An employer's guide to endometriosis at work

The number of women who suffer from endometriosis in the UK is one in ten, making this condition as common as asthma or diabetes. Lingering social taboos about discussing menstrual problems, along with a drawn-out average diagnosis time of over seven years in the UK, mean that awareness of endometriosis is sorely lacking.

The difference between a healthy menstrual cycle and endometriosis is significant, and sufferers experience a range of health difficulties and symptoms.

As endometriosis is a chronic condition, it will affect a person in the workplace at least some of the time. Employers should have a good idea of how to support any employees with this condition, as well as any laws they need to abide by.

What is endometriosis?

Typically affecting women between puberty and the menopause, endometriosis is a long-term, chronic condition in which tissue similar to the lining of the womb grows in other parts of the body, including the fallopian tubes and ovaries. In the UK, it is the second most common gynaecological condition, with around 10% of women affected.

Not all women with endometriosis experience all of the below symptoms, and while some can suffer severely, some may not have any noticeable symptoms at all. Common daily symptoms include:

• pain in the lower abdomen or back (or pelvic pain)
• fatigue
• intense period pain that prevents normal activity
• pain when passing urine or faeces during periods
• nausea, constipation or diarrhoea during periods
• blood in urine or faeces during periods
• difficulty getting pregnant

Another common symptom of endometriosis is heavy bleeding during periods, which could mean the need to use multiple pads or tampons, visiting the toilet often, or bleeding though to clothing.

The impact of all these symptoms can affect some women so much that it leads to depression.

Although there is no cure for endometriosis, there are treatments that can help make the symptoms easier to manage:

• painkillers like paracetamol or ibuprofen
• hormonal medicines and contraceptives, such as the contraceptive patch, combined pill, contraceptive implants, intrauterine system (IUS), or gonadotrophin-releasing hormone (GnRH) analogues
• surgery to remove areas of endometriosis tissue
• surgery to remove part or all of any organs affected by the tissue, including the appendix, the womb (hysterectomy), or part of the colon

Facts and figures: endometriosis in the workplace

• 40% of women with endometriosis are worried it could threaten their job security
• 27% report they have missed out on a promotion
• 55% say they need time off work “often” or “very often”
• 54% have said that endometriosis has had a negative impact on their income
• 87% say their long-term financial situation has been affected by the condition
• 17% of women with endometriosis leave work permanently

The All Party Parliamentary Group (APPG) published a report in 2020. This report states that, every year, endometriosis costs the UK economy £8.2 billion due to loss of work and healthcare. This could be helped by employers offering better support in the workplace.

Employment law and endometriosis: giving support as an employer

Endometriosis may be considered a disability, depending on the severity of the symptoms. A disability is a mental or physical impairment which has a long-term and substantial adverse effect on a person's ability to complete normal day-to-day activities.

If an employee is deemed disabled under the Equality Act 2010, they are entitled to request reasonable adjustments. These are changes to their working schedule, environment or workload that reduce the disadvantage they suffer due to disability, or enable them to continue working.

Reasonable adjustments are a legal obligation employers must abide by. Their definition, along with other disability rights, are laid out on the Equality and Human Rights Commission website.

An employer that is thinking of rejecting a request or offering an alternative should take advice before making a final decision. Our team at Neathouse Partners can offer advice on how to deal with reasonable adjustment requests.

Occupational health

If there are any concerns about an employee's health and safety in the workplace, or if a formal assessment is required to investigate the extent of a disability, an employer should commission an occupational health report.

To get full and proper advice, an employer will have to consult with various medical practitioners, given the employee's consent. Occupational health consultants, GPs and gynaecological consultants can all provide crucial advice regarding a fair and legal solution.

Flexible working requests and reasonable adjustments

All employees in the UK have the legal right to request flexible working, although employers need only consider them. There is no legal obligation to grant them.

If an employee with endometriosis has symptoms severe enough to classify as a disability, and requests reasonable adjustments, then an employer will have a legal duty to grant them under the Equality Act 2010. In this case, the adjustments granted may consist of flexible working.

It is vitally important at this stage that both employer and employee are clear on what is being agreed to.

Implementing reasonable adjustments

As the condition varies so dramatically from person to person, two different employees' needs could be very different.

Typical adjustments could include:

• Time off for medical appointments without using annual leave
• Treating endometriosis-related absences separately from other sickness absences
• A change in working hours
• Hybrid or remote working
• Providing special equipment
• Change in duties
• Amendment of targets
• Access to a hot water bottle and a place to lie down

Adjustments like these can help an employee manage their condition while also taking steps to prevent a negative impact on their current and future career.

How can employers support workers with endometriosis?

Endometriosis UK has published research that, despite 10% of women in the UK suffering from the condition, 54% of people, including 74% of men, do not know what endometriosis is. Education and awareness at all levels within companies should be increased so that employees can receive the support they require.

Bespoke training can be obtained from an organisation like Endometriosis UK.

Making employees aware that the company fosters a culture of openness when it comes to reproductive health issues helps to reduce stigma around conditions like endometriosis. If they know there will be no negative repercussions, staff suffering from the condition will be more likely to approach managers or HR for support.

Internal training, particularly for management or HR, can help increase awareness.

Endometriosis UK has an Endometriosis Friendly Employer Scheme. By signing up for this, employers can demonstrate their commitment to supporting a culture and environment at work that empowers employees with the condition to develop and grow.

The scheme also gives guidance to employers on how to offer support to employees with menstrual health conditions, with a focus on making positive changes to the working environment in regard to communication, management support, and removing stigma and improving culture.

Supporting staff can be as simple as supplying a list of external sites or organisations that provide information. Employees could also be offered access to occupational health professionals who could help with suggesting reasonable adjustments.

Checking in regularly with staff can also allow an overview of employee wellbeing, meaning offered support can evolve over time to better meet their needs.

Get expert advice

If you have questions about supporting employees with endometriosis, creating reasonable adjustments and flexible working arrangements, expert advice from our professionals at Neathouse Partners can be invaluable. Our team of HR consultants and employment lawyers can help you navigate the implementation of ongoing support while protecting your business interests.

Call 0333 041 1094 today or use our contact form.