Evaluation & Diagnosis

Answers begin here.

Our diagnostic process starts with a crucial step, listening deeply to your story. Our aim is to identify the true source of your pain, including causes often missed elsewhere.

Female nurse writing down female patient's information on clipboard while patient smiles.

As Thorough as it Gets

Our Evaluation Process

At Lotus Endometriosis Institute, evaluation starts with something simple that is often overlooked: we listen deeply to your story. The goal is not to just check boxes, but to uncover the true root cause of your pain or fertility challenges. This includes potentially diagnosing highly related conditions — which are often missed, ignored, or not even considered by other providers.

We listen, thoroughly

We start by learning about and hearing your full story — every symptom, flare pattern, and past treatment — so nothing important is overlooked. This is why the introductory materials and questionnaires we also send are extremely helpful.  Using the written information in your own words and listening more than one time and usually by more than one provider, gives us the best chance to help you. 

Root Cause Exploration

We conduct careful examination combined with diagnostic insight to distinguish endo from look-alike or coexisting conditions.  Endometriosis can cause a lot of different and sometimes seemingly unrelated symptoms or findings, but it can’t and does not cause everything.  Using clinical expertise, we dig into the details and apply a modern functional approach that produces actionable results.

Oncologic-Level Vigilance

We pay careful attention to rare but serious concerns such as pelvic masses or cancer risk in patients with long-standing or complex disease.  This is combined with evaluation and discussion of any genetic factors than can strongly influence decisions and prognosis.

Targeted Advanced Imaging

Expertly interpreted MRI, ultrasound, or other imaging to identify suspected endometriosis and related pelvic conditions.

Microbiome & Gut Health Testing

When symptoms suggest, we assess for SIBO, leaky gut, and dysbiosis, which can amplify inflammation and pain.

Infection & Environmental Triggers

Selected patients may benefit from evaluation for Lyme disease, mold/mycotoxin exposure, or other chronic infections that worsen immune imbalance.

Immune & Hormonal Screening

We conduct testing for autoimmune overlap, thyroid dysfunction, PCOS, or adrenal imbalance that may complicate symptoms or fertility.

Pelvic Floor & Neurologic Assessment

Identifying pelvic floor dyssynergia, small fiber neuropathy, or central sensitization that contribute to chronic pain.

Vascular & Structural Conditions

Depending upon your symptoms, evaluation may include testing for pelvic venous congestion, May-Thurner Syndrome, and hernias that mimic or worsen endo pain.

Diagnosis

Our evaluation process is designed to be as thorough and comprehensive as possible, not only to look for signs of endometriosis, but to also address related conditions and ensure you receive truly complete care. These steps help us rule out look-alike issues, uncover contributing factors, and guide treatment planning with accuracy. That said, endometriosis cannot be 100% confirmed through imaging, lab work, blood tests, genetic testing, or any other non-surgical method. Because the disease develops within the pelvic cavity and organs, the only way to access the tissue, perform a biopsy, and provide an official diagnosis is through minimally invasive surgery.

Comprehensive Care

Endometriosis rarely exists in isolation, which is why we guide you through a holistic, whole-body evaluation. This includes conditions that mimic, worsen, or coexist with endometriosis — from gut dysbiosis and pelvic floor dysfunction to vascular issues, autoimmune overlap, or even rare but critical cancer risks. Validation through a correct diagnosis is always the first priority. Once we know what’s really happening, treatment can be tailored to your unique condition and goals — whether it be relief of daily pain, improving quality of life, or restoring fertility potential.

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My lower abdomen hurts the most. a young female patient talking to a doctor in their office.

Your Care Continues

Pre & Post-operative Evaluation

In some cases, certain biomarkers can help evaluate endometriosis and may be elevated before surgery. Re-testing these markers after surgery to confirm improvement is part of our routine 3-month follow-up appointment (provided free of charge). If endometriomas were found and removed, follow-up ultrasound may also be recommended. For California patients, we can order these studies directly; for out-of-state patients, we provide guidance on what to request locally and review the results with you to ensure nothing is missed.

Portrait of smiling young nurse showing digital tablet screen to senior African American woman in hospital bed

After Surgery & Beyond

Post-operative Testing

At Lotus Endometriosis Institute, the surgical intervention does not end when the procedure is complete. We go the extra mile by analyzing the tissues removed, looking for factors that may influence your long-term prognosis and guide tailored recommendations for additional therapies.


This may include:

  • Mitotic index testing – measuring how actively cells are dividing, which provides insight into the biological behavior of your endometriosis.

  • Tissue mast cell density – identifying the level of mast cell activity, which may explain heightened inflammation, pain sensitivity, and symptom severity.

  • Immune and molecular markers – when appropriate, we evaluate immune profiles or emerging biomarkers (such as cfmiR research applications) that can inform ongoing monitoring and future treatment options.

  • Hormone receptor profiling – understanding estrogen and progesterone receptor activity in excised tissue can help personalize decisions about adjuvant hormonal support.

Laboratory assistant putting test tubes into the holder, Close-up view focused on the tubes

Ready When You Are

Ready to start your evaluation?

Most centers stop after surgery. At Lotus, we continue looking for hidden drivers of recurrence or persistent pain, so treatment can be fine-tuned. This “post-op lens” is part of why our care is more complete, and why patients feel more secure after surgery.

Reach Out

Have a question?

We understand that healthcare can be complex and overwhelming, and we are committed to making the process as easy and stress-free as possible.

Call Us

(424) 255-1340

Santa Monica, CA

2121 Santa Monica Blvd, Santa Monica, CA 90404

Operating Hours

9:00 am - 5:00 pm

Monday - Friday

Arroyo Grande, CA

154 Traffic Way, Arroyo Grande, CA 93420