The Potential Role of Vaping in the Increasing Burden of Endometriosis Among Women of Reproductive Age in Sub-Saharan Africa: A Public Health Concern

The use of electronic nicotine delivery systems (ENDS) is increasing rapidly across Sub-Saharan Africa (SSA), particularly among young women, while endometriosis remains substantially underdiagnosed in the region. Emerging evidence suggests that vaping may influence hormonal, inflammatory, and oxidative pathways relevant to endometriosis. This scoping review followed PRISMA guidelines and searched PubMed, Web of Science, Scopus, African regional databases, and grey literature to identify studies examining vaping exposure in relation to reproductive or hormonal outcomes and gynecologic pathology. Eligible studies were appraised using the Newcastle–Ottawa Scale and STROBE criteria, and findings were narratively synthesized due to methodological heterogeneity. Across epidemiologic and mechanistic domains, the evidence indicates that nicotine-product use is associated with higher odds of dysmenorrhea and suspected endometriosis; disrupts the hypothalamic–pituitary–gonadal axis and estrogen–progesterone signaling; induces oxidative stress, mitochondrial dysfunction, and NF-κB activation; and may drive epigenetic and immune alterations that promote endometrial adhesion, angiogenesis, and impaired fertility. Contextual vulnerabilities in SSA including environmental co-exposures, infectious disease burden, limited diagnostic capacity, and dual use of vaping with alcohol may further amplify these risks. Although direct causal data from SSA remain limited, the convergence of biological plausibility and emerging epidemiologic signals highlights vaping as a potential reproductive health concern, underscoring the need to integrate vaping into sexual and reproductive health guidelines and to prioritize region-specific research.