Awareness and Knowledge of Libyan Women about Endometriosis

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INTRODUCTION
Endometriosis is a chronic inflammatory disease that has only recently been more 38 thoroughly characterized but affects about 10% of women of childbearing age [1], World endometriosis society reports more than 176 million women suffer from endometriosis across the world.[2]Endometriosis exists when endometrium-like tissue (the lining of the womb) develops outside the uterus.[3], Bearing in mind that gender is a major social determinant of health, many women experience sexual and reproduction health issues which account for a third of all health challenges experienced in the reproductive years of women [4], Women of childbearing age are disproportionately affected by endometriosis, a chronic inflammatory condition linked to estrogen [5], The association between endometriosis and infertility is well supported throughout the literature, the prevalence of endometriosis increases to as high as 25%-50% in women with infertility and 30%-50% of women with endometriosis have infertility [6], the real risk of endometriosis recurrence in oestrogen-only hormone replacement therapy (EO-HRT)users after pelvic clearance for endometriosis.[7], Women suffering from endometriosis have always been misdiagnosed.The misdiagnosis leads to years of suffering and pain before their illness is truly detected [8], Endometriosis (END) and adenomyosis (AD) are benign, estrogen-dependent, chronic gynecological disorders which co-exist in approximately 35% of the patients' sharing mechanisms of etiopathogenesis, The management of patients with END and/or AD includes both surgical and medical treatments.The pharmacological approach aims to suppress ovulation and menstruation through hormonal treatments, with combined oral contraceptives (COCs) with low dose estrogen being considered as a first-line therapy, among other treatments.[9], Many women with endometriosis experience delay between the onset of symptoms and initial diagnosis, which is mainly due to lack of awareness, which in turn affects progress of the disease and the prognosis of the condition.[2], Endometriosis surgery worsens the phenomenon induced by endometriosis itself as the disease is associated with infertility through various mechanisms, such as chronic inflammation, increased oxidative stress, impaired angiogenesis and cell cycle dysregulation [10].Evidence on women's fundamental knowledge of endometriosis and its consequences among college, medical and nursing students, is insufficient.[11].Since the search for a non-invasive diagnostic endometriosis marker has been conducted for many years without success so far, it seems that awareness of the clinical presentation and reported symptoms may help to provide earlier diagnoses.[12], the outcome is important, given that stronger awareness, acknowledgement, and education about endometriosis among the general public have been coined the "bedrock of an improved response" [13], Although endometriosis affects an estimated 176 million women worldwide, it has been wrongly reported that endometriosis is a rare condition among African women, mainly due to lack of awareness among healthcare providers and historical bias [14], Adoption of Positive coping strategies had a significant effect on women's knowledge, practices related to endometriosis.[15], Knowledge and attitudes to counsel endometriosis patients on fertility issues and fertility preservation options should be included in the training curricula of gynecologists.[16], Women with endometriosis experience that they are treated with ignorance regarding endometriosis in nonspecialized care.They experience delays in both their diagnosis and treatment [17], It is evident from the present study outcome, the general population has limited knowledge on the signs and symptoms of endometriosis, which inhibited them from turning towards medical treatment on right time, which contributes to the delay in diagnosis and proper management of endometriosis.[2], secondary school girls report dysmenorrhea.Although most reporting atypical periods had seen a doctor, over a quarter did not know whether their period was typical or regular.The majority do not have knowledge of endometriosis, contrasting with adolescents' familiarity with other common chronic conditions such as diabetes and epilepsy.[18], The creation of dedicated networks also helps to improve the management of patients with endometriosis.[1],Strategies to lessen diagnostic delay of endometriosis in adolescents must include integrated actions by educators and healthcare providers to improve health literacy and awareness of common causes of pelvic pain in this age group.[19], the awareness level of endometriosis among the respondents was also poor and they were not familiar with content on endometriosis in the mass media.. [20].Insufficient knowledge about endometriosis among women is one of the causes of its delayed diagnoses.Due to the elusiveness of symptoms, the most important component of early detection is proper and exhaustive knowledge.[21].Awareness of the possibility of developing the disease in a particular patient, combined with appropriate use of ultrasound examination, can contribute to the decrease in diagnostic delay.[22].

MATERIAL AND METHODS SAMPLE COLLECTION
-Samples were collected during the awareness campaign about endometriosis, through personal interviews, and questionnaires were distributed about the extent of women's knowledge of endometriosis from most Libyan cities, from east to west and south.
-The questionnaire included sociodemographic data such as, age, , marital status, educational level and place of residence

SAMPLE SIZE
During the one-year study period [January 1, 2021 to December 31, 2022], 1840 women were answer the questions of questionnaire.

STATISTICAL ANALYSIS
The distribution of categorical variables was compared with the frequency and percent test, and quantitative variables with correlation (R) test.Statistical significance was set at p < 0.05.The statistical analyses were performed with the Statistical Package for the Social Sciences software, release 26.0 for Windows.

Conclusion
From these results, we conclude that the educational level has nothing to do with the extent of awareness among women about endometriosis, and therefore we find that the percentage of those suffering from endometriosis is very high, as shown in Figure 1, and that women need a lot of awareness and knowledge about the endometriosis disease.

Table 1 ,
Number of participants (%) of Demographic Characteristics

Table 2 ,
shown that the Frequency and percent of Knowledge Questions Most of the answers were "I don't know" and the answer was "No."This indicates a lack of information about endometriosis Do you have the knowledge that there are complications of endometriosis in the event that it is not diagnosed and the situation worsens?Do you have the knowledge that pain is the result of bleeding from cells and tissues inside the uterus, as well as from cells and tissues outside the uterus?

Table 3 ,
The Correlations between Knowledge and Education Levels, the p-value > 0.05 means there is no relationship between education level and knowledge of endometriosis

Table 2 ,
(2)wn that the frequency and percent of Knowledge Questions Most of the answers were "I don't know" and the answer was "No."This indicates a lack of information about endometriosis, Figure (1) illustrated that who suffer from endometrioses were the highest percent 75.5 %, I Don`t know 21.2 %.Figure(2)Illustrated that the percent of education the answer I don`t know 19.4 %, and by no 26.1 %.In Table [1] A. Abd Elrahim, S. Abdelnaem, O. Abuzaid, and M. H. Allah, "Educational Intervention and Referral for Early Detection of Endometriosis among Technical Secondary Schools Students," Egypt Nurs J, vol.19, no. 2, p. 141, 2022, doi: 10.4103/enj.enj_14_22.