Abstract
Retrograde menstruation is common, whereas endometriosis is rare. This Perspective proposes a model in which initiation may depend on the selection of rare intact epithelial–stromal foundercandidate fragments from refluxed tissue. Cervical impedance and dysperistalsis may favour focal fragment generation and retrograde delivery, whereas fallopian-tube transit may select fragments with preserved architecture, survival competence and stromal permissiveness. The model generates testable predictions for menstrual-effluent profiling, peristalsis imaging and stretch priming, and its central translational prediction is a disease-associated shift, relative to controls, in the architecture-preserved mechanical survival fraction of menstrual-effluent fragments under a standardised confinement-and-pulsatile-shear challenge, after adjustment for total menstrual volume.
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A mechanometabolic founder fragment model for endometriosis initiation
Description
Retrograde menstruation is common, whereas endometriosis is rare. This Perspective proposes a model in which initiation may depend on the selection of rare intact epithelial–stromal foundercandidate fragments from refluxed tissue. Cervical impedance and dysperistalsis may favour focal fragment generation and retrograde delivery, whereas fallopian-tube transit may select fragments with preserved architecture, survival competence and stromal permissiveness. The model generates testable predictions for menstrual-effluent profiling, peristalsis imaging and stretch priming, and its central translational prediction is a disease-associated shift, relative to controls, in the architecture-preserved mechanical survival fraction of menstrual-effluent fragments under a standardised confinement-and-pulsatile-shear challenge, after adjustment for total menstrual volume.
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