Endometriosis, defined by the presence of endometrial-like tissue outside the uterine cavity, is a chronic inflammatory condition affecting an estimated 10% of women of reproductive age globally [1]. It is a leading cause of chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, imposing a substantial burden on physical health, mental well-being, socioeconomic productivity, and diminished quality of life [2][3].

In high-income countries, increased awareness and access to advanced imaging and laparoscopy have improved early diagnosis and management. For decades, a persistent medical myth suggested that endometriosis was rare among women of African descent. Recent evidence has decisively debunked this, revealing that African women often suffer from more aggressive, late-stage phenotypes due to systemic diagnostic delays [4]. However, endometriosis remains underdiagnosed and often misinterpreted as a functional or psychosomatic condition. Cultural normalization of menstrual pain, limited specialist availability, and financial barriers contribute to diagnostic delays, resulting in more extensive disease at the time of surgery [5].

The management of endometriosis is multimodal, encompassing medical therapy, surgery, and often, assisted reproductive technologies. Surgery, particularly laparoscopic excision, plays a pivotal role in providing a definitive diagnosis, relieving pain, improving fertility in specific cases, and treating associated complications [6][7]. The primary goals of surgical intervention are the complete removal of all visible endometriotic lesions, restoration of normal pelvic anatomy through adhesiolysis, and symptom alleviation.

Despite its global prevalence, the clinical profile and surgical outcomes of endometriosis in Sub-Saharan Africa (SSA) remain poorly characterized. Diagnostic delays are common due to limited access to advanced imaging (e.g., magnetic resonance imaging) and specialized gynecological care, often leading to presentation at advanced disease stages [8][9]. Furthermore, the availability and outcomes of laparoscopic surgery, the gold standard for endometriosis management, are not well-documented in many African contexts.

In Cameroon, as in many SSA countries, there is a critical gap in data regarding the patient-reported outcomes following intervention. Understanding the local epidemiological and clinical landscape is essential for developing context-appropriate guidelines and advocating for the necessary resources.

Quality of life is now recognized as a key outcome measure in endometriosis management, alongside traditional surgical and fertility endpoints. Validated instruments such as the Endometriosis Health Profile (EHP-5) allow standardized assessment of patient-centered outcomes [10].

This study aimed to bridge this knowledge gap by describing the surgical aspects and evaluating the impact on quality of life and pain in women who underwent surgery for endometriosis in two hospitals in Yaoundé, Cameroon. We sought to provide evidence on the feasibility and effectiveness of surgical management within our resource-constrained setting.

This study provides a comprehensive snapshot of the surgical management of endometriosis in a Cameroonian urban setting, highlighting both the significant burden of the disease and the tangible benefits of surgical intervention. Our findings contribute to the sparse literature on endometriosis in Central Africa and offer insights relevant for clinical practice and health system planning. These findings confirm that women in this setting present at a young age but with advanced disease, consistent with reports from other African data [4][5].

The demographic profile of our cohort, young (mean age 31 years), predominantly nulliparous (80%), and highly educated, aligns with classic descriptions of endometriosis patients globally, often characterized by delayed childbearing [12]. However, the strikingly high rates of nulliparity and nulligestation in our study may reflect a dual reality: the disease’s impact on fertility and potential sociocultural factors influencing marriage and pregnancy timing in our context. The overwhelming urban residence (84%) likely indicates disparities in healthcare access, where rural women with chronic pelvic pain may never receive a definitive diagnosis.

The clinical presentation was dominated by severe pain, with near-universal dysmenorrhea and high rates of deep dyspareunia and chronic pelvic pain. This “pain triad” is a hallmark of endometriosis and its significant impact is quantitatively confirmed by the exceedingly high preoperative VAS (9.5/10) and EHP-5 scores [13]. The 44% prevalence of infertility is consistent with global estimates and underscores endometriosis as a major cause of tubal and peritoneal factor infertility [1][14].

The distribution of disease phenotypes reveals important patterns. While superficial disease and endometriomas were common, the 38% prevalence of DIE is notable. This is higher than some early laparoscopic series but resonates with more contemporary studies suggesting DIE is frequently underdiagnosed without adequate expertise [15][16]. The high proportion of moderate-to-severe rASRM stages (70.3%) points to substantial diagnostic delay, a critical challenge in low-resource settings where symptom normalization and limited access to specialized care are prevalent [4][8]. The reliance on ultrasound over MRI reflects resource constraints, yet pelvic ultrasound, when performed by trained personnel, can accurately diagnose endometriomas and suggest DIE [17].

The surgical approach was encouragingly minimally invasive, with 88% of procedures initiated laparoscopically. This demonstrates that advanced laparoscopic surgery for complex benign gynecology is feasible in our setting with appropriate training and infrastructure. The surgical techniques employed, however, reveal a pragmatic approach. During laparoscopic management of ovarian endometriomas, cyst drainage and hemostasis were performed using bipolar electrosurgical energy. No ultrasonic or advanced energy devices were routinely available during the study period. The preference for cyst drainage over excision for endometriomas, while less optimal for preventing recurrence, may be influenced by concerns over ovarian reserve and the technical difficulty of complete excision in the presence of dense adhesions [18][19]. However, this may be a double-edged sword, as drainage is associated with higher recurrence rates and may contribute to the 35% of patients experiencing persistent pain. The relatively low rate of complete resection of deep nodules (41.7% of those resected) highlights the technical complexity of DIE surgery and the need for multidisciplinary teams, which may not be routinely available [20].

The core finding of this study is the profound improvement in patient-reported outcomes. The statistically and clinically significant reduction in pain (VAS decrease of 5.8 points) and the dramatic improvement in EHP-5 scores represent a transformative effect of surgery on women’s lives. These results are comparable to or even exceed those reported in high-income settings following laparoscopic excision, affirming the effectiveness of surgical care when it is accessible [21][22]. The fact that only 18% of patients received postoperative hormonal suppression (primarily Triptorelin) suggests that symptom relief was largely attributable to surgery itself. This is an important consideration in contexts where long-term medical therapy may be unaffordable or poorly tolerated. The low utilization of postoperative hormonal therapy reflects a combination of factors specific to our context, including financial constraints, limited access to long-term hormonal treatments, patient preference, and the absence of standardized local postoperative protocols. In addition, some providers prioritized surgical symptom relief alone, particularly in patients desiring pregnancy, thereby limiting the prescription of suppressive hormonal therapyQuality-of-life improvement after surgery, underscores that, even in resource-limited settings, surgical treatment can yield meaningful patient-centered benefits. However, the modest fertility outcomes highlight the need for earlier diagnosis and integrated fertility care.

The fertility outcomes, while based on a small subset, are cautiously promising, with a 21.4% spontaneous conception rate. This aligns with studies showing improved natural conception rates after surgery for mild-to-moderate endometriosis [23]. The high rate of first-trimester miscarriage (66.6% of pregnancies) is concerning and warrants further investigation into potential associated factors like untreated inflammation or autoimmune phenomena linked to endometriosis [24][25].

This study has several strengths, including its focus on patient-centered outcomes using validated tools (VAS, EHP-5), the combined data from public and private sectors, and the detailed reporting of surgical phenotypes. However, limitations must be acknowledged. The sample size, though robust for the local context, limits subgroup analyses. The cross-sectional design with retrospective clinical data collection is susceptible to information bias. The follow-up period for fertility assessment was variable and likely insufficient to capture all potential conceptions. We lacked a control group (e.g., medical management only) and data on long-term recurrence rates. The reliance on telephone interviews for outcome assessment, while practical, may introduce recall bias. This retrospective assessment of baseline EHP-5 scores introduces a potential recall bias, as patients’ recollection of preoperative quality of life may be influenced by their postoperative improvement. This limitation should be considered when interpreting the magnitude of change in EHP-5 scores.

This study demonstrates that endometriosis in Yaoundé presents as a severe, pain-inducing condition, often diagnosed at advanced stages and primarily affecting young nulliparous women. Surgical management, predominantly laparoscopic, is strongly associated with significant improvements in pain and quality of life, representing a vital therapeutic pathway.

To build upon these findings, the authors recommend the following actions:

Enhance diagnostic capacity through training in advanced pelvic ultrasound and improved access to MRI for suspected deep infiltrating endometriosis (DIE) to reduce diagnostic delays.Strengthen surgical training and multidisciplinary care by supporting specialized training in laparoscopic deep excisional surgery and fostering collaboration with colorectal and urological surgeons for complex DIE cases.Develop integrated postoperative care through standardized protocols for hormonal suppression and structured fertility counseling, bridging surgical and reproductive medicine services.Promote patient advocacy and awareness via public and professional education campaigns to destigmatize chronic pelvic pain and encourage early referral.Advance prospective research by establishing a national endometriosis registry to track long-term surgical outcomes, recurrence rates, and fertility success, thereby generating robust local evidence to inform policy and practice.

Effectively addressing endometriosis in Sub-Saharan Africa requires a concerted effort to bridge the gap between the significant unmet need and the demonstrated potential of surgical care to restore health and hope.

All authors who contributed to this work have declared that they have read and approved the final version of the manuscript.