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Effect of Endometriosis Education on Recognition of Endometriosis Symptoms among Women of Reproductive Age in Nigeria

Abstract

Endometriosis is a chronic gynaecological condition in which tissue similar to the lining of the uterus grows outside the uterine cavity and may cause pelvic pain, painful menstruation, pain during sexual intercourse, painful bowel movements, painful urination, heavy or irregular menstrual bleeding, fatigue, and difficulties with fertility. Despite its potential impact on women's physical, reproductive, emotional, and social wellbeing, endometriosis may remain undiagnosed or be diagnosed late. Women of reproductive age in Nigeria may have limited knowledge of the condition and may mistake persistent or severe symptoms for normal menstrual experiences. Limited awareness, menstrual stigma, misconceptions, cultural beliefs, financial barriers, and inadequate access to specialized healthcare may contribute to delayed recognition and healthcare-seeking. Endometriosis education provides an opportunity to improve women's understanding of the condition and recognition of symptoms that may warrant professional assessment. Against this background, this study investigates the effect of endometriosis education on recognition of endometriosis symptoms among women of reproductive age in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Framework, and Social Ecological Model. The Health Belief Model explains how women's perceptions of susceptibility to endometriosis, perceived severity of symptoms, perceived benefits of early recognition, perceived barriers, self-efficacy, and cues to action may influence symptom recognition and healthcare-seeking. The Health Literacy Framework emphasizes women's ability to access, understand, evaluate, and apply reliable information about endometriosis and reproductive health. The Social Ecological Model emphasizes the influence of individual, interpersonal, family, community, healthcare, cultural, socioeconomic, and health-system factors on recognition of endometriosis symptoms. Collectively, these theoretical perspectives provide a suitable framework for explaining how endometriosis education may influence recognition of endometriosis symptoms among women of reproductive age in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise women aged 18–49 years residing in selected urban and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, and eligible women. Endometriosis education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, information on endometriosis, painful menstruation, chronic pelvic pain, pain during sexual intercourse, painful bowel movements, painful urination during menstruation, heavy or irregular menstrual bleeding, fatigue, infertility-related concerns, symptom patterns, risk factors, misconceptions about menstrual pain, available diagnostic services, appropriate healthcare providers, treatment options, and reliable sources of reproductive-health information. Recognition of endometriosis symptoms will be assessed using indicators such as women's ability to identify persistent or severe menstrual pain, chronic pelvic pain, pain associated with sexual intercourse, painful bowel or urinary symptoms, abnormal menstrual bleeding, fatigue, fertility-related concerns, symptom patterns that differ from expected menstrual discomfort, and situations requiring professional gynaecological assessment. Data will be collected using structured questionnaires, standardized endometriosis knowledge and symptom-recognition assessment tools, scenario-based questions, healthcare records where ethically accessible, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, menstrual and reproductive health history, previous exposure to endometriosis information, sources of information, symptom experiences, and recognition patterns. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of endometriosis education on recognition of endometriosis symptoms. Where a quasi-experimental design is adopted, symptom-recognition scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that endometriosis education has a significant positive effect on recognition of endometriosis symptoms among women of reproductive age in Nigeria. Women exposed to structured, evidence-based, culturally sensitive, and sustained endometriosis education are expected to demonstrate greater ability to recognize possible symptoms than women without comparable education. Education may improve understanding of severe or persistent menstrual pain, chronic pelvic pain, painful sexual intercourse, bowel and urinary symptoms associated with menstruation, abnormal bleeding, fatigue, and fertility-related concerns. It may also help women distinguish symptoms that warrant professional assessment from common menstrual discomfort and reduce the normalization of severe pain. Scenario-based education may strengthen women's ability to identify symptom patterns and encourage appropriate discussions with qualified healthcare professionals. However, menstrual stigma, cultural beliefs, misinformation, financial barriers, geographical barriers, limited availability of gynaecological services, shortage of trained specialists, and normalization of menstrual pain may reduce the effectiveness of education alone. The study therefore expects accessible, practical, culturally appropriate, and sustained endometriosis education, supported by appropriate reproductive-health and referral services, to contribute significantly to improved recognition of endometriosis symptoms among women of reproductive age in Nigeria. The study is expected to contribute to the literature on endometriosis, women's reproductive health, symptom recognition, menstrual health education, gynaecological health, healthcare-seeking behaviour, health literacy, women's health, chronic pain, fertility health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, gynaecology clinics, healthcare professionals, women's health organizations, reproductive-health practitioners, community health workers, development partners, and policymakers regarding strategies for improving early recognition of endometriosis. The study will also provide evidence-based recommendations for integrating endometriosis education into reproductive and primary healthcare programmes, strengthening menstrual-health counselling, improving access to appropriate gynaecological assessment and referral services, addressing misconceptions surrounding severe menstrual pain, increasing public awareness of endometriosis symptoms, and developing sustainable interventions that promote early recognition and appropriate healthcare-seeking among women of reproductive age across Nigeria.

Keywords: Endometriosis education, endometriosis symptom recognition, women of reproductive age, endometriosis, reproductive health, menstrual health, gynaecological health, health education, health literacy, healthcare-seeking, Nigeria, public health.