“Out of sight, out of mind?” Menstrual leave vs. workplace supports for employees with endometriosis

As women’s workforce participation nears parity in many countries, there is growing recognition of the need for workplace policies that support reproductive and gynecological-related health. Endometriosis, a chronic inflammatory illness that begins in the uterus and can spread throughout the body, causes debilitating symptoms such as pelvic pain and fatigue that negatively impact people’s work, education, and well-being. Despite affecting ∼5–14% of women and those presumed female at birth, endometriosis is poorly understood, stigmatized, and insufficiently supported in most workplaces. As a result, many employees rely on sick leave and unpaid leave to manage their condition and often avoid disclosing their diagnosis due to fears of stigma and discrimination. This commentary draws from global literature on workplace policies related to menstruation, menopause, and endometriosis, applying Bacchi’s “What’s the Problem Represented to be?” framework to critically examine two policy responses—additional leave and flexible work—and explore their potential for supporting employees with endometriosis. While additional (menstrual) leave entitlements may offer financial security during symptom flares, they risk reinforcing stigma by framing endometriosis as an individual health issue and removing endometriosis-affected employees from workplaces rather than addressing organizational and cultural shortcomings. Conversely, flexible working arrangements, when codesigned and combined with education and training, show greater potential to accommodate diverse needs, reduce stigma, and foster inclusive workplaces for employees with endometriosis. We recommend that researchers, policymakers, unions, and workplaces codesign, implement, and evaluate policies that support people with endometriosis at work in ways that are inclusive, evidence-informed, and fit-for-purpose.