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Endometriosis in Patients in Sub-Saharan Africa

Author's details

  • Dr. Khashau Eleburuike
  • MBBS (Ilorin) MSc. Global Health Karolinska Institute.
  • Resident doctor in family medicine in Northern Sweden.

Reviewer's details

  • Dr. Jolayemi Waliyat. A
  • (MBBS, MPH-Epid, FWACS, FMCOG)
  • Consultant Obstetrician and Gynaecologist. Evercare Hospital Lekki, Lagos, Nigeria.
  • Date Published: 2025-04-29
  • Date Updated: 2025-04-29

Endometriosis in Patients in Sub-Saharan Africa

Introduction

What is Endometriosis? 

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. This tissue can be found on the ovaries where it forms cyst often called chocolate cyst, fallopian tubes, other organs in the pelvis, rectum, belly button and in faraway organs outside the pelvis such as the chest, brain though rare. During the menstrual cycle, this tissue responds like normal uterine tissue, thickening, breaking down, and bleeding. However, because the blood has no way to exit the body, it becomes trapped, leading to pain, inflammation, and other complications. It is a common condition found in 1 out of 10 women.

Discussion
Common Symptoms of Endometriosis
  • Severe pelvic pain, especially during menstruation (more than normal period pain).
  • Pain during or after sexual intercourse.
  • Heavy menstrual periods or spotting between periods.
  • Infertility or difficulty getting pregnant.
  • Fatigue, diarrhoea, constipation, bloating, and nausea, especially during menstruation.
  • Frequent urinary infections which occur during menstruation.
Causes of Endometriosis

While the exact cause is unknown, factors that may increase your risk include:

  • Family history of endometriosis.
  • Early onset of menstruation or periods lasting more than seven days.
  • Having short menstrual cycles (less than 21 days).
  • Environmental factors such as exposure to toxins and chemicals in some developing regions may also contribute.
Cultural and Social Context in Sub-Saharan Africa 

In some parts of Sub-Saharan Africa, discussions about reproductive health can be sensitive or even stigmatized. Women suffering from pelvic pain may be misunderstood or blamed for their condition, as there may be limited awareness about diseases like endometriosis. Sometimes, painful menstruation might be normalized as a part of being a woman, preventing timely medical care. It is important to seek help from a healthcare provider, especially if you experience unusual or severe pain.

Diagnosis of Endometriosis

Endometriosis can be challenging to diagnose, and it may require:

  • Your medical doctor is going to ask about symptoms like painful menstruation, deep painful sexual intercourse, infertility, frequent urinary infections or from the bowels especially during menstruation.
  • Pelvic exams: A doctor may feel for abnormalities.
  • Ultrasound: This can help detect cysts associated with endometriosis, but it does not show all cases.
  • MRI scan- this may be needed especially if you have an extensive endometriosis involving your bladder, bowel or situation your healthcare provider is not certain of findings on your ultrasound.
  • Laparoscopy: A keyhole surgical procedure where a camera is used to look inside the pelvic area. There may still be endometriosis even if the laparoscopy examination is normal

Access to healthcare services in some rural or underserved areas might be limited, but it’s important to seek out clinics or specialists, when possible, for accurate diagnosis.

Treatment Options of Endometriosis

While there is no cure for endometriosis, treatments can help manage symptoms. Treatment options include:

  1. Medication:
  • Pain relief: Over-the-counter pain relievers such as non-steroidal anti-inflammatory drugs like Ibuprofen or prescribed pain medication can help.
  • Hormone therapy: Hormonal treatments can reduce or stop the growth of endometrial tissue outside the uterus. The aim is to be period free. Menstruation worsens endometriosis. Pregnancy is planned. Drugs like combined oral contraceptive pills, progestogen containing device like mirena, injection such as gonadotrophin releasing hormone agonist (GnRH-a).
  1. Surgery: In cases where medication does not help, surgery can be done to remove endometriotic tissue. In severe cases, a hysterectomy (removal of the uterus) with or without removal of your ovaries (bag of eggs) may be recommended, though this is a last resort.
  2. Lifestyle Changes: Regular exercise, a balanced diet, and stress management can help alleviate symptoms.
Living with Endometriosis in Sub-Saharan Africa:
  • Support Networks: If you have endometriosis, talking to others with the condition can help. Try to connect with local women’s groups or health organizations that address reproductive health.
  • Seek Medical Advice Early: If you experience severe menstrual pain that is preventing you from going to school or work or any of the symptoms mentioned, seek medical advice as early as possible. Even if healthcare services are far, early intervention can prevent complications.
  • Advocate for Awareness: Sharing information about endometriosis in your community may help reduce stigma and encourage others to seek medical care.
Conclusion

Endometriosis is a serious medical condition, but with the right diagnosis and treatment, you can manage the symptoms and improve your quality of life. Seeking help, even in challenging healthcare environments, is crucial for maintaining your reproductive health and overall well-being. If you have any questions or concerns, consult a healthcare professional at your nearest clinic or hospital.

References
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  • Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocrine reviews. 2019 Aug 1;40(4):1048-79.
  • Olive DL, Pritts EA. Treatment of endometriosis. New England Journal of Medicine. 2001 Jul 26;345(4):266-75.
  • Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, Bush D, Kiesel L, Tamimi R, Sharpe-Timms KL, Rombauts L. World Endometriosis Society consensus on the classification of endometriosis. Human reproduction. 2017 Feb 1;32(2):315-24.
  • RCOG patient information leaflet. Endometriosis. Dec 2023. Available at: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/endometriosis/ Accessed April 2025