{"paper_id":"39367d87-b819-477d-bbd9-75c1940fdf3f","body_text":"International Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 1 \n \nExploring Endometriosis Awareness Levels \namong Married Women Residing in Rural \nCommunities of Sundargarh District of Odisha \n \nAlita Minz1, Anup Kumar Kujur2 \n \n1Department of Home Science, Berhampur University, Odisha \n2Department of Linguistics, Berhampur University, Odisha \n \nABSTRACT \nThis research explores the awareness of endometriosis among village married women in Sundargarh \ndistrict, Odisha, India, focusing on the unique healthcare needs of rural populations. Endometriosis, a \nchronic gynecological condition, often remains undiagnosed or misdiagnosed in rural areas due to limited \naccess to healthcare resources and insufficient awareness. Through a descriptive study involving 100 \nrespondents, including 75 employed and 25 unemployed individuals, the research aims to assess the level \nof awareness among village women regarding endometriosis, its symptoms, and associated risks. Data \ncollection involved personal interviews conducted at respondents' homes, followed by meticulous \ntabulation and statistical analysis. The findings highlight the prevalence of endometriosis symptoms, such \nas pelvic and abdominal pain, among respondents, with varying degrees of severity. The study underscores \nthe importance of targeted educational campaigns and interventions to empower women to recognize early \nsigns of endometriosis, seek timely medical assistance, and navigate the healthcare system effectively. By \naddressing cultural, social, and economic barriers to healthcare access, stakeholders can work towards \nimproving reproductive health outcomes and reducin g the burden of endometriosis on women's lives in \nrural India. \n \nKEYWORDS: Endometriosis, Rural Women, Reproductive Health, Diagnostic Delays \n \n1. INTRODUCTION \nThe present research on the awareness of endometriosis among village married women in Sundargarh \ndistrict holds significant importance in addressing the unique healthcare needs of rural populations. \nEndometriosis, a chronic gynecological condition, often remains undiagnosed or misdiagnosed due to lack \nof awareness and understanding, particularly in rural areas where access to healthcare resources may be \nlimited. By conducting this study, researchers can assess the level of awareness among village women \nregarding endometriosis, its symptoms, and associated risks. This understanding is crucial for developing \ntargeted educational campaigns and interventions aimed at empowering women to recognize the signs of \nendometriosis early, seek timely medical assistance, and navigate the hea lthcare system effectively. \nSundergarh district is located in the state of Odisha, India. It is situated in the western part of Odisha and \nshares borders with the states of Jharkhand and Chhattisgarh. The district headquarters of Sundergarh is \nthe town of Sundergarh itself. It is known for its rich cultural heritage, natural resources, and industrial \ndevelopment. \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 2 \n \nThe study can shed light on the cultural, social, and economic factors that influence awareness and \nhealthcare-seeking behaviors related to endometriosis in rural communities. In many rural areas, cultural \ntaboos and social stigmas surrounding women's heal th issues may prevent open discussion and access to \nappropriate medical care. By identifying and addressing these barriers, healthcare providers and \npolicymakers can work towards improving healthcare access, promoting reproductive health, and reducing \nthe burden of endometriosis on women's lives in Sundargarh district. Ultimately, the findings from this \nstudy can inform targeted strategies for raising awareness, improving healthcare infrastructure, and \nadvocating for policy changes to better support the rep roductive health needs of village married women \nin rural India. \n Women, as the cornerstone of households, juggle numerous familial and professional roles, necessitating \nvigilant attention to their health for the benefit of both family and society. Often suffering silently, they \nface the challenge of endometriosis, a chr onic condition where endometrial tissue grows beyond the \nuterus, affecting areas like the pelvis, abdomen, bladder, and diaphragm. Diagnostic delays, common in \nthis progressive disease affecting individuals as young as 15, can diminish reproductive potent ial and \nquality of life. Endometriosis manifests with diverse symptoms such as painful periods, chronic pelvic \npain, and fatigue, complicating diagnosis due to symptom resemblance with other conditions. Risk factors, \nincluding early menarche and hormonal e xposure, contribute to its complexity. Timely suspicion and \ndetection are vital, yet hindered by the normalization of symptoms and difficulties in discerning them from \nordinary menstrual complaints. Treatment involves pain management and hormonal therapies , aiming to \nreduce estrogen levels to alleviate symptoms. Lifestyle adjustments, such as exercise and dietary \nmodifications, may complement medical interventions. In severe cases requiring surgery, expertise in \nlaparoscopic techniques is crucial for optimal outcomes. Ultimately, the prognosis hinges on the severity \nof the disease, underscoring the importance of comprehensive management strategies. \nThis multifaceted issue underscores the necessity of raising awareness about endometriosis and \nempowering women to recognize and address their symptoms proactively. Education efforts aimed at both \npatients and healthcare providers are essential for facilit ating early detection and timely intervention, \nthereby minimizing the detrimental impact of the disease on women's health and well-being. Furthermore, \nresearch into more effective diagnostic methods and treatment modalities is imperative to improve \noutcomes and enhance the quality of life for individuals affected by endometriosis. By addressing the \ncomplex interplay of biological, social, and environmental factors contributing to this condition, we can \nwork towards developing more tailored and holistic appr oaches to its management. In essence, tackling \nthe challenges posed by endometriosis requires a concerted effort from various stakeholders, including \nhealthcare professionals, policymakers, advocacy groups, and the broader community. By prioritizing \nawareness, education, research, and access to comprehensive care, we can strive towards a future where \nwomen affected by endometriosis receive the support and resources they need to live fulfilling and healthy \nlives. \n \n2. STATEMENT OF THE PROBLEM  \nEndometriosis, a chronic medical condition affecting women, poses significant challenges due to \ndiagnostic delays, varied symptoms, and multifactorial causes. This disease impacts women's quality of \nlife, causing symptoms such as painful periods, chronic p elvic pain, and infertility. Detecting \nendometriosis is complicated by its symptom overlap with other conditions, leading to underdiagnosis. \nTreatment involves pain management and hormonal therapies, but surgery may be necessary. Early \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 3 \n \nsuspicion and detection are crucial for timely management, emphasizing the need for increased awareness \nand education. \n \n3. OBJECTIVES \n1. To examine the socio-economic conditions of the female participants. \n2. To identify the prevalence of endometriosis among married women of reproductive age. \n3. To promote awareness among women of reproductive age regarding endometriosis. \n \n4. LITERATURE REVIEW \nEndometriosis is a complex and often misunderstood gynecological condition that affects millions of \nwomen worldwide. Despite its prevalence, there is a significant lack of awareness surrounding this \ncondition, particularly in rural communities where access  to healthcare resources may be limited. \nUnderstanding the levels of endometriosis awareness among married women residing in rural areas, such \nas the Sundargarh district, is essential for addressing the unique challenges faced by this population and \nimproving their reproductive health outcomes. \nSeveral studies have highlighted the need to enhance awareness and knowledge about endometriosis \namong women, healthcare providers, and the general public. Donald P. and Pal Dmowsk (1998) explored \nthe dysfunctional immune response associated with endometri osis, proposing a model that suggests \nendometrial cells utilize immune system products to establish ectopic foci of disease. This model \nhighlights the intricate interplay between the immune system and endometrial cells, underscoring the need \nfor a comprehensive understanding of the immunological mechanisms underlying endometriosis. \nLebovic et al. (2001) conducted research on the immunobiology of endometriosis, emphasizing the role \nof defective immunosurveillance in the development of this condition. Their findings underscored the \nimportance of early detection and treatment in preventing the progression of endometriosis and mitigating \nits adverse effects on women's health. Berkkanoglu and Arici (2003) investigated the immunological \nfactors implicated in the development of endometriosis, emphasizing the role of aberrant immune \nresponses during retrograde menstruation. Their study revealed various immune alterations, including \nincreased macrophage activity and changes in the cytokine network, which may contribute to the \npathogenesis of endometriosis. \nKhan  et al (2010) investigate the pathogenesis of endometriosis, focusing on the origin of endometriotic \nstromal cells. Understanding the cellular and molecular mechanisms underlying endometriosis \ndevelopment can contribute to improved awareness and manag ement strategies among women in rural \ncommunities. Nnoaham et al (2011) assesses the impact of endometriosis on the quality of life and work \nproductivity of affected women. Findings from this study underscore the need for increased awareness \nand support fo r women with endometriosis, particularly in rural settings where access to healthcare \nservices may be limited. Dun et al (2015) compare surgical and clinical diagnosis methods for \nsymptomatic endometriosis. Improved diagnostic accuracy is essential for rai sing awareness and \nfacilitating early intervention among women in rural areas where healthcare resources may be limited. \nZondervan et al (2018) provide a comprehensive overview of endometriosis, covering its epidemiology, \npathophysiology, diagnosis, and ma nagement. Increased awareness of endometriosis among women, \nhealthcare providers, and communities is crucial for improving outcomes and reducing the burden of this \ncondition, particularly in rural settings. Surrey and Mccleary (2019) provide an overview of endometriosis, \nincluding its epidemiology, pathophysiology, clinical manifestations, diagnosis, and management. \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 4 \n \nUnderstanding the multifaceted nature of endometriosis is crucial for improving awareness levels among \nwomen, healthcare providers, and communities. More recently, Vallve-Juanico et al. (2019) examined the \nendometrial immune environment in women with endometriosis, identifying consistent findings related to \nspecific immune cell populations and their functionality. Their research highlighted the predominance of \npro-inflammatory immune cell phenotypes in the endometrium of women with endometriosis, suggesting \na dysregulated immune response in this population. \nBy synthesizing findings from these studies and incorporating them into the exploration of endometriosis \nawareness levels among married women in rural communities of Sundargarh District, researchers can \ndevelop targeted interventions and educational initia tives to improve early detection, diagnosis, and \nmanagement of endometriosis. This holistic approach is essential for addressing the unique healthcare \nneeds of women in rural areas and reducing the overall burden of endometriosis on individuals, families, \nand communities. While existing literature provides valuable insights into the immunological aspects of \nendometriosis, there is a paucity of research focusing on awareness levels among rural populations, \nparticularly in regions like the Sundargarh district . By exploring endometriosis awareness levels among \nmarried women residing in rural communities, this study aims to fill this gap in the literature and inform \ntargeted interventions to improve reproductive health outcomes in underserved areas. \n \n5. MATERIALS AND METHODS \nThe research design employed in this study was descriptive research, aimed at providing a comprehensive \noverview of endometriosis awareness among women in the target population. A sample size of 100 \nrespondents was selected, consisting of 75 employed and 2 5 unemployed individuals. The sampling \ntechnique utilized was random sampling, ensuring that each participant had an equal chance of being \nselected from the population. The study was conducted in one village of Lathikata Block, located within \nSundargarh District of Odisha. \nData collection was facilitated through the use of interviews, allowing researchers to gather information \ndirectly from the respondents regarding various aspects of endometriosis, including awareness, symptoms, \nand healthcare-seeking behaviors. Personal in terviews were conducted with each selected respondent at \ntheir respective homes to ensure comfort and convenience. \nUpon collection, the data was meticulously tabulated and analyzed using statistical methods such as \nanalysis of variance and Chi -square tests. These statistical techniques allowed for the calculation of \npercentages and the examination of relationships betw een different variables, providing insights into the \nlevel of awareness and understanding of endometriosis among the surveyed population. The findings were \nthen presented in a clear and organized manner, enabling researchers to draw meaningful conclusions and \nrecommendations based on the data analysis. \n \n6. RESULT AND DISCUSSION  \nThe present investigation has the purpose to find out the endometriosis among the women of the \nreproductive age. The obtain results, which are statistically analyzed, have been presented in the table. \n \nTable-1 (Age) \nProfile Details Employed Unemployed Total \n20-30 10 05 15 \n31-40 35 10 45 \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 5 \n \n41-50 25 05 30 \nAbove 50 05 05 10 \nTotal 75 25 100 \n \nThe table-1 provides a breakdown of the respondents' age distribution based on their employment status, \ndistinguishing between those who are employed and those who are unemployed. The different age groups \nin which respondents are categorized, include 20-30, 31-40, 41-50, and above 50. In the age group 20-30, \nthere are 10 employed respondents and 5 unemployed respondents, totaling 15 respondents in that age \nbracket. Similarly, in the age group 31 -40, there are 35 employed respondents and 10 unemployed \nrespondents, totaling 45 respondents in that age bracket.  Overall, the table provides a clear and concise \nsummary of the age distribution among employed and unemployed respondents, allowing for comparisons \nand insights into how age demographics vary between the two employment groups. \n \nTable-2 (Education) \nProfile Details Employed Unemployed Total \nIlliterate 05 10 15 \nUnder matric 30 10 40 \nmatric 10 05 15 \nIntermediate 05 05 10 \nGraduate 05 05 10 \nPostgraduate 05 05 10 \nTotal 60 40 100 \n \nThe table-2 presents the educational qualifications of respondents categorized by their employment status, \ndistinguishing between those who are employed and those who are unemployed. It lists different \neducational qualifications, ranging from Illiterate to Postgradua te. The numerical values within the table \nindicate the count of respondents falling into each specific education category and employment status. For \nexample, among the employed respondents, there are 5 who are Illiterate, 30 with an educational \nqualification of Under matric, 10 with Matric, 5 with Intermediate, 5 who are Graduates, and 5 who are \nPostgraduates. Similarly, among the unemployed respondents, there are 10 who are Illiterate, 10 with \nUnder matric, 5 with Matric, 5 with Intermediate, 5 who are Gra duates, and 5 who are Postgraduates. \nOverall, the table provides a clear overview of the distribution of educational qualifications among \nemployed and unemployed respondents, facilitating comparisons and insights into how educational \nattainment varies between the two employment groups. \n \nTable-3 (Family Type) \nProfile Details Employed Unemployed Total \nJoint Family 00 05 05 \nNuclear Family 75 20 95 \nTotal 75 25 100 \n \nThe table -3 sums up the number of respondents within each family type for both employed and \nunemployed individuals, providing a total count for comparison. The numerical values within the table \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 6 \n \nindicate the count of respondents falling into each specific family type and employment status. For \nexample, among employed respondents, none belong to joint families, while 75 belong to nuclear families. \nAmong unemployed respondents, 5 belong to joint fam ilies, and 20 belong to nuclear families. Overall, \nthe table offers a concise overview of the distribution of family types among employed and unemployed \nrespondents. It highlights the prevalence of nuclear families within both employment groups and provides \ninsights into how family structure may vary based on employment status. \n \nTable-4 (Occupation) \nProfile Details Percentage \nAnganwadi Workers 30 \nAsha Workers 25 \nLabour 25 \nTeacher 10 \nClerical 5 \nSelf- Employment 5 \nTotal 100 \n \nThis table -4 lists various occupations held by respondents, which include Anganwadi Workers, Asha \nWorkers, Laborers, Teachers, Clerical workers, and those involved in Self -Employment. There are 30 \nrespondents who work as Anganwadi Workers. 25 respondents are employed as Asha Workers. Similarly, \n25 respondents are engaged in Labor work. 10 respondents work as Teachers. 5 respondents each are \ninvolved in Clerical work and Self-Employment. \n \nTable-5 (Symptom) \nSl. \nNo. Symptoms Frequency Frequency \nNumber Percentage \n01 \nPelvic, abdominal and lower back pain during \nperiods \nAlways 30 30 \nSometimes 50 50 \nnever 20 20 \nTotal 100 100% \n02 \nPelvic, abdominal and lower back pain in \nbetween periods \nAlways 30 30 \nSometimes 50 50 \nNever 20 20 \nTotal 100 100% \n03 Pain during intercourse \nAlways 15 15 \nSometimes 30 30 \nnever 55 55 \nTotal 100 100% \n04 Painful bowel movement during periods \nAlways 15 15 \nSometimes 55 55 \nNever 30 30 \n Total 100 100% \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 7 \n \nThis table-5 provides a detailed analysis of the frequency and prevalence of various symptoms experienced \nby respondents. Let's analyze each symptom category individually: \n1. Pelvic, abdominal, and lower back pain during periods: \n• 30% of respondents reported experiencing this pain \"Always.\" \n• 50% reported experiencing it \"Sometimes.\" \n• 20% reported \"Never\" experiencing it during their periods. \n2. Pelvic, abdominal, and lower back pain in between periods: \n• Similar to the previous symptom, 30% of respondents reported experiencing this pain \"Always.\" \n• 50% reported experiencing it \"Sometimes.\" \n• 20% reported \"Never\" experiencing it in between periods. \n3. Pain during intercourse: \n• 15% of respondents reported experiencing pain during intercourse \"Always.\" \n• 30% reported experiencing it \"Sometimes.\" \n• The majority, 55%, reported \"Never\" experiencing pain during intercourse. \n4. Painful bowel movement during periods: \n• Similar to the previous symptoms, 15% of respondents reported experiencing painful bowel \nmovements \"Always.\" \n• 55% reported experiencing it \"Sometimes.\" \n• 30% reported \"Never\" experiencing it during their periods. \nIt reveals varying degrees of prevalence for each symptom category among the surveyed population. While \nsome symptoms, such as pain during intercourse, are less commonly reported, others, like pelvic, \nabdominal, and lower back pain during periods and in between periods, are more prevalent. This analysis \nprovides valuable insights into the frequency and impact of these symptoms on the respondents' health \nand quality of life. It underscores the importance of addressing these symptoms through appropriate \nmedical interventions and support services. \nThe table-5 allows for comparisons between different symptoms in terms of their frequency of occurrence. \nFor instance, it shows that pelvic, abdominal, and lower back pain during periods and in between periods \nare both experienced with similar frequencies by the resp ondents. Similarly, painful bowel movements \nduring periods are reported more frequently than pain during intercourse.  The percentage breakdown of \neach symptom's frequency provides a clear understanding of the distribution within the surveyed \npopulation. This information is crucial for healthcare professionals and policymakers in prioritizing \nsymptom management strategies and allocating resources effectively. Additionally, it highlights the need \nfor further research and interventions to address th e symptoms that significantly impact the respondents' \nwell-being. Overall, this analysis of the table underscores the importance of recognizing and addressing \nthe diverse range of symptoms associated with gynecological issues such as endometriosis. By \nunderstanding the prevalence and severity of these symptoms, healthcare providers can tailor their \napproaches to better support individuals affected by these conditions and improve their quality of life. \n \nTable No-6 \nSl. No. Scores Frequency of respondents percentage \n01 0 25 25 \n02 1-3 35 35 \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 8 \n \n03 4-6 25 25 \n04 7-10 15 15 \n Total 100 100% \n \nThe distribution of scores indicates the varying levels of symptom severity experienced by the \nrespondents. The concentration of respondents scoring between 1 and 3 suggests that a significant portion \n(35%)  of the surveyed population experiences mild to moderate symptoms. 25% of th e respondents \nscoring 0 and those scoring between 4 and 6 implies that a comparable number of individuals experience \neither minimal symptoms or moderate symptoms that may have a noticeable impact on their daily lives. \nThe smallest percentage of respondents (15%) scoring between 7 and 10 indicates that fewer individuals \nexperience severe symptoms, which may significantly affect their quality of life and require more intensive \nmanagement and support. Understanding the distribution of scores provides valuable insights for \nhealthcare professionals in prioritizing interventions and allocating resources effectively. For instance, \nindividuals scoring higher may require more comprehensive treatment plans, including medications, \nsurgeries, or specialized care, while those scoring lower may benefit from symptom management \nstrategies such as lifestyle modifications, pain management techniques, or counseling. \nMoreover, this analysis underscores the importance of regular symptom assessment and monitoring to \ntrack changes in symptom severity over time and adjust treatment approaches accordingly. By addressing \nsymptoms early and effectively, healthcare providers can improve the overall well -being and quality of \nlife of individuals affected by gynecological conditions like endometriosis. \n \n7. CONCLUSION  \nThe present study focusing on the awareness of endometriosis among village married women in \nSundargarh district is of paramount importance in addressing the unique healthcare needs of rural \npopulations. Endometriosis, a chronic gynecological condition, oft en goes undiagnosed or misdiagnosed \ndue to insufficient awareness, particularly in rural areas where access to healthcare resources may be \nlimited. Through this research, the level of awareness among village women regarding endometriosis, its \nsymptoms, and associated risks can be assessed. This understanding is crucial for developing targeted \neducational campaigns and interventions aimed at empowering women to recognize early signs of \nendometriosis, seek timely medical assistance, and navigate the healthcare system effectively. \nSundargarh district, situated in Odisha, India, holds significance for its rich cultural heritage, natural \nresources, and industrial development. By shedding light on the cultural, social, and economic factors \ninfluencing awareness and healthcare -seeking behaviors related to endometriosis in rural communities, \nthis study can inform efforts to improve healthcare access, promote reproductive health, and reduce the \nburden of endometriosis on women's lives in the district. Cultural taboos and social stigmas sur rounding \nwomen's health issues prevalent in many rural areas may hinder open discussion and access to appropriate \nmedical care. Identifying and addressing these barriers can lead to improved healthcare access and better \nsupport for reproductive health needs in rural India. \nWomen, playing pivotal roles in households and society, often endure various familial and professional \nresponsibilities, necessitating vigilant attention to their health. Endometriosis, characterized by the growth \nof endometrial tissue beyond the uterus, p oses significant challenges due to its diverse symptoms and \ndiagnostic complexities. Early suspicion and detection are vital for timely management, highlighting the \nneed for increased awareness and education. The research findings underscore the importance of targeted \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240215862 Volume 6, Issue 2, March-April 2024 9 \n \nstrategies for raising awareness, improving healthcare infrastructure, and advocating for policy changes \nto support the reproductive health needs of village married women in rural India. \nIn conclusion, the study's insights into endometriosis awareness and its implications for rural communities \nprovide a foundation for targeted interventions and policy reforms. By addressing the multifaceted \nchallenges posed by endometriosis through collaborative efforts, stakeholders can work towards ensuring \nthat women receive the support and resources necessary for optimal health and well-being. \n \n8. REFERENCES \n1. Lebovic, D. I., Mueller, M. D., & Taylor, R. N. (2001). Immunobiology of endometriosis. Fertility \nand Sterility, 75(1), 1-10. \n2. Berkkanoglu, M., & Arici, A. (2003). Immunology and endometriosis. American Journal of \nReproductive Immunology, 50(1), 48-59. \n3. Donald, P., & Pal, D. (1998). Endometriosis: abnormal endometrium and dysfunctional immune \nresponse. The Journal of Rheumatology, 25(6), 1379-1385. \n4. Dun EC, Kho KA, Morozov VV, et al. (2015). Surgical versus clinical diagnosis of symptomatic \nendometriosis: a systematic review. Int J Womens Health. 2015;7:159-170. \n5. Khan KN, Kitajima M, Inoue T, et al. (2010). Pathogenesis of Endometriosis: The Origin of \nEndometriotic Stromal Cells. Gynecol Obstet Invest. 2010;71(2):89-103. \n6. Nnoaham KE, Hummelshoj L, Webster P, et al. (2011). Impact of endometriosis on quality of life and \nwork productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373. \n7. Surrey ES, Mccleary JL. (2019). Endometriosis. In StatPearls [Internet]. Available from: \nhttps://www.ncbi.nlm.nih.gov/books/NBK470438/ \n8. Vallve-Juanico, J., Suárez-Salvador, E., Castellví, J., Ballesteros, A., Taylor, A. H., & Gil-Moreno, A. \n(2019). The endometrial immune environment of women with endometriosis. Human Reproduction \nUpdate, 25(5), 564-591. \n9. Zondervan KT, Becker CM, Koga K, et al. (2018). Endometriosis. Nat Rev Dis Primers. 2018;4(1):9.","source_license":"CC0","license_restricted":false}