article · Frontiers in Reproductive Health
Endometriosis causes chronic pelvic pain, infertility, and broader quality of life and economic burdens. In low-resource settings, delays in diagnosis and treatment often stem from systemic pathway failures, including normalised symptoms, weak first-contact identification, and irregular follow-up. To address these service delivery challenges, a pragmatic 5R Framework has been developed, covering Recognition, Rule-Out, Relief, Referral, and Review. Designed for symptom-led care before definitive specialist confirmation is accessible, the model translates international guidance, imaging recommendations, and task-redistribution evidence into an accountable clinical sequence. It guides healthcare providers to recognise symptoms early, rule out alternative conditions, deliver fertility-sensitive relief, organise referrals, and schedule regular reviews. The model serves as a testable framework intended for local health facility adaptation, consensus refinement, and prospective implementation research rather than as a validated decision rule.
Endometriosis affects physical health, psychological well-being, and economic productivity, yet women in low-resource settings often endure prolonged diagnostic delays. By structuring care pathways around common symptoms rather than immediate specialist access, healthcare systems can safely initiate early relief, protect reproductive health, and streamline referrals, helping mitigate severe long-term personal and economic disruptions.
The framework offers an early-stage clinical pathway model suitable for healthcare systems, clinical protocol developers, and facility managers in low- and middle-income settings. It could enable standardised clinical decision-support tools, facility audit packages, or digital health triage workflows. However, the model is at a conceptual, pre-validation stage and requires local adaptation, consensus refinement, and prospective implementation research before deployment in real-world health services.
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Endometriosis is a chronic inflammatory gynecological condition associated with severe dysmenorrhea, chronic pelvic pain, deep dyspareunia, cyclic bowel or urinary symptoms and infertility. It is also linked to psychological morbidity, reduced quality of life and lost economic productivity. In low-resource settings, diagnostic and therapeutic delays often reflect pathway failure rather than specialist scarcity alone: symptoms are commonly normalized, first-contact recognition remains weak, differential diagnosis is inconsistent, referral pathways are poorly governed and structured follow-up is frequently absent. This article proposes a pragmatic 5R Framework (Recognition, Rule-Out, Relief, Referral and Review) tailored for symptom-led endometriosis care in low-resource settings. The framework draws on international guidelines, clinical review evidence, African and low- and middle-income country (LMIC) evidence on access barriers, global scoping reviews of policy and service-delivery gaps, imaging guidance, and health-systems evidence on task redistribution. Its central proposition is that endometriosis-compatible symptoms should trigger structured first-contact recognition, safety-oriented rule-out, fertility-sensitive first-line relief, need-based referral and planned review before definitive specialist confirmation is available. The framework is not a validated clinical decision rule; rather, it isa testable pathway model for local adaptation, consensus refinement, facility-level audit and prospective implementation research. Its utility lies in translating established evidence-based principles into an accountable care sequence that permits earlier action without compromising diagnostic caution, reproductive goals or referral responsibilities.
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DOI: 10.3389/frph.2026.1901655
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