Is endometriosis due to evolutionary maladaptation?

Is retrograde menstruation a universal, recurrent, physiological phenomenon? A systematic review of the evidence in humans and non-human primates

“…Most researchers believe that endometriosis originates from the endometrium via RM. In this vein, several investigators have recently begun to bring under the spotlight the impressive increase, over the past two centuries, in the number of ovulatory menstruations that occur in the period between the progressively anticipated menarche and the delayed first full-term pregnancy ( Jarrell et al , 2016 ; Jarrell, 2018 ; Fathalla, 2019 ; Scioscia et al , 2019 ; Yovich et al , 2020 ; Pei et al , 2022 ; Guo, 2023 ; Mumusoglu and Hsueh, 2023 ; Vercellini et al , 2023 ). Thus, it is probably time to focus also on this macroscopic epidemiologic change, in addition to scrutinizing the numerous potential molecular and cellular pathogenic mechanisms that have been proposed in recent decades but have not yet led to a convincing and consistent clarification of the actual cause(s) of endometriosis.…”

“…Thus, it cannot be excluded that the overall iron-related pelvic oxidative stress ( Bulletti et al , 2002 ; Van Langendonckt et al , 2002a , b ; Defrère et al , 2008 ; Bokor et al , 2009 ; Lousse et al , 2009 , 2012 ; Pirdel and Pirdel, 2014 ; Donnez et al , 2016 ; Bulun et al , 2019 ; Ng et al , 2020 ; Ansariniya et al , 2022 ; Wyatt et al , 2023 ), is sufficient in itself to explain the development of endometriosis. In addition, the reductionist model accounts for the impressive increase in the number of ovulatory menses observed in the post-industrial era, which, according to several investigators, should not be considered physiological ( Jarrell et al , 2016 ; Jarrell, 2018 ; Fathalla, 2019 ; Scioscia et al , 2019 ; Yovich et al , 2020 ; Pei et al , 2022 ; Guo, 2023 ; Mumusoglu and Hsueh, 2023 ; Vercellini et al , 2023 ).…”