The exact cause for endometriosis has not been found however, there are certain hypotheses for the same.
Certain research assumes that during menstruation, some endometrial tissue is not expelled out of the vagina. Instead, it moves through the fallopian tubes and accumulates on the different organs of the reproductive system and abdomen/pelvis. This phenomenon is also called “reverse menstruation” or “retrograde menstrual flow”. This can also be due to surgical scar after a C-section.
Some lines of thought also link it to foetal development. For instance, Müllerian ducts are primordial structures in the foetus that develops into some part of the vagina, cervix, uterus, and the fallopian tubes. When some part of these ducts are misplaced elsewhere in the pelvic/abdominal region, it can lead to endometriosis. This is the Müllerian theory.
A weakened immune system that is unable to destroy the “rogue” endometrial cells.
It can also be due to genetic disposition. Abdominal cells can undergo mutation and form endometrium-like tissue.
Hormones have been thought to alter abdominal cells into endometrial cells.