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

Abstract

Endometriosis is an important women's health concern that may affect women of reproductive age and is often associated with chronic pelvic pain, painful menstruation, pain during sexual intercourse, infertility, fatigue, bowel or urinary symptoms, and other health and quality-of-life challenges. Despite its potential impact, endometriosis may remain unrecognized or be mistaken for normal menstrual discomfort or other conditions, contributing to delays in seeking appropriate medical evaluation and diagnosis. Limited awareness of endometriosis symptoms, misconceptions about menstrual pain, inadequate access to reliable reproductive-health information, and fear or stigma surrounding gynaecological symptoms may further contribute to delayed recognition. Endometriosis education provides an opportunity to improve women's understanding of the condition and increase their ability to recognize symptoms that may warrant professional assessment. Against this background, this study investigates the effect of endometriosis education on endometriosis symptom recognition among women of reproductive age in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Theory, and Social Ecological Model. The Health Belief Model explains how women's perceptions of susceptibility to endometriosis, perceived severity, perceived benefits of recognizing symptoms, perceived barriers, self-efficacy, and cues to action may influence symptom recognition and healthcare-seeking behaviour. Health Literacy Theory emphasizes women's ability to obtain, understand, evaluate, and use reliable health information to recognize symptoms and make appropriate healthcare decisions. The Social Ecological Model highlights the influence of individual, interpersonal, community, healthcare-system, and broader social factors on women's awareness, recognition, and access to reproductive-health services. Collectively, these theoretical perspectives provide a suitable framework for explaining how endometriosis education may influence endometriosis symptom recognition 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, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, and eligible women. Endometriosis education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, knowledge of endometriosis, causes and risk factors, common symptoms, menstrual pain that interferes with daily activities, chronic pelvic pain, painful menstruation, pain during sexual intercourse, bowel-related symptoms, urinary symptoms, fatigue, infertility-related concerns, symptom patterns, misconceptions about severe menstrual pain, available diagnostic and treatment services, and appropriate healthcare-seeking pathways. Endometriosis symptom recognition will be assessed using indicators such as the ability to identify common endometriosis symptoms from case scenarios, distinguish potentially concerning menstrual or pelvic symptoms from expected menstrual discomfort, recognize persistent or severe symptoms, identify symptoms associated with infertility, recognize bowel or urinary symptoms that may occur with endometriosis, identify when professional medical evaluation is warranted, and indicate appropriate sources of reproductive-health information. Data will be collected using structured questionnaires, endometriosis knowledge assessment tools, validated symptom-recognition questions, case scenarios, 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, reproductive-health experiences, previous exposure to endometriosis information, sources of health information, and baseline symptom recognition. 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 symptom recognition. 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 endometriosis symptom recognition among women of reproductive age in Nigeria. Women exposed to structured and evidence-based endometriosis education are expected to demonstrate greater ability to recognize symptoms that may be associated with endometriosis than women without comparable exposure. Education may improve understanding of persistent or severe menstrual pain, chronic pelvic pain, painful sexual intercourse, bowel or urinary symptoms, fatigue, and infertility-related concerns and help women distinguish potentially concerning symptoms from menstrual discomfort that is often normalized. Case-based education, menstrual-health discussions, symptom checklists, and culturally appropriate reproductive-health communication may further improve women's ability to identify symptoms and seek appropriate professional evaluation. However, menstrual stigma, normalization of severe menstrual pain, misinformation, cultural beliefs, limited access to gynaecological services, financial barriers, and shortages of trained healthcare professionals may reduce the effectiveness of education alone. The study therefore expects accessible, culturally appropriate, evidence-based, and sustained endometriosis education, supported by appropriate reproductive-health 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 health, menstrual health, reproductive health, symptom recognition, health literacy, health education, early healthcare-seeking, gynaecological health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospitals, primary healthcare centres, healthcare professionals, gynaecological services, women's health organizations, community health workers, public health practitioners, development partners, and policymakers regarding strategies for improving awareness and early recognition of endometriosis. The study will also provide evidence-based recommendations for expanding community-based endometriosis education, integrating endometriosis awareness into reproductive-health programmes, strengthening menstrual-health education, improving recognition of concerning symptoms, reducing normalization and stigma surrounding menstrual and pelvic pain, strengthening referral pathways, and improving access to appropriate diagnostic and treatment services for women across Nigeria.

Keywords: Endometriosis education, endometriosis symptom recognition, women of reproductive age, endometriosis, menstrual health, reproductive health, women's health, health literacy, symptom awareness, gynaecological health, Nigeria, public health.