Introduction: Although the prevalence of endometriosis is to a certain extent documented in women living in high resource countries, its prevalence in black Africa is unknown. Since the current view is that endometriosis hardly affects indigenous Africans, we aim to provide a systematic review of prevalence of endometriosis among the indigenous Africans. Objective: To determine the prevalence and clinical presentation of endometriosis in the indigenous African women. Methodology: A systematic literature search was carried out for relevant articles on all citations on PubMed, based on the key words “Endometriosis” and “Africa”. An additional search was done on African journal Online. Outcome Measures: The primary outcome measure was the prevalence of endometriosis among indigenous Africans. Results: Out of 58 identified paper’s, only 4 were eligible for the systematic review. The prevalence of endometriosis was 4.3% (Osefo et al. [1] and 8.2% (Ekwempu et al. [2]) in the laparotomy and hysterectomy specimen respectively. In the paper by Fawole et al. [3], where endometriosis was diagnosed on the basis of laparoscopic visualization alone without histological confirmation, the prevalence was 48.1%. Somigliana et al. [4] estimated endometriosis to be 0.2% based on clinical history, clinical examination and imaging, without surgical procedure to confirm this estimation. Due to differences in study populations, methodology and diagnostic criteria, it was not possible to have pooled prevalence of endometriosis. Conclusion: Although existing evidence suggests that the prevalence of endometriosis in indigenous Africans is 0.2% - 48.1%, the study analyzed had limitations. Prospective multi-centered studies with laparoscopic diagnosis and histological confirmation of endometriosis are required to establish the prevalence of endometriosis among the general population in the indigenous Africans. Endometriosis in Africa needs to receive more research attention. This paper is expected to stimulate and sensitize the clinicians and researchers in Africa about this condition.