Chronic Endometrial Degeneration (CED): an international expert recommendation to replace the term 'endometrosis' in mares

Gary England, England GC, Gary Cw England, Aurich C, Christine Aurich, Sai Fingerhood, Fingerhood S, R.O. Gilbert, Gilbert RO, Robert O Gilbert, John Newcombe, Newcombe J, Paccamonti DL, Dale L. Paccamonti, Troedsson MH, Mats H.T. Troedsson, Ferreira-Dias GM, Graça Ferreira‐Dias, Graça M.L. Ferreira-Dias, de Brot S, Simone de Brot, Sarah L Freeman, Freeman SL
Theriogenology · 2026 · vol. 267 , pp. 118185 · doi:10.1016/j.theriogenology.2026.118185 · PMID:42753366 · W7212394361
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An international expert panel recommends replacing the term 'endometrosis' with Chronic Endometrial Degeneration (CED) for equine endometrial reporting to avoid confusion with human endometriosis and achieve consensus.

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Abstract

The term 'endometrosis', coined in 1992 to describe chronic degenerative changes of the equine endometrium, is descriptively imprecise and readily confused with 'endometritis' and the human gynaecological condition 'endometriosis'. A modified four-round electronic Delphi (e-Delphi) process was conducted with an international panel of eight specialists to achieve consensus on a replacement term. Fifteen candidate terms were evaluated in Round 1 using a 7-point Likert scale and preference rankings; terms were retained if >50% of respondents scored ≥4/7. Round 2 (Refinement) evaluated shortlisted terms plus five panel-proposed new terms against a ≥75% threshold. Round 3 (Consensus Vote) presented six retained terms and four variants for a forced-choice ranking. The primary criterion (≥75% scoring ≥6/7) was not met by any individual term, therefore a pre-specified Round 4 binary vote resolved the outcome. 'Endometrosis' (proposed for retention by one panel member) was near-unanimously rejected in Round 2 (median 1/7; IQR 1-3). In Round 3, Chronic Endometrial Degeneration (CED) achieved the highest support (median 6/7; IQR 5-7; 71.4% scoring ≥6/7) and all seven respondents placed CED or its variant Chronic Equine Endometrial Degeneration (CEED) as their first preference. In Round 4, five of eight panel members (62.5%) selected CED. Chronic Endometrial Degeneration (CED) is recommended as the replacement term for 'endometrosis' in equine endometrial biopsy reporting, clinical practice and scientific publication. CED is well-suited as a consensus term; it is concise, broad and generates a memorable acronym. CEED is an accepted alternative where species specificity is required.

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MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometrium Endometrium Endometrium Endometrium Endometrium Endometrium Endometrium Endometrium

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