{"paper_id":"dee72d84-b1b5-4bbf-a067-4f9bb929c980","body_text":"Open Journal of Obstetrics and Gynecology, 2026, 16(5), 687-699 \nhttps://www.scirp.org/journal/ojog \nISSN Online: 2160-8806 \nISSN Print: 2160-8792 \n \nDOI: 10.4236/ojog.2026.165067  May 9, 2026 687 Open Journal of Obstetrics and Gynecology \n \n \n \n \nPrevalence and Correlates of Pelvic \nEndometriosis in an Urban Center of \nCameroon: A Cross-Sectional Study \nThéophile Njamen Nana1,2, Alida Estelle Noundjeu Tongna1, Robert Tchounzou2,3*,  \nFulbert Mangala Nkwele1,4, Humphry Neng2,3, Cedric Junior Nana Njamen1,  \nFidelia Kobenge Mbi1, Chrisantus Ndzometia2, Isaac Mboh Eyong2, Andre Gaetan Simo Wambo2, \nAlphonse Ngalame2, Charlotte Tchente Nguefack1,4, Gregory Halle Ekane1,2,  \nThomas Obinchemti Egbe1,2, Henri Essome4, Emile Mboudou3,5 \n1Department of Obstetrics and Gynecology, Douala General Hospital, Douala, Cameroon \n2Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Buea, Cameroon \n3Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Pediatric Hospital of Douala, Douala, Cameroon \n4Department of Surgery and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, \nCameroon \n5Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, \nCameroon \n \n \n \nAbstract \nBackground:  Endometriosis is a common gynecological condition worldwide \nbut remains poorly documented in sub-Saharan Africa, largely due to limited \naccess to diagnostic laparoscopy. Understanding its prevalence and associated \nfactors is essential for imp roving clinical recognition and management. Ob-\njective:  To determine the surgical prevalence and factors associated with pel-\nvic endometriosis among women undergoing gynecological laparoscopy in \nDouala, Cameroon. Methods:  We conducted a retrospective cross -sectional \nstudy over a 10 -year period (January 2014 -December 2022) in three tertiary \nhospitals in Douala. Medical records of women who underwent gynecological \nlaparoscopy for indications such as infertility, chronic pelvic pain, adnexal \nmasses, or suspected ectopic pregnancy were reviewed. Pelvic endometrio sis\n \nwas primarily diagnosed by direct laparoscopic visualization of characteristic \nlesions by experienced surgeons. Biopsy with histological confirmation was \nperformed when lesions were atypical or when diagnostic uncertainty existed. \nData were analyzed using SPSS version 24.0. Bivariate and multivariate logistic \nregression analyses were performed to identify factors associated with pelvic \nendometriosis. Adjusted odds ratios (AORs) with 95% confidence intervals \n(CIs) were calculated, and statistical significan ce was set at p < 0.05. Results:  \nHow to cite this paper: Nana, T.N., \nTongna, A.E.N., Tchounzou, R., Nkwele, \nF.M., Neng, H., Njamen, C.J.N., Mbi, F.K., \nNdzometia, C., Eyong, I.M., Wambo, \nA.G.S., Ngalame, A., Nguefack, C.T., \nEkane, G.H., Egbe, T.O., Essome, H. and \nMboudou, E. (2026) Prevalence and Corre-\nlates of Pelvic Endometriosis in an Urban \nCenter of Cameroon: A Cross-Sectional \nStudy. Open Journal of Obstetrics and Gy-\nnecology, 16, 687-699. \nhttps://doi.org/10.4236/ojog.2026.165067 \n \nReceived:  March 5, 2026 \nAccepted: May 6, 2026 \nPublished: May 9, 2026 \n \nCopyright © 2026 by author(s) and  \nScientific Research Publishing Inc. \nThis work is licensed under the Creative \nCommons Attribution International  \nLicense (CC BY 4.0). \nhttp://creativecommons.org/licenses/by/4.0/   \n  \nOpen Access\n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 688 Open Journal of Obstetrics and Gynecology \n \nA total of 440 women were included. The surgical prevalence of laparoscopi-\ncally diagnosed pelvic endometriosis was 22.5%. Histological confirmation \nwas obtained in 81 of the 88 biopsied cases (92.0%). In multivariate analysis, \nage at menarche ≤ 11 years (A OR = 5.14; 95% CI: 2.49 - 10.64; p < 0.001) and \nmenstrual cycle length ≤ 27 days (AOR = 5.20; 95% CI: 2.91 -  9.30; p < 0.001) \nwere independently associated with increased odds of endometriosis. Con-\nversely, a history of pelvic surgery (AOR = 0.30; 95% CI: 0.14 - 0.61; p < 0.001), \nprimigravidity (AOR = 0.49; 95% CI: 0.25 - 0.98; p = 0.045), and paucigravidity \n(AOR = 0.34; 95% CI: 0.16 -  0.70; p = 0.003) were inversely associated with \nendometriosis. Conclusion:  Nearly one-quarter of women undergoing gyne-\ncological laparoscopy in three tertiary hospitals in Douala had pelvic endome-\ntriosis. Early menarche and short menstrual cycles were strongly associated \nwith the condition, while prior pelvic surgery and low grav idity showed in-\nverse associations. These findings highlight the impo rtance of improving ac-\ncess to laparoscopic diagnostic services to enhance the detection and manage-\nment of endometriosis in similar resource-limited settings.  \n \nKeywords \nPelvic Endometriosis, Prevalence, Associated Factors, Laparoscopy, \nCameroon, Sub-Saharan Africa \n \n1. Introduction \nEndometriosis is a chronic gynecological condition characterized by the presence \nof endometrial glands and/or stroma outside the uterine cavity, commonly involv-\ning the ovaries, fallopian tubes, and pelvic peritoneum, with possible extra-pelvic \nmanifestations [1]-[3]. Its clinical presentation is heterogeneous, ranging from se-\nvere symptoms to asymptomatic disease, which often leads to delayed diagnosis. \nGlobally, endometriosis affects approximately 10% of women of reproductive \nage, representing nearly 190 million individuals worldwide and constituting a ma-\njor public health concern [4]. The true burden of disease is likely underestimated \ndue to nonspecific symptoms, such as chronic pelvic pain and infertility, and lim-\nited access to diagnostic laparoscopy in many settings [5]-[7]. \nIn sub-Saharan Africa, reported prevalence rates are relatively low, largely re-\nflecting underdiagnosis and restricted availability of minimally invasive surgical \ntechniques [8]. However, hospital-based studies in Cameroon have documented \nprevalence rates between 13.5% and 22.5% among women undergoing surgery for \ninfertility or chronic pelvic pain, suggesting a substantial but under recognized \ndisease burden [9] [10]. \nSeveral reproductive, menstrual, and surgical factors have been associated with \nendometriosis, although reported risk profiles vary across studies due to differ-\nences in populations, diagnostic methods, and study designs [11]-[13]. In resource-\nlimited settings, identifying context-specific associated factors is essential to im-\nprove clinical suspicion and guide appropriate referral for surgical diagnosis. \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 689 Open Journal of Obstetrics and Gynecology \n \nIn Cameroon, data on endometriosis remain scarce, and limited access to lapa-\nroscopy contributes to delayed diagnosis, with significant consequences for fertil-\nity, quality of life, and psychological well-being [14]. As the surgical prevalence and \nassociated factors of endometriosis in urban Cameroonian settings remain insuf-\nficiently characterized, this study aimed to determine the prevalence and identify \nfactors associated with pelvic endometriosis among women undergoing laparo-\nscopic surgery in three hospitals in Douala, Cameroon. \n2. Materials and Methods \n2.1. Study Design and Period \nWe conducted a hospital-based cross-sectional analytical study with retrospective \ndata collection. Medical records covering a 10-year period from January 1, 2014 \nto December 31, 2022 were reviewed. Data collection and analysis were conducted \nover a five-month period from January to June 2025. \n2.2. Study Setting \nThe study was conducted in the gynecology departments of three specialized \nhealthcare facilities in Douala, Cameroon: \n Douala General Hospital (HGD) \n Douala Gyneco-Obstetrics and Pediatrics Hospital (DGOPH) \n Clinique de l’Aéroport (CA) \nThe first two institutions are tertiary-level teaching and referral hospitals \nproviding advanced gynecological care and specialist training. Clinique de l’Aéro-\nport is a private healthcare facility specialized in minimally invasive gynecological \nsurgery and assisted reproductive techniques. \nAll three centers are equipped with video-laparoscopy systems enabling direct \nvisualization of pelvic structures. Laparoscopic procedures were performed by ex-\nperienced gynecologic surgeons with 8 - 35 years of surgical experience. \n2.3. Study Population and Eligibility Criteria \nA non-probabilistic exhaustive sampling method was used. \nWe included all medical records of women who underwent diagnostic and/or \noperative gynecological laparoscopy during the study period for indications in-\ncluding infertility, chronic pelvic pain, adnexal masses, or suspected ectopic preg-\nnancy. \nA diagnosis of pelvic endometriosis was retained when one of the following cri-\nteria was met: \n1) Laparoscopic diagnosis: Direct visualization of typical endometriotic lesions \nsuch as powder-burn lesions, ovarian endometriomas, or deep infiltrating nodules \nby experienced surgeons. \n2) Histological  confirmation: Identification of endometrial glands and/or \nstroma on histopathological examination of biopsy specimens obtained during \nlaparoscopy. \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 690 Open Journal of Obstetrics and Gynecology \n \nDiagnosis was primarily based on laparoscopic visualization. Biopsy with his-\ntological examination was performed when lesions appeared atypical or when di-\nagnostic uncertainty existed. \nMedical records with incomplete data (defined as missing more than 20% of \nrequired study variables) were excluded from the analysis. \n2.4. Data Collection and Study Variables \nFollowing administrative authorization and ethical approval, surgical registers \nwere reviewed to identify eligible cases. Complete medical files were subsequently \nretrieved from hospital archives. Data were collected using a standardized data ex-\ntraction form developed in accordance with the study objectives and relevant lit-\nerature. The form was pretested on a subset of medical records not included in the \nfinal analysis and refined accordingly. Data extraction was carried out by trained \nphysicians under the supervision of the principal investigator. To ensure data qual-\nity and consistency, a random sample of records was cross-checked, and any dis-\ncrepancies were resolved through consensus. \nSociodemographic characteristics: Age, marital status, education level, and oc-\ncupation. \nGynaecological and reproductive variables: Age at menarche, menstrual cycle \nlength and regularity, gravidity, parity, and family history of endometriosis. \nMedical and surgical history: History of diabetes mellitus, hypertension, prior \nabdominal or pelvic surgery. \nLifestyle factors: Alcohol consumption and tobacco use. \nAll laparoscopic procedures were performed by senior surgeons with docu-\nmented expertise in minimally invasive gynaecological surgery. \n2.5. Sampling Method and Sample Size \nAn exhaustive sampling approach was adopted, including all eligible cases that \nmet the inclusion criteria during the study period. As a result, no a priori sample \nsize calculation was performed. The final sample size corresponded to the total \nnumber of complete medical records available and eligible across the three study \nsites. \n2.6. Data Management and Statistical Analysis \nData were entered and analyzed using SPSS version 24.0. \nCategorical variables were summarized as frequencies and percentages. \nBivariate analysis was performed to evaluate associations between pelvic endo-\nmetriosis and independent variables using crude odds ratios (ORs) with their 95% \nconfidence intervals (CIs). \nVariables with p < 0.20 in bivariate analysis were included in a multivariate lo-\ngistic regression model to identify independent factors associated with endome-\ntriosis while controlling for potential confounders. \nAdjusted odds ratios (AORs) with 95% confidence intervals were reported. Sta-\ntistical significance was set at p < 0.05. \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 691 Open Journal of Obstetrics and Gynecology \n \nFamily history of endometriosis was not included in the multivariate model due \nto complete separation, as no cases were observed among the control group, pre-\nventing reliable estimation of adjusted odds ratios. \n2.7. Ethical Considerations \nThe study was conducted in accordance with the ethical principles of biomedical \nresearch involving human subjects. Ethical approval was obtained from the Insti-\ntutional Ethics and Research Committee (2025/083/UDM/PR/CEAQ ). Given the \nretrospective nature of the study, informed consent was waived. Patient confiden-\ntiality was strictly maintained by anonymizing all extracted data and restricting \naccess to study files to the researchers. \n3. Results \n3.1. Study Population and Surgical Prevalence of Pelvic \nEndometriosis \nDuring the study period, 506 women underwent gynecological laparoscopy in the \nthree participating centres. Of these, 440 patients (87.0%) met the inclusion crite-\nria and were included in the analysis. \nPelvic endometriosis was identified in 99 women, yielding a surgical prevalence \nof 22.5% among women undergoing laparoscopy. \nDiagnosis was based on direct laparoscopic visualization of typical endometri-\notic lesions (Figures 1 -3). Biopsies for histological confirmation were performed \nin 88 cases (20.0%), with histopathology confirming endometriosis in 81 cases, \ncorresponding to a confirmation rate of 92.0%. \n \n \nFigure 1.  Bilateral endometrioma. \n \n \nFigure 2.  Laceration of the pelvic parietal peritoneum. Clear, reddish, and brownish endo-\nmetriotic vesicles. \n\n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 692 Open Journal of Obstetrics and Gynecology \n \n \nFigure 3. Brownish hemoperitoneum; clear endometriotic vesicles. On a hypervascularized \nparietal peritoneum. \n3.2. Bivariate Analysis of Socio-Demographic Factors \nIn bivariate analysis, occupation in the private sector was significantly associated \nwith pelvic endometriosis. Women working in the private sector had more than \ntwice the odds of endometriosis compared with those in the informal sector (OR \n= 2.47; 95% CI: 1.20 - 5.09; p = 0.014). \nAge, marital status, and level of education were not significantly associated with \npelvic endometriosis in bivariate analysis (Table 1 ). \n \nTable 1 . Socio-demographic factors associated with pelvic endometriosis (Bivariate analy-\nsis). \nVariables  \nEndometriosis  \nPresent  (N = 99) \nn (%) \nEndometriosis  \nAbsent (N = 341) \nn (%) \nOdds Ratio \n(OR) \n(95% CI) \np-Value \nAge (years)     \n15 - 24 9 (9.1) 28 (8.2) 4.18 (0.48 - 36.53) 0.196 \n25 - 34 59 (59.6) 170 (49.9) 4.51 (0.58 - 35.24) 0.151 \n35 - 44 30 (30.3) 130 (38.1) 3.00 (0.38 - 23.83) 0.299 \n45 - 54 1 (1.0) 13 (3.8) 1 (reference)  \nMarital status     \nSingle 33 (33.3) 146 (42.8) 1 (reference)  \nMarried 63 (63.6) 190 (55.7) 1.47 (0.91 - 2.35) 0.112 \nWidow/divorced 3 (3.0) 5 (1.5) 2.65 (0.60 - 11.67) 0.196 \nOccupation     \nPrivate 22 (22.2) 43 (12.6) 2.47 (1.20 - 5.09) 0.014 \nPublic 36 (36.4) 134 (39.3) 1.30 (0.69 - 2.43) 0.415 \nInformal 18 (18.2) 87 (25.5) 1 (reference)  \nNone 23 (23.2) 77 (22.6) 1.44 (0.72 - 2.87) 0.296 \n\n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 693 Open Journal of Obstetrics and Gynecology \n \nContinued  \nLevel of education     \nPrimary 3 (3.0) 19 (5.6) 1 (reference)  \nSecondary 26 (26.3) 129 (37.8) 1.28 (0.35 - 4.63) 0.710 \nHigher 70 (70.7) 193 (56.6) 2.30 (0.66 - 8.00) 0.191 \nNotes: 1) The reference group for Age is 45 - 54 years, 2) The reference group for Marital \nstatus is Single, 3) The reference group for Occupation is Informal, 4) The reference group \nfor Level of education is Primary , 5) Significant result at p < 0.05: Occupation (Private) is \nassociated with a higher odds of endometriosis (OR = 2.47, p = 0.014). \n3.3. Bivariate Analysis of Clinical and Reproductive Factors \nSeveral clinical and reproductive variables were significantly associated with pel-\nvic endometriosis (Table 2 ). \n \nTable 2 . Clinical factors associated with pelvic endometriosis (Bivariate analysis). \nVariables  \nEndometriosis  \nPresent  (N = 99) \nn (%) \nEndometriosis  \nAbsent (N = \n341) \n  \nOR  \n(95% CI) p-Value \nAge at menarche (years)     \n≤11 22 (22.2) 19 (5.6) 4.84 \n(2.50 - 9.39) <0.001 \n>11 77 (77.8) 322 (94.4) 1 (reference)  \nCycle length (days)     \n≤27 48 (48.5) 51 (15.0) 5.35 \n(3.27 - 8.77) <0.001 \n>27 51 (51.5) 290 (85.0) 1 (reference)  \nGravidity     \nNulligravid 49 (49.5) 102 (30.1) 1 (reference)  \nPrimigravid 19 (19.2) 88 (26.0) 0.45 \n(0.25 - 0.82) 0.009 \nPaucigravid 18 (18.2) 106 (31.3) 0.35 \n(0.19 - 0.65) <0.001 \nMultigravid 12 (12.1) 31 (9.1) 0.81 \n(0.38 - 1.70) 0.57 \nGrand multigravid 1 (1.0) 12 (3.5) 0.17 \n(0.02 - 1.37) 0.097 \nParity     \nNulliparous 72 (72.7) 207 (60.7) 1 (reference)  \nPrimiparous 18 (18.2) 82 (24.0) 0.63 \n(0.35 - 1.12) 0.117 \nPauciparous 9 (9.1) 42 (12.3) 0.62 \n(0.29 - 1.33) 0.216 \nMultiparous 0 (0.0) 10 (2.9) NA 0.965 \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 694 Open Journal of Obstetrics and Gynecology \n \nContinued  \nFamilial endometriosis 12 (12.1) 0 (0.0) NA <0.001 \nLate menopause 5 (5.1) 0 (0.0) NA 0.976 \nNeoplasia 2 (2.0) 1 (0.3) 7.00 \n(0.63 - 77.97) 0.128 \nLupus 1 (1.0) 0 (0.0) NA 0.225 \nHypertension 1 (1.0) 10 (2.9) 2.96 \n(0.37 - 23.42) 0.469 \nDiabetes 0 (0.0) 2 (0.6) NA 1.000 \nPelvic surgery 13 (13.1) 121 (35.5) 0.27 \n(0.15 - 0.51) <0.001 \nAbdominal surgery 2 (2.0) 26 (7.6) 0.25 \n(0.06 - 1.07) 0.058 \nAlcohol consumption 35 (35.4) 121 (35.5) 0.99 \n(0.62 - 1.59) 0.981 \nTobacco smoking 3 (3.0) 6 (1.8) 1.75 \n(0.43 - 7.11) 0.432 \nNotes: 1) OR: Odds ratio; CI: Confidence interval , 2) Reference category indicated where \napplicable, 3) NA: Not applicable (cell count = 0, OR not estimable) , 4) Percentages are \ncalculated per column, 5) Statistical significance set at p < 0.05. \n \nAn age at menarche ≤ 11 years was associated with a nearly fivefold increased \nrisk of endometriosis (OR = 4.84; 95% CI: 2.50 - 9.39; p < 0.001). Similarly, a men-\nstrual cycle length ≤ 27 days significantly increased the odds of endometriosis (OR \n= 5.35; 95% CI: 3.27 - 8.77; p < 0.001). \nConversely, primigravidity (OR = 0.45; 95% CI: 0.25 - 0.82; p = 0.009), pauci-\ngravidity (OR = 0.35; 95% CI: 0.19 - 0.65; p < 0.001), and a history of pelvic surgery \n(OR = 0.27; 95% CI: 0.15 - 0.51; p < 0.001) were associated with reduced odds of \npelvic endometriosis. \nA family history of endometriosis was significantly associated with the condi-\ntion (p < 0.001). Other medical comorbidities and lifestyle factors, including hy-\npertension, diabetes, alcohol consumption, and tobacco use, showed no signifi-\ncant association. \n3.4. Multivariate Analysis of Factors Associated with Pelvic \nEndometriosis \nAfter adjustment for potential confounders in multivariate logistic regression \nanalysis (Table 3 ), five variables remained independently associated with pelvic \nendometriosis. \nAn age at menarche ≤  11 years (aOR = 5.14; 95% CI: 2.49 - 10.64; p < 0.001) \nand a menstrual cycle length ≤ 27 days (aOR = 5.20; 95% CI: 2.91 - 9.30; p < 0.001) \nwere independently associated with increased odds of pelvic endometriosis. \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 695 Open Journal of Obstetrics and Gynecology \n \nTable 3 . Factors associated with endometriosis (Multivariate analysis). \nVariables  Adjusted  Odds Ratio (aOR) \n(95% Confidence  Interval)  p-Value \nAge at menarche (years)   \n≤11 5.14 (2.49 - 10.64) <0.001 \nDuration of cycle (days)   \n≤27 5.20 (2.91 - 9.30) <0.001 \nGravidity   \nPrimigravid 0.49 (0.25 - 0.98) 0.045 \nPaucigravid 0.34 (0.16 - 0.70) 0.003 \nPelvic surgery 0.30 (0.14 - 0.61)  \n \nIn contrast, a history of pelvic surgery (aOR = 0.30; 95% CI: 0.14 - 0.61; p < \n0.001), primigravidity (aOR = 0.49; 95% CI: 0.25 - 0.98; p = 0.045), and paucigra-\nvidity (aOR = 0.34; 95% CI: 0.16 - 0.70; p = 0.003) were independently associated \nwith reduced odds of endometriosis \n4. Discussion \n4.1. Summary of Findings \nThis study found a surgical prevalence of pelvic endometriosis of 22.5% among \nwomen undergoing gynecological laparoscopy in three hospitals in Douala be-\ntween 2014 and 2022. This prevalence is consistent with the findings of Nana N. \net al., who also reported a prevalence of 22.5% among women undergoing lapa-\nroscopy for chronic pelvic pain in Cameroon [10] . However, it is higher than the \n3.12% prevalence reported by Bilkissou et al. [15]. These differences may reflect \nvariations in study design and patient selection. While Bilkissou et al. included \nclinically diagnosed cases, the present study focused exclusively on women under-\ngoing laparoscopy, which likely increased the detection of endometriotic lesions.  \nHistological confirmation was not performed systematically in our study. Nev-\nertheless, among cases where biopsy was performed, histopathology confirmed \nendometriosis in 92% of cases. This high concordance between laparoscopic and \nhistological findings may reflect the expertise of the surgeons performing the pro-\ncedures. McKee \net al. reported that visual diagnosis during laparoscopy has high \nsensitivity but moderate specificity when compared with histological confirma-\ntion [16]. In contrast, Buchweitz \net al. highlighted the variability in laparoscopic \ndiagnosis and emphasized the importance of histological confirmation when fea-\nsible [17]. \n4.2. Interpretation of Associated Factors \nEarly menarche (≤11  years) and short menstrual cycle length (≤27  days) were \nstrongly associated with pelvic endometriosis. Women with early menarche had \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 696 Open Journal of Obstetrics and Gynecology \n \napproximately fivefold higher odds of endometriosis (AOR = 5.14; 95% CI: 2.49 - \n10.64; p < 0.001), while those with shorter menstrual cycles had a similarly in-\ncreased risk (AOR = 5.20; 95% CI: 2.91 - 9.30; p < 0.001). These findings are con-\nsistent with those reported by Burghaus et al., who identified early menarche and \nshorter menstrual cycles as important risk factors for the development of endo-\nmetriosis [18]. From a pathophysiological perspective, early menarche increases \nlifetime exposure to estrogen, while shorter cycles increase the frequency of men-\nstruation and the likelihood of retrograde menstruation, a central mechanism \nproposed in Sampson’s theory of endometriosis pathogenesis [19]. \nA history of pelvic surgery was inversely associated with endometriosis in the \npresent study (AOR = 0.30; 95% CI: 0.14 - 0.61; p < 0.001). This finding contrasts \nwith the results of Ashrafi et al., who reported pelvic surgery as a potential risk \nfactor for endometriosis [20]. The observed inverse association should be inter-\npreted cautiously, as it may reflect reverse causation or selection bias rather than \na true protective effect. Women with prior pelvic surgery may have undergone \nprocedures for conditions unrelated to endometriosis, or surgical history may in-\nfluence referral patterns for laparoscopy. \nSimilarly, primigravidity and paucigravidity were inversely associated with en-\ndometriosis. This observation aligns with findings from Ashrafi et al. , who re-\nported a negative association between the number of pregnancies and endometri-\nosis [20]. Pregnancy reduces the number of menstrual cycles and is associated \nwith prolonged exposure to progesterone, which exerts antiproliferative effects on \nendometrial tissue [21]. However, the relationship between pregnancy and endo-\nmetriosis remains complex. A meta-analysis by Leeners et al. did not confirm a \nconsistent protective effect of pregnancy, suggesting that residual confounding \nand reverse causation may influence these associations [22]. \nA family history of endometriosis was strongly associated with the disease in \nbivariate analysis (p < 0.001). However, this variable was not retained in the mul-\ntivariate model due to complete separation, as no cases were reported among the \ncontrol group. This prevented reliable estimation of adjusted odds ratios. Previous \nstudies have demonstrated that genetic susceptibility plays an important role in \nthe development of endometriosis, with familial aggregation suggesting involve-\nment of hormonal, inflammatory, and immune regulatory pathways [23] [24]. \nThe association observed between private-sector employment and endometri-\nosis in bivariate analysis may reflect socioeconomic differences in access to \nhealthcare. In many resource-limited settings, laparoscopic procedures may be \nmore accessible to women with higher socioeconomic status, potentially leading \nto underdiagnosis among women in the informal sector. \n4.3. Strengths and Limitations \nThis study has several strengths. It included a relatively large sample size and in-\nvolved three specialized healthcare facilities performing laparoscopic surgery, \nwhich enhances the reliability of the findings. In addition, all procedures were \n\nT. N. Nana et al. \n \n \nDOI: 10.4236/ojog.2026.165067 697 Open Journal of Obstetrics and Gynecology \n \nperformed by experienced surgeons trained in minimally invasive gynecological \nsurgery. \nHowever, some limitations should be acknowledged. The retrospective design \nmay have introduced information bias due to incomplete documentation in med-\nical records. Histological confirmation was not performed systematically in all \ncases, which may introduce some diagnostic misclassification. Furthermore, the \nstudy population consisted exclusively of women undergoing laparoscopy for spe-\ncific gynecological indications, which may limit the generalizability of the findings \nto the broader population. \n5. Conclusion \nPelvic endometriosis was identified in 22.5% of women undergoing gynecological \nlaparoscopy in three tertiary hospitals in Douala, Cameroon. Early menarche (≤11  \nyears) and shorter menstrual cycle length (≤27 days) were strongly associated with \nincreased odds of endometriosis, while prior pelvic surgery and lower gravidity \nshowed inverse associations. These findings provide insight into the surgical prev-\nalence and correlates of endometriosis among women undergoing laparoscopic \nevaluation in this urban Cameroonian setting. Improving access to laparoscopic \ndiagnostic services and increasing clinical awareness may facilitate earlier detec-\ntion and management of endometriosis in similar resource-limited settings. \nAuthors’ Contributions \nRT, TNN, AENT and FGMN conceptualized and designed the study. AEN, CNN, \nFKM, and CYN were responsible for participant recruitment at the study sites. \nAGS, ANN and HTN also contributed to participant recruitment and provided \nfeedback on the manuscript. The manuscript was written by TNN, RT, CTN, and \nETO. GHE, and CTN, ETO critically revised and reviewed the manuscript for im-\nportant intellectual content. All authors read and approved the final version of the \nmanuscript. \nConflicts of Interest \nAuthors declare no conflicts of interest.  \nReferences \n[1] European Society of Human Reproduction and Embryology (ESHRE) (2022) Endo-\nmetriosis Guideline. 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