For the estimated 1 in 10 women living with endometriosis, the condition doesn't stop at the office door. Pain, fatigue and unpredictable flare-ups can affect attendance, performance and whether someone stays in their role. Here's how employers can make working with endometriosis more manageable.

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Despite current efforts, female health and menstruation can often feel like a stigmatised subject in a place of work. It is important that we recognise the struggles of those living and working with Endometriosis, which starts with businesses embracing a wider understanding of the condition and how it affects their workforce. Endometriosis is a condition which can affect anyone born with a female reproductive system, in which the standardly-unbearable symptoms of periods can become chronic and debilitating; not discussed frequently enough and often misunderstood. It is a significantly difficult condition to live with, in which the body produces excess tissue that mimics that of the lining of the womb in areas that it would not - and should not - normally develop.  With such little discourse around the subject, here are some things you may not realise about Endometriosis:

• It affects as many as 1 in 10 women around the world.
• It could affect masc-presenting employees who may still have a female reproductive system.
• It can cause fertility issues, as well as a range of psychological conditions.
• While many believe it is incurable, there are a number of medical and surgical options for treatment.
• While it most commonly presents with painful symptoms, some sufferers may be asymptomatic or have misdiagnosed symptoms and therefore be unaware of it's presence. 
  

So, how can it affect the workplace, and what can you do to help as an employer?

Flexible working hours

The pain of Endometriosis can be exhausting, and could cause employees to struggle with standing, walking and travelling, as well as making them lethargic and affecting their concentration, communication and commitment to projects. They might need more time away from the office, and even from home, for regular doctor’s appointments, collecting prescriptions, receiving therapy or downtime for pain management. Be sure to be understanding instead of critical should this happen, and consider offering a more flexible work schedule to accommodate them. This could include a varying timetable in which they can dictate their own hours, as well as supplying them with the equipment to have a desk both in the office and at home. Consider including optional, regular screen-time so that being away from the office doesn’t diminish their face-to-face time with colleagues.

Job security and maternity options

As well as a realm of uncomfortable symptoms, in a more severe case Endometriosis could lead to infertility. For many women, this would come as a huge psychological blow, and if still looking to begin a family it will also become a financial consideration too. This could cause panic when looking at their future within the company. Consider an open discussion about maternity leave and job security, as this will encourage mothers-to-be to feel secure, and meaning worry around this subject would be less likely to affect their work or even move them to leave the company. Make sure maternity information is easily accessible and available from the point of hire.  As an employer, it is useful to be in a position to support and educate employees, which can include having a rounded understanding of what employees are going through and putting yourself in a position to actively help. Try to remember that the further you go to support your staff, the more loyal a workforce you’ll obtain, which will eventually lead to better retention of staff and a dedicated team.

Ensure a compassionate workplace

With such a high number of women suffering with menstrual conditions, it is important to remind employees that they are not alone. It can feel alienating to live with a chronic condition, and you have no idea how many of your staff could be struggling silently. Someone with Endometriosis may not feel comfortable with disclosing their diagnosis for fear that assumptions about their productivity might be made. Ensure to create an open and compassionate environment, with easily accessible and in-person support facilities. 

More sanitation awareness

You can go to extra lengths by openly offering menstrual equipment in bathrooms, and including posters and information on the back of toilet doors, for example. This instils in people’s minds that the company is supportive and aware, and will continue to encourage an open discourse. By doing so, you promote a healthier mindset when approaching female wellbeing.

Encourage medical attention

As well as offering your employees support, or the chance to work from a home office, you can encourage them to seek professional medical help, and reassure them that there are a range of treatment options. Specialists are now able to manage pain levels and even operate in severe conditions. It no longer needs to be a lifetime diagnosis.  Don’t forget to remain educated. Continue to read up on women’s health and have tools to hand should you be approached. Here are some further tips you could offer an employee who thinks they might have Endometriosis: 

• Keep a symptom diary to make conversations with a health care provider easier, including noting pain levels and how they fluctuate. 
• Record any pain involved with urination and bowel movements and encourage a lack of stigma around such subjects.
• Remember that the pain and symptoms associated are genuine and debilitating, and remind employees of the option to take over-the-counter medication.
• Remind them that some women do suffer from heavier and more intense periods, and that while this may not be Endometriosis, they don’t need to suffer in silence and should seek medical advice for methods of controlling this. 

How to support employees with PMOS

Polyendocrine metabolic ovarian syndrome (PMOS) affects around 1 in 10 women and people assigned female at birth in the UK. Symptoms vary from person to person and can include irregular or heavy periods, fatigue, pain, weight changes, skin and hair changes, and low mood or anxiety. Many people wait years for a diagnosis.

PMOS is a long-term condition, so the most useful support is consistent rather than one-off. Employers can help by:

• Naming it in your policy. Mention PMOS in your women's health or wellbeing policy so employees know it's covered.
• Offering specialist advice. GP appointments are short, and employees often need more time to understand their symptoms and treatment options.
• Allowing time for appointments. Diagnosis and ongoing care can involve blood tests, scans and follow-ups.
• Being flexible. Fatigue and pain can come and go, so flexibility on start times or working from home helps.
• Avoiding comments about weight or appearance. These symptoms are often the hardest for people to live with, and well-meant remarks can do harm.

Reasonable adjustments for endometriosis and PMOS

Endometriosis and PMOS can both meet the definition of a disability under the Equality Act 2010 if symptoms have a substantial and long-term effect on day-to-day activities. Where they do, employers have a legal duty to make reasonable adjustments. Even where they don't, the same adjustments are usually low cost and help people stay well at work.

Adjustments to consider:

• Flexible start and finish times, or working from home on bad days
• Time off for appointments, treatment and recovery from surgery
• Recording related absence separately from general sickness absence, so it doesn't unfairly trigger absence procedures
• Easy access to toilets and breaks when needed
• A comfortable workspace, such as a supportive chair, a heat pad or somewhere quiet to rest
• Temporary changes to duties or targets during flare-ups or after surgery
• A phased return to work after surgery or extended leave

Agree adjustments with the employee, write them down and review them regularly. Symptoms change over time, and so will what helps.

Tips for managers

Managers are usually the first person an employee goes to, and how that first conversation goes shapes whether they ask for help again.

• Check in privately and regularly. Ask open questions like "How are things going?" and "Is there anything that would make work easier right now?"
• Let the employee lead. They don't need to share a diagnosis or details of their symptoms to get support.
• Focus on what they need. You don't need to be an expert in the condition, but you do need to listen and act.
• Keep it confidential. Agree who else needs to know, if anyone, and what they'll be told.
• Know where to point them. Share your policy, any specialist support you offer and how to ask for adjustments.
• Follow up. Put a review date in the diary and keep it.

With Peppy, employees can speak to women's health specialists about endometriosis and PMOS, and managers get guidance on how to support their teams.

Healthcare for these types of things can often be difficult to obtain, especially if a chronic diagnosis is affecting someone’s mental health. By offering your employees a service like Peppy, they have free access to hands-on specialists who are qualified to diagnose, advise and support, and don’t need to concern themselves with taking time off work for appointments or financing their own private subscriptions.  It can also offer you and your team advice on how to retain dedicated employees, encouraging them to give back to you the support you have shown them. We can assist with maternity leave advice and how to offer a regimented plan, as well as administrative and medical support whenever you’re struggling to assist an employee with a recent diagnosis. 

FAQs

Q: Is endometriosis a disability under the Equality Act?

It can be. Endometriosis isn't automatically classed as a disability, but it is likely to count under the Equality Act 2010 if it has a substantial and long-term effect on someone's ability to carry out day-to-day activities. Long-term means it has lasted, or is likely to last, at least 12 months. Employment tribunals have found endometriosis to be a disability in a number of cases. If it is, employers must make reasonable adjustments and protect the employee from discrimination. In practice, the safest approach is to offer support based on what the employee needs, whatever the label.

Q: What reasonable adjustments help employees with PMOS?

The most helpful adjustments are usually simple and low cost: flexible start and finish times, working from home on difficult days, time off for appointments and tests, regular breaks and easy access to toilets. Some people also benefit from temporary changes to workload during flare-ups. Agree adjustments with the employee rather than assuming what they need, write them down and review them regularly, as symptoms can change over time.

Q: How should a manager talk to an employee about endometriosis?

Find a private time, keep it informal and let the employee lead. Ask open questions such as "How are you doing?" or "Is there anything that would make work easier at the moment?" They don't have to share a diagnosis or describe their symptoms to get support. Focus on what would help, agree any next steps together, keep the conversation confidential and set a date to check in again.

Q: Can employees take sick leave for endometriosis?

Yes. Employees can take sick leave for endometriosis in the same way as for any other health condition, including time off for surgery and recovery. Normal sick pay rules apply. Because symptoms can be recurring, it's good practice to record endometriosis-related absence separately so it doesn't unfairly trigger absence management procedures, particularly where the condition may count as a disability.

Q: What workplace support helps with PMOS symptoms?

PMOS symptoms vary, so support works best when it is flexible and personal. Helpful steps include naming PMOS in your women's health or wellbeing policy, giving employees access to specialist advice on symptoms and treatment, training managers to have supportive conversations, and allowing flexibility around fatigue, pain and appointments. Avoid comments about weight or appearance, which many people with PMOS find particularly difficult.