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Endometriosis is primarily diagnosed through laparoscopy and biopsy due to its ability to provide direct visualization of the pelvic organs and any endometrial-like tissue present outside the uterus. Laparoscopy is a minimally invasive surgical procedure in which a small camera is inserted into the abdomen, allowing a healthcare provider to assess the extent of the disease. If endometrial tissue is identified, a biopsy can confirm the presence of the condition.

While ultrasound can assist in identifying certain cysts associated with endometriosis, it cannot definitively diagnose the disease. A physical examination and a thorough medical history are important in the initial assessment and can suggest the possibility of endometriosis, but they are not conclusive methods for diagnosis. Blood tests may indicate the presence of certain markers or conditions but are not diagnostic for endometriosis itself. Therefore, laparoscopy combined with biopsy is the most reliable and definitive method for diagnosing endometriosis.