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The condition may be due to weakness of the supporting tissue

6.1 The vascular endothelial dysfunction Endothelial cells line the inner layer of blood vessels and play critical roles in regulating vascular tone, maintaining blood flow, and providing anticoagulant properties

In a separate letter published in the NEJM, U.S

Regulating estrogen and progesterone levels in women for a healthy reproductive system

These include:[ref] Inflammatory cytokines (IL-1B, IL-33), which cause the release of IL-6, TNF, IL-8, and VEGF Heavy metals (aluminum, cadmium, mercury) Herbicides (atrazine, glyphosate) Pathogens (Lyme disease, lipopolysaccharides from bacteria, certain viruses, and mold spores) These triggers can cause a two-phase reaction : Immediately released mediators include histamine, TNF, tryptase, RANKL, and serotonin