Endometriosis is the survivor of reflux endometrium by hypoxia selection—As the phoenix nirvana, a regeneration story of endometrial cells

The etiology of endometriosis is still an enigma after nearly 90-year study. Endometriosis is closely related to the menstruation, during which uterine spiral arteries contract and endometrium is shed due to ischemia and hypoxia. Endometrial cells that are misplaced along with menstrual reflux are in ischemic and hypoxic state until angiogenesis in the pelvic cavity. In fact, recent experimental and clinical studies have suggested that hypoxia affects a series of biological parameters like metabolism, apoptosis, proliferation and angiogenesis of cells. The article focuses on the role of hypoxia in the development of endometriosis, which may be able to provide a new perspective for the study and treatment of the disease.