A 43-year-old multiparous woman presents with progressive dysmenorrhea, heavy menstrual bleeding, and chronic pelvic pain over 3 years. On examination, her uterus is diffusely enlarged, globular, soft, and tender. After failed medical therapy, hysterectomy is performed. The gross specimen shows a diffusely thickened myometrium with a trabeculated cut surface. The structures marked **B** in the diagram—small hemorrhagic cystic spaces scattered throughout the myometrium—represent ectopic endometrial tissue. Which of the following best describes the pathophysiological mechanism by which these structures contribute to the patient's heavy menstrual bleeding?
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