are nearby.
Do I need to do anything to prepare?
Yes. For 30 minutes before the sample you should not eat, drink, smoke, chew gum, wear lipstick, brush your teeth or rinse your mouth, and you should wash your hands first. A sample should not be taken while you are unwell with an infection [3]. Your instructions come with the kit.
How long do results take?
Results are typically returned within a few weeks, and a follow-up appointment is arranged to discuss what yours means and what happens next.
What happens if my result is positive?
Your clinician talks you through what it means at a follow-up appointment and sets out the options, which may include imaging, a referral for specialist gynaecology care, or a plan to manage your symptoms. A result is the start of a conversation, not the end of one.
Can I have the test if I am outside the 18 to 43 age range?
No. LivingCare cannot accept samples from patients outside that range, because the test has not been validated for use outside it. A women's health consultation is still open to you, and your clinician can discuss other routes to investigation.
Medically reviewed by: Dr Becky Mawson, General Practitioner with Special Interest in Women's Health. Last reviewed: 13/10/26.
This article is for general information and is not sponsored content.
