What Employers Should Know About Endometriosis

I employ a lot of women. Community health centers run on them: medical assistants, nurses, front desk, billing, behavioral health, providers. Statistically, one in ten of the women on my payroll of reproductive age has endometriosis, whether or not she has a diagnosis yet, and most of them have never mentioned it to anyone at work.

I also happen to be married to a woman with the disease, and I am the father of one. So I have watched what it costs from both sides of the desk. This page is for the other side, the employer side, and I am writing it as a CEO to other CEOs, managers, and HR leads, because most of what exists on this subject is written by patient advocates, and employers tend to tune that out. You should not tune this out. It is a productivity problem sitting in your building right now, and it is one of the cheaper problems you will ever fix.

The numbers, and what they mean at your company

The World Health Organization estimates endometriosis affects about ten percent of women and girls of reproductive age, roughly 190 million people worldwide. Think about your headcount. If you employ two hundred women under fifty, that is around twenty people.

The best data on what it costs at work comes from the World Endometriosis Research Foundation's Global Study of Women's Health, published in Fertility and Sterility in 2011, which followed 1,418 women across sixteen centers in ten countries. Each affected woman lost on average 10.8 hours of work per week. The finding that should get your attention is the next sentence: that loss came mainly from reduced effectiveness while working, not from time off. Women with endometriosis lost thirty-eight percent more work productivity than women without it. The weekly cost per woman ranged from four dollars in Nigeria to 456 dollars in Italy, depending on wages.

Read that again as an employer. Most of the cost never shows up as sick days on a report. It shows up as a capable person at her desk, in pain, doing seventy percent of what she can do, and hiding it. That is called presenteeism, it is invisible in your attendance data, and it is where the money goes.

Why she has not told you

Because telling people has not gone well for her. The largest survey of women with this disease, 3,075 women published by Endometriosis UK in March 2026, found that eighty-three percent had been told by a clinician that their symptoms were normal or had been dismissed. The average wait for a diagnosis is now nine years and four months. If her own doctors spent nine years telling her it was nothing, she has no reason to expect her manager to do better.

There is also the plain fact that this disease involves periods, pelvic pain, bowel symptoms, and pain during sex. Nobody wants to explain that to the person who signs their review. So she says she has a migraine. She says it is a stomach bug. She takes the vacation day rather than the sick day so it does not look like a pattern. And she keeps doing seventy percent, quietly, for years.

An employer who wants to fix the productivity problem has to first make it survivable to name the cause.

What actually helps, in order of cost

Most of this is free. I have listed it in roughly the order I would do it.

Say the word out loud. Once. In a benefits newsletter, in a manager training, in the health resources page on the intranet. "Endometriosis affects about one in ten women. If it affects you, here is how to talk to us about what you need." You are not asking anyone to disclose. You are telling them the door is open, which is different from assuming it is.

Train managers not to require proof. A woman with endometriosis has spent years presenting her pain like evidence to people who did not believe her. If her manager's first response to "I need to work from home tomorrow" is a request for a doctor's note, she will not ask again. She will just do seventy percent from her desk. Train the first response to be "what do you need."

Make flexibility real rather than theoretical. Flare days are unpredictable. Working from home on a bad day, shifting hours, a quiet place to lie down for twenty minutes, being able to leave a meeting without an explanation. None of that costs money. All of it recovers hours you are currently losing.

Treat sick leave for a chronic condition as a chronic-condition problem. If your sick leave policy is built for the flu, it punishes anyone with a disease that flares monthly. Consider how intermittent leave, whether under FMLA in the United States or under your own policy, applies, and make sure HR knows the answer before someone has to ask.

Fix the physical things. Access to a bathroom without asking. A heating pad that does not have to be smuggled in. Somewhere to sit for roles that stand all day. These are small and they are noticed.

Look at your health plan. Does it cover a pelvic pain specialist without a long referral chain? Does it cover the imaging the new guidance calls for? If you are self-insured, you have more say over this than you think, and the cost of covering good care is far below the cost of nine years of presenteeism.

I built a Workplace Support Planner for the employee side of this conversation. It helps her prepare for the discussion with you. Hand it to your HR team as well, so both sides walk in with the same picture.

What changed this year that employers should know

In March 2026, the American College of Obstetricians and Gynecologists published new guidance that allows endometriosis to be diagnosed and treated based on symptoms and examination, without waiting for surgical confirmation. For employers this matters in one practical way. An employee who has been stuck in "we are waiting on a specialist" for a year may now be able to get treatment started in primary care. If your plan and your leave policies are built to accommodate that, you will get a functioning employee back sooner. I wrote about what the guidance means inside a clinic from the healthcare leadership side.

The thing I would say to another CEO

You already accommodate chronic conditions. Diabetes, asthma, migraine, back injuries. Nobody on your leadership team thinks twice about an insulin pump. Endometriosis is as common as several of those and costs you more hours than most of them, and the only reason it is treated differently is that it is a women's disease that involves periods and nobody wants to say the word in a meeting.

Say the word in a meeting. It is a five-minute agenda item. It will recover more productivity per dollar than most of what you approved last quarter, and it will tell the women who work for you something about whether they are believed here.

I wrote a book called Believe Her the First Time for the men who love someone with this disease. The title works for employers too.

Nothing here is medical or legal advice. Leave laws vary by country and state; check yours. For diagnosis and treatment, your employees should work with a qualified clinician.