31% women denied job promotions, 20% fired due to Endometriosis

Hyderabad: Endometriosis can end patients' careers and hamper their education. It's time to wake up and recognise it as a potential chronic disability, says Dr. Vimee Bindra, endometriosis excision surgery specialist and co-founder of Endocrusaders.

Endometriosis affects more than 170 million women worldwide and up to 10% of women of reproductive age, with a higher prevalence in women with painful periods/dysmenorrhea (40–60%), subfertility (21–47%), and/or pelvic pain (71–87%).

Endometriosis may cause a deterioration of daily functioning due to related symptoms such as pain, fatigue, and psychological distress. Endometriosis may jeopardize work ability, as suggested in mainly survey-based case-control studies.

Patients with endometriosis often describe their pain as a "stabbing" pain during their period, back pain, pain during bowel movements, and pain while going to the toilet and during sex. They might have stomach pain, vomiting and diarrhoea, headaches, muscle aches, and tiredness. Have you ever imagined dealing with this every single day at work and not knowing when symptoms might strike?

How patients with endometriosis struggle at work

Patients with endometriosis may find difficulties focusing on work because of unpredictable symptoms, side effects of strong painkillers, and frequent trips to the toilet. They may find it difficult to explain this to their colleagues or boss at work. They may also find it embarrassing. They may feel like it may interfere with their career opportunities and sharing such things may make them feel like an invasion of privacy.

They may not be left with sick leaves and may feel pressured to work while sick.

Emma Watkins, the former Yellow Wiggle, went public with her battle to balance endometriosis and work. Pain and the need for surgery forced her to pull out of the 2018 Wiggles national tour.

Endometriosis can take years to be diagnosed

Many patients with endometriosis start to see symptoms when they are teenagers but they are officially diagnosed only in their 30s. On average, it may take 7-10 years to be diagnosed. It happens because of normalisation of symptoms and dismissing of patients' complaints.

Given that endometriosis usually occurs during the same years as education and career-building, career development may be affected.

A Danish case-control study showed that women with endometriosis aged 26–35 years reported poorer work ability and more sick days than women without endometriosis.

Concerning employment status, cross-sectional case-control studies suggest that women with endometriosis are less likely to be employed and practice their desired profession.

A longitudinal case-control study in the USA evaluated endometriosis-related exits from the workforce and found increased risks of sick leave and short-term disability.

Women with endometriosis more often reported over 10 days' sickness absenteeism during the previous year. Women/patients with endometriosis had on average 10 more disability days compared with unaffected women/patients. Endometriosis and sickness absenteeism and poorer work ability were aggravated by fatigue, pain, depression, and long intervals between symptom onset and diagnosis.

How can we support endometriosis patients to stay at work?

This includes offering flexibility in the workplace – whether that's through job modifications and time off in lieu, or flexible work hours and working from home.

Creating a supportive workplace culture is also important. Non-judgemental responses to patients' experiences with endometriosis are also key. Additional sick leaves for patients with endometriosis may also help to manage the demands of their job and symptoms.

These are great starts for women already in work, but we need to do more and start earlier.

Girls and women need flexibility early in their education to cope with the unpredictable nature of endometriosis. Virtual classrooms could help minimise missed days at school and college. Flexibility and allowing them to complete their education over a longer period could help.

For healthcare practitioners, we encourage recognition of the problem, early diagnosis, avoiding normalizing symptoms, and the relevance of organising timely care for endometriosis patients to promote work ability.