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The uterosacral ligaments are also common implant sites (alternatively called the pelvic sites) ( Retrograde menstruation The most frequent accepted theory that explains the pathogenic process by which these lesions occur is the theory of retrograde menstruation, the theory that the backup of extrinsic menstrual tissues into the fallopian tubes, pelvis, and peritoneum is a driving force in the formation of endometriomal implants

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Specific hereditary backgrounds are implicated, such as FOXP3 pathogenic variants in immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, and autoimmune regulator (AIRE) mutations in APS type 1 (Klubo-Gwiezdzinska And Wartofsky 2022)

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