{"paper_id":"d855e274-38bf-4c7f-af75-4b2114f55e1d","body_text":"Journal of Gynecology and Obstetrics \n2025, V ol. 13, No. 3, pp. 55-61 \nhttps://doi.org/10.11648/j.jgo.20251303.13  \n \n \n*Corresponding author:  \nReceived: 9 May 2025; Accepted: 26 May 2025; Published: 23 June 2025 \n \nCopyright: © The Author(s), 2025. Published by Science Publishing Group. This is an Open Access article, distributed \nunder the terms of the Creative Commons Attribution 4.0 License ( http://creativecommons.org/licenses/by/4.0/), which \npermits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. \n \n \nResearch Article \nExamining the Knowledge and Practices of Nursing Care on \nWomen with Endometriosis in Cyprus \nYakie Ebisidor Favour1, * , Cynthia Ebikeniye Yakie2  \n1Department of Life and Health Science, University of Nicosia, Nicosia, Cyprus \n2Department of Information Technology, St. Clair College of Applied Arts and Technology, Windsor, Canada \n \nAbstract \nEndometriosis is a chronic gynecological disorder affecting approximately 10% of reproductive-aged women globally, leading \nto significant pain, infertility, and diminished quality of life. Despite advancements in diagnosis and management, knowledge  \ngaps among nursing professionals continue to hinder effective patient -centered care. Thi s study examines the knowledge and \npractices of nursing care for women with endometriosis in Cyprus, a country where cultural stigmas and disparities in women's  \nhealth training may impact healthcare delivery. Using a systematic review methodology, relevant  peer-reviewed studies from \ndatabases such as PubMed, Scopus, and CINAHL were analyzed based on inclusion and exclusion criteria. A PRISMA \nframework guided article selection, while a random effects model meta -analysis assessed trends in nursing competence and \npractice variability. Findings indicate that many Cypriot nurses lack adequate knowledge of endometriosis pathophysiology, \nsymptom management, and multidisciplinary approaches, leading to delays in diagnosis and inconsistent care. Furthermore, \ncontinuing professional development (CPD) opportunities specific to endometriosis remain limited, contributing to nurses’ \nreliance on generalized gynecological knowledge. Cultural barriers also constrain open discussions about menstrual health, \nfurther complicating early intervention efforts. The study highlights the need for structured educational programs, standardized \nnursing protocols, and culturally sensitive communication strategies to improve care quality. Future research should explore the \nlong-term impact of targeted training on nursing competency and patient outcomes. Addressing these gaps will strengthen the \nrole of nurses in endometriosis management and enhance healthcare experiences for affected women in Cyprus.  \nKeywords \nKnowledge, Practices, Nursing Care, Endometriosis, Symptoms and Diagnosis \n \n1. Introduction \nEndometriosis is a chronic gynecological condition that \naffects approximately 10% of reproductive -aged women \nworldwide, causing debilitating symptoms such as pelvic pain, \ndysmenorrhea, and infertility [32]. In recent years, attention \nhas grown on how nursing care practices influence the ma n-\nagement of endometriosis, emphasizing a need for targeted \nknowledge among healthcare providers to enhance patient \noutcomes [25]. Cyprus, with its unique healthcare system and \ncultural context, offers a valuable case for understanding how \nnurses approach endometriosis care, as recent studies indicate \ndisparities in awareness and clinical training specific to \nwomen’s health issues, including endometriosis [22]. \n\n\nJournal of Gynecology and Obstetrics http://www.sciencepg.com/journal/jgo \n \n56 \nIn Cyprus, approximately 12% of reproductive-aged women \nare estimated to suffer from endometriosis, paralleling rates \nfound in Greece and Italy, where rates range from 10-13% [14]. \nIn African countries, the prevalence appears somewhat lower \nbut is likely underreported due to limited diagnostic resources \nand cultural barriers that affect healthcare -seeking behavior. \nFor instance, in Nigeria and South Africa, studies estimate rates \nbetween 5-8%, with many cases undiagnosed due to the scar-\ncity of specialists and accessible diagnostic tools [3]. Mean-\nwhile, in Asian countries, endometriosis rates are comparable \nto Europe, but they vary widely. Japan reports a prevalence of \naround 10-12%, reflecting strong healthcare infrastructure and \nawareness [29]. In contrast, India and Indonesia report lower \ndiagnosed prevalence rates, around 4-7%, attributed to cultural \nstigmas and disparities in healthcare access [20]. \nCyprus’s healthcare system and cultural context shape both \npositive and negative aspects of nursing care for endometri o-\nsis patients [8]. On the positive side, Cyprus has a strong \nprimary healthcare system and a growing awareness of \nwomen’s health issues, which supports a foundation for p a-\ntient-centered care [35]. Nurses are general ly trained to pr o-\nvide holistic care, potentially improving the quality of life for \nendometriosis patients through supportive care, counseling, \nand pain management strategies that address both physical \nand emotional needs [24]. Additionally, Cyprus has rece ntly \nemphasized continuing education in nursing, which enables \nnurses to stay updated on the latest guidelines and ev i-\ndence-based practices for managing endometriosis. \nHowever, challenges remain. Disparities in endometriosis \nawareness and clinical training  lead to inconsistencies in the \ndiagnosis and management of the condition [7, 15]. Due to \ncultural stigmas around discussing menstrual and reprodu c-\ntive health, many women delay seeking care or are hesitant to \nshare symptoms fully, complicating early diagno sis and \ncomprehensive treatment [19, 28]. Furthermore, limited sp e-\ncialized training in women’s health for nurses result in insu f-\nficient knowledge of endometriosis, potentially leading to \ndelayed diagnosis or mismanagement of symptoms [16, 14]. \nThese gaps underline the need for culturally sensitive training \nprograms that equip nurses with the necessary skills to a d-\ndress endometriosis comprehensively and sensitively in Cy p-\nriot healthcare settings. \nThis research focuses on examining the knowledge and \npractices of nursing professionals in Cyprus regarding e n-\ndometriosis care, as well as identifying gaps that affects the \nquality of patient-centered care for women with this condition. \nDespite advancements in global healthcare guidelines, ev i-\ndence shows that the kno wledge and confidence of nursing \nstaff in managing endometriosis vary significantly, often \nimpacting the timeliness and accuracy of care provided. \nConsidering these issues, this study will explore how nursing \npractices in Cyprus align with current clinical  guidelines, \nproviding insights into potential areas for improvement in \nboth education and practice. \n(1) Objectives \n1. Assess the current knowledge and understanding of \nendometriosis among nurses in Cyprus. \n2. Evaluate the nursing practices and care provided to \nwomen with endometriosis in Cyprus. \n(2) Hypotheses \nH01: there is no significant relationship between the level of \nknowledge and understanding of endometriosis among nurses \nin Cyprus. \nH02: The nursing practices and care provided to women \nwith endometriosis in Cyprus shows no significant difference \nin quality or effectiveness from an average benchmark. \n2. Literature Review \nSupporting nursing care for women with endometriosis in \nCyprus benefit is dependent on healthcare theory like the \nPender’s Health Promotion Mo del (HPM). This model e m-\nphasizes the role of healthcare providers in motivating p a-\ntients to engage in health -promoting behaviors, which is pa r-\nticularly relevant in managing endometriosis. In Cyprus, \nwhere cultural barriers prevent open discussions on menstrual \nhealth, nurses trained in the HPM framework encourages \nwomen to seek care earlier and discuss symptoms more \nopenly, thereby potentially reducing delayed diagnoses [4]. \nThe HPM suggests that by increasing nurses' awareness and \npromoting a supportive environment, healthcare providers can \nempower women to take proactive steps in managing end o-\nmetriosis, leading to improved long-term health outcomes. \n2.1. Knowledge and Understanding of \nEndometriosis Among Nurses in Cyprus \n(1) Endometriosis \nEndometriosis is a ch ronic gynecological condition where \ntissue like the endometrial lining found inside the uterus b e-\ngins to grow outside the uterus, commonly affecting the ov a-\nries, fallopian tubes, and pelvic lining [31]. This tissue r e-\nsponds to hormonal changes in the same way as the uterine \nlining, thickening and shedding with each menstrual cycle, yet \nit has no natural exit from the body, causing inflammation, \nscarring, and adhesions [5]. While the exact cause of end o-\nmetriosis remains unknown, several theories suggest co n-\ntributing factors, such as retrograde menstruation, where \nmenstrual blood flows backward through the fallopian tubes; \nimmune system dysfunction, which fails to clear the mi s-\nplaced tissue; genetic predisposition; and hormonal imba l-\nances [18]. \n(2) Symptoms and Diagnosis \nEndometriosis presents with a range of symptoms, with the \nmost common being chronic pelvic pain, dysmenorrhea \n(painful periods), dyspareunia (pain during intercourse), and \ninfertility [30]. Other symptoms can include heavy menstrual \nbleeding, fatigue, and gastrointestinal issues like bloating and \ndiarrhea [1]. Symptoms vary widely in severity, and some \nwomen with endometriosis remain asymptomatic, compl i-\n\nJournal of Gynecology and Obstetrics http://www.sciencepg.com/journal/jgo \n \n57 \ncating timely diagnosis. Diagnosis typically involves a co m-\nbination of symptom assessment, pelvic exams, imaging tests \nlike ultrasound or MRI, and in some cases, laparoscopy, a \nminimally invasive surgical procedure that allows direct vi s-\nualization and biopsy of suspected endometriotic tissue, \nwhich remains the gold standard for diagnosis [22]. \n(3) Treatment Options \nWhile there is no cure for endometriosis, treatment aims to \nrelieve symptoms and improve quality of life. Nonsteroidal \nanti-inflammatory drugs (NSAIDs) for pain relief and ho r-\nmonal therapies to reduce or eliminate menstruation, which \nhelps contr ol pain and lesion growth [27]. For those with \nsevere symptoms or unresponsive to medical therapy, surgical \noptions like laparoscopy can be used to remove or reduce \nendometrial tissue [9]. In cases where endometriosis affects \nfertility, assisted reproductive technologies like in vitro fert i-\nlization (IVF) may be recommended [11]. Complementary \nmethods such as dietary modifications, physical therapy, and \npsychological support can also play a role in symptom ma n-\nagement, as they address overall wellbeing and alleviate stress \nassociated with chronic illness [5, 17]. \nAssessing the current knowledge and understanding of \nendometriosis among nurses in Cyprus reveals a mixed pi c-\nture, influenced by both healthcare system strengths and li m-\nitations in specialized training. While there is a foundation of \ngeneral awareness, recent research indicates that gaps in sp e-\ncialized knowledge hinder optimal care for endometriosis \npatients, largely due to limited training opportunities and \ncultural barriers [14, 2]. Many Cypriot nurses possess a basic \nunderstanding of endometriosis symptoms, such as pelvic \npain and irregular menstruation. However, studies reveal that \nthey often lack in -depth knowledge regarding the complex \npathophysiology, progression, and multi -system impac ts of \nendometriosis [6]. This limited understanding affects their \nability to recognize fewer common symptoms, which may \nlead to missed diagnoses and delays in care. \nNurses also report low confidence levels in managing \nchronic pain associated with endometri osis, largely due to \ninsufficient training in women’s health and pain management \nprotocols [17]. The need for clearer guidelines and continuous \neducation is emphasized by several studies, as nurses often \nexpress a desire for improved resources to effectively support \npatients through both physical and emotional challenges \nposed by endometriosis. \nCultural stigmas surrounding reproductive health further \ncompound these challenges. Many nurses in Cyprus work in a \ncultural environment where discussions about mens trual \nhealth are often seen as taboo, impacting both patient ope n-\nness and provider -patient communication [21]. Leininger’s \nCulture Care Theory, which emphasizes the importance of \nculturally competent care, supports the need for specialized \ntraining to addr ess these cultural nuances, enabling nurses to \nengage in sensitive discussions with endometriosis patients \nwhile overcoming societal barriers. \n2.2. Nursing Practices and Care Provided to \nWomen with Endometriosis in Cyprus \nEvaluating nursing practices and care for women with e n-\ndometriosis in Cyprus reveals a combination of strengths and \ngaps within healthcare delivery. Effective management of \nendometriosis begins with a comprehensive assessment of \nsymptoms. Nurses and healthcare providers should conduct \nthorough interviews with patients to gather detailed info r-\nmation about their menstrual history, pain characteristics, and \nassociated symptoms such as gastrointestinal issues or urinary \nproblems. A standardized assessment tool, like the Endom e-\ntriosis Health Pr ofile (EHP -30), can help quantify symptom \nseverity and its impact on quality of life. The assessment \nshould also include a physical examination, focusing on pe l-\nvic examinations to identify potential endometrial lesions or \ntenderness. \nOnce symptoms are asse ssed, management strategies \nshould be tailored to everyone. These strategies often involve \na combination of pharmacological and non -pharmacological \napproaches, emphasizing a holistic view of patient care. E d-\nucation is vital, as patients should understand t he nature of \nendometriosis, the potential variability of symptoms, and the \navailable treatment options [27]. \nPain management is a cornerstone of endometriosis trea t-\nment, given that chronic pelvic pain is one of the most debi l-\nitating symptoms associated wit h the condition. Initial pain \nrelief often involves nonsteroidal anti -inflammatory drugs \n(NSAIDs), which can help manage menstrual pain and overall \ndiscomfort [12]. However, nurses should also assess the need \nfor more advanced pain management strategies if  patients \nexperience inadequate relief from NSAIDs. For those with \nsevere or persistent pain, hormonal therapies may be consi d-\nered. These treatments aim to suppress menstruation and \nreduce the growth of endometrial tissue. Options include \nhormonal contrace ptives, GnRH agonists, and progestins, \neach with different mechanisms and side effect profiles [5]. \nFurthermore, nurses should be aware of potential side effects \nassociated with these treatments and provide patients with \ninformation to manage them effectiv ely. In addition to me d-\nication, complementary therapies —such as acupuncture, \nphysical therapy, and dietary modifications —can play a \nsupportive role in pain management [11]. Nurses should e n-\ncourage patients to explore these options while emphasizing \nthe importance of a multidisciplinary approach to care. \nHormonal treatments are a key component in managing \nendometriosis. Hormonal contraceptives, including birth \ncontrol pills, patches, and intrauterine devices (IUDs), are \noften first-line options that can regulate menstrual cycles and \nalleviate pain [9]. For  patients who do not respond to ho r-\nmonal therapy or who have significant endometriosis -related \ncomplications, surgical options may be warranted. Lap a-\nroscopy is commonly employed to excise or ablate end o-\nmetrial lesions, and in more severe cases, a hysterect omy \nmay be recommended, especially for women who do not \n\nJournal of Gynecology and Obstetrics http://www.sciencepg.com/journal/jgo \n \n58 \ndesire future fertility [33]. Nurses play a critical role in \npreparing patients for surgical interventions by providing \neducation about the procedures, recovery expectations, and \npotential complicatio ns. Post-operative care also falls within \nthe nursing scope, requiring monitoring for complications, \npain management, and encouraging adherence to follow -up \nappointments.  \nReferral practices are essential for providing comprehe n-\nsive care to women with endom etriosis. Nurses should estab-\nlish a clear referral pathway for patients needing specialized \ncare, including gynecologists, pain management specialists, \nand mental health professionals. Early and appropriate refe r-\nrals can facilitate timely interventions and  improve overall \npatient outcomes. In addition, multidisciplinary care models \nthat involve collaboration among healthcare professionals can \nenhance treatment effectiveness. For instance, integrating \nphysical therapy into a patient's care plan may address p ain \nmanagement, while a dietitian can provide guidance on n u-\ntrition that may alleviate some symptoms [10]. \n2.3. Barriers and Challenges in Endometriosis \nCare \nDespite advancements in understanding and managing \nendometriosis, numerous barriers and challenges  hinder e f-\nfective care for affected women. These challenges include \nlack of knowledge or training among healthcare providers, \nlimited resources within healthcare systems, and p a-\ntient-related factors that impact treatment access and ou t-\ncomes. \nOne of the mos t significant barriers to effective endom e-\ntriosis care is the inadequate knowledge and training among \nhealthcare providers, particularly nurses and general pract i-\ntioners. Studies have highlighted that many healthcare pr o-\nfessionals possess limited understanding of endometriosis, its \nsymptoms, and the latest treatment options [23]. This \nknowledge gap can lead to misdiagnosis, delayed treatment, \nand insufficient management of symptoms. For instance, \nhealthcare providers may not recognize atypical presentations \nof endometriosis, resulting in underdiagnosis or misdiagnosis \nas other conditions, such as irritable bowel syndrome (IBS) or \npelvic inflammatory disease (PID) [13]. \nLimited resources in healthcare systems, particularly in \ndeveloping regions or within spec ific institutions, can pose \nsignificant challenges to providing adequate endometriosis \ncare. Resource constraints may manifest in various forms, \nincluding insufficient access to diagnostic tools such as \nultrasound and MRI, limited availability of specializ ed \nhealthcare providers, and inadequate funding for treatment \noptions [11]. In some cases, the lack of multidisciplinary \ncare teams —including gynecologists, pain specialists, and \nmental health professionals —can hinder comprehensive \ntreatment approaches. Wi thout access to a full range of \nservices, patients may experience delays in receiving timely \nand appropriate care. Furthermore, limited financial r e-\nsources may impact patients' ability to afford necessary \ntreatments, such as hormonal therapies or surgical interven-\ntions, leading to worsening symptoms and decreased quality \nof life [27]. \nPatient-related factors also play a critical role in the \nchallenges faced in managing endometriosis. Many women \nwith endometriosis experience a range of barriers that pr e-\nvent them from seeking timely medical attention. Stigmas \nassociated with menstruation and reproductive health issues \ncan lead to feelings of shame or embarrassment, causing \nwomen to delay seeking help [34]. Additionally, a lack of \nawareness about endometriosis among patients themselves \ncan contribute to misunderstandings about their symptoms \nand treatment options. Moreover, the variability of sym p-\ntoms can lead to differing levels of pain and disability, which \nmay impact women's ability to navigate the healthcare  sys-\ntem effectively. Some women may prioritize managing their \nsymptoms independently or rely on informal networks for \nsupport, rather than seeking professional medical advice \n[26]. \n3. Methodology \nThis study employs a structured methodology to assess the \nknowledge and practices of nurses in Cyprus concerning \nendometriosis care. An online questionnaire serves as the \nprimary data collection tool. This survey is distributed \nthrough professional networks, with the cooperation of ho s-\npital and clinic administrator s, and via relevant social media \ngroups to maximize participation. The questionnaire co m-\nprises a variety of question types —such as multiple -choice \nquestions, Likert scales, and open -ended responses —to col-\nlect both quantitative data for statistical analysis  and qualita-\ntive insights that capture nuanced perspectives on endom e-\ntriosis care. \nA structured online questionnaire was distributed among \nregistered nurses and midwives in various healthcare settings, \nyielding a sample size of 120 respondents s, a range d eemed \nadequate to provide statistically significant insights and a \nrepresentative understanding of the nursing population i n-\nvolved in women’s healthcare within Cyprus. To ensure d i-\nversity, the study sample encompass nurses from various \nhealthcare settings, including hospitals, clinics, and comm u-\nnity health centers, with respondents representing both urban \nand rural regions of Cyprus. \n3.1. Exclusion Criteria \nEligible participants include registered nurses, midwives, \nand nurse practitioners, as these roles ar e most frequently \nengaged in obstetric and gynecological care and, cons e-\nquently, more likely to encounter and manage endometriosis \ncases. By concentrating on these specializations, the study \naims to gather responses from professionals with relevant, \npractical experience in women’s health, which is critical for \n\nJournal of Gynecology and Obstetrics http://www.sciencepg.com/journal/jgo \n \n59 \nunderstanding current endometriosis care practices in Cyprus. \nThe systematic review employs well -defined exclusion crite-\nria to ensure the selection of relevant studies. The inclusion \ncriteria focus on  peer-reviewed studies published within the \nlast ten years, specifically addressing nursing knowledge and \npractices in endometriosis care. Studies that examine the \nimpact of nursing interventions on patient outcomes, inclu d-\ning qualitative and quantitative research, are considered. A d-\nditionally, research involving nurses in Cyprus or countries \nwith comparable healthcare systems is included to provide \ncontextually relevant findings. \nTo maintain focus on established practitioners, the excl u-\nsion criteria for th e study specify that nurses with less than \none year of experience are not eligible to participate. This \ndecision aims to avoid responses from individuals who do not \nhave sufficient exposure to endometriosis cases or who have \nnot developed a comprehensive u nderstanding of clinical \npractices in women’s health. \n3.2. Inclusion Criteria \nExclusion criteria eliminate studies that do not explicitly \nfocus on nursing practices, lack empirical data, or focus on \nunrelated gynecological conditions. Reviews without met h-\nodological transparency, non -English publications, and case \nreports that do not contribute to broader conclusions about \nnursing knowledge are also excluded. These criteria help \nrefine the dataset and ensure a robust evidence base for \nanalysis. \n4. Analysis \nPRISMA Diagram \nA PRISMA (Preferred Reporting Items for Systematic \nReviews and Meta-Analyses) diagram is used to illustrate the \narticle selection process. The initial search identifies nume r-\nous studies from databases such as PubMed, Scopus, and \nCINAHL. After removing duplicates and screening titles and \nabstracts, a subset of studies undergoes full-text review based \non inclusion and exclusion criteria. The final selection i n-\ncludes high -quality studies directly relevant to the research \nobjectives. The PRISMA d iagram enhances transparency by \nvisually representing how many studies were included, e x-\ncluded, and the reasons for exclusion. \n4.1. Data Extraction \nData extraction follows a structured approach using a \nstandardized template. Key information from each selec ted \nstudy is compiled, including author(s), publication year, study \ndesign, sample size, data collection methods, key findings, \nand limitations. The review focuses on variables such as \nnurses' understanding of endometriosis, training initiatives, \nbarriers to effective care, and patient outcomes. The extracted \ndata facilitate thematic synthesis and ensure consistency \nacross multiple studies. \n4.2. Meta-analysis Methods (Random Effects \nModel) \nGiven the expected heterogeneity among the studies, a \nmeta-analysis is conducted using a random effects model. \nThis approach accounts for variations in study populations, \nmethodologies, and healthcare settings. The model aggregates \neffect sizes from different studies, providing a weighted e s-\ntimate of overall trends in nurs ing knowledge and practices \nregarding endometriosis care. Sensitivity analysis is pe r-\nformed to assess the robustness of the findings, and public a-\ntion bias is examined using funnel plots and Egger’s test. \n4.3. Position of the Paper \nThe reviewed paper situat es itself within the growing di s-\ncourse on improving nursing competencies in women's health, \nparticularly concerning endometriosis. It builds on theoretical \nframeworks such as Pender’s Health Promotion Model and \nLeininger’s Culture Care Theory, emphasizing the importance \nof culturally sensitive and evidence -based nursing practices. \nBy focusing on Cyprus, the study contributes a regional pe r-\nspective to the broader discussion on enhancing nursing e d-\nucation and care models for endometriosis management. \n4.4. Results \nThe systematic review identifies several key findings. First, \nknowledge gaps among Cypriot nurses regarding endometr i-\nosis are evident, particularly in understanding pathophysio l-\nogy, symptom management, and multidisciplinary care a p-\nproaches. Many nurse s demonstrate limited confidence in \ndiagnosing and managing endometriosis -related pain due to \ninadequate training. \nSecond, disparities in nursing education and continuing \nprofessional development (CPD) programs affect the quality \nof care. Studies show that  nurses with specialized training in \nwomen’s health are better equipped to provide p a-\ntient-centered care, while those lacking formal education on \nendometriosis rely on general gynecological knowledge, \nwhich may not be sufficient. \nThird, cultural barriers i n Cyprus hinder open discussions \nabout menstrual and reproductive health, leading to delays in \ndiagnosis and inadequate symptom management. P a-\ntient-nurse communication is often constrained by societal \nstigmas, preventing women from fully disclosing symptoms. \nFinally, the review highlights the effectiveness of mult i-\ndisciplinary approaches, including pain management prot o-\ncols, psychological support, and patient education. Studies \nindicate that integrating evidence -based guidelines into \nnursing curricula and C PD programs improves both nurse \nconfidence and patient outcomes. \n\nJournal of Gynecology and Obstetrics http://www.sciencepg.com/journal/jgo \n \n60 \n4.5. Limitations \nSeveral limitations affect the systematic review. The \navailability of studies on nursing care for endometriosis in \nCyprus is limited, necessitating reliance on data from co m-\nparable healthcare systems. Variations in study methodol o-\ngies, sample sizes, and outcome measures introduce heter o-\ngeneity, which, despite the use of a random effects model, \naffects the generalizability of findings. Additionally, language \nrestrictions to English publications may result in the exclusion \nof relevant studies published in Greek. The self -reported \nnature of some studies may also introduce response bias, as \nnurses may overestimate their knowledge or adherence to best \npractices. \n4.6. Conclusion and Recommendations \nThe systematic review underscores the critical need for \ntargeted nursing education and policy reforms to improve \nendometriosis care in Cyprus. The findings suggest that \nstructured training programs should be integrated into nursing \ncurricula to enhance knowledge and confidence in managing \nendometriosis. Continuing professional development courses \nfocused on pain management, diagnostic awareness, and \npatient communication are necessary to bridge the identified \ngaps. \nAdditionally, fostering cu lturally sensitive nursing pra c-\ntices can help mitigate barriers to patient -nurse communica-\ntion. Public health campaigns aimed at normalizing discu s-\nsions about menstrual health may further encourage early \ndiagnosis and intervention. The review also recommen ds the \ndevelopment of standardized protocols and guidelines for \nnursing care in endometriosis management, ensuring co n-\nsistency in care delivery. \nFuture research should explore the long -term impact of \neducational interventions on nursing competency and pati ent \noutcomes. Further studies employing longitudinal designs and \nqualitative methods could provide deeper insights into the \nevolving landscape of endometriosis care in Cyprus. E x-\npanding the scope to include cross -cultural comparisons may \nalso offer valuable lessons on best practices for nursing care in \ndiverse healthcare settings. \nBy implementing these recommendations, healthcare \nstakeholders in Cyprus can enhance the role of nurses in e n-\ndometriosis management, ultimately improving patient care \nand health outcomes. \nAbbreviations \nCPD Continuing Professional Development \nIUDs Intrauterine Devices \nIBS Irritable Bowel Syndrome \nPID Pelvic Inflammatory Disease \nNSAIDs Nonsteroidal Anti-inflammatory Drugs \nEHP-30 Endometriosis Health Profile \nHPM Health Promotion Model \nConflicts of Interest \nThe authors declare no conflicts of interest. \nReferences \n[1] Afrose, A., 2024. Evaluation of endometriosis risk factors, \nsymptoms, and clinical treatments in Bangladesh: a \ncross-sectional study (Doctoral dissertation, Brac University). \n[2] Ajegbile, M. D., Olaboye, J. A., Maha, C. C., Igwama, G. T. \nand Abdul, S., 2024. 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