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A comprehensive review of 36 studies (1993-2024) confirms effects on growth factor upregulation, VEGF/VEGFR2 expression, and FAK-paxillin cell migration pathways

They assume continuous perfect refrigeration because that's the only legally defensible standard

In fact, reports of bacterial endotoxin in the pelvic cavity and menstrual blood of people with endometriosis 37 have led to a bacterial contamination hypothesis suggesting endotoxin/bacteria in the menstrual effluent contributes to pelvic inflammation, growth, and progression of endometriotic lesions (reviewed in 38,39 )

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Jcker M, Gnther A, Gradl G, Fonatsch C, Krueger G, Diehl V, et al