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The pathophysiology involves complex interactions of endocrine, immunologic, and inflammatory processes, with retrograde menstruation as the most accepted theory for ectopic tissue implantation (6).Estrogen metabolism and chronic inflammation are key pathophysiological mechanisms, with emerging evidence highlighting the microbiomeparticularly the gut and genital tract microbiotain modulating estrogen metabolism and inflammation, potentially influencing disease etiology and symptomatology (7)

Ma Q, et al