The cause of endometriosis is not known. The most predominant theory is the retrograde menstruation theory, which suggests that endometriosis results from a backflow of endometrial tissue from the uterus into the pelvic cavity during menstruation. This flow starts through the fallopian tubes and passes into the peritoneal cavity, where it implants to form atypical (ectopic) sites of endometrial tissue. Other theories of endometrial etiology include: the transformation of cells lining the peritoneum undergo metaplastic transformation and give rise to the endometrial lesions; spread of tissue via the vascular and lymphatic systems; and also the idea that dormant, immature cells spread during the embryonic period and metaplasia is now occurring in adulthood. There also may be a genetic predisposition for endometriosis. Women who have had mothers and sisters with this disease process have been found to be at higher risk of developing endometriosis.

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