Knowledge Base · Workplace
A pattern analysis drawn from 95 lived accounts. These are not edge cases – they are the norm. Every pattern here has a legal implication and a practical remedy.
What the data shows
4–5
Jobs lost on average across a working life – not a single incident
8 yrs
Average diagnostic delay – during which women receive disciplinary warnings for medical absences
⅔
of endometriosis' total cost is lost work productivity – not healthcare. The failure lands in working life, not the clinic
The RTO debate, turned on its head
The loss doesn't happen when she's away. It happens when she shows up and pushes through the pain at half capacity. The answer isn't stricter attendance – it's autonomy over when and where.
23.2 days
of productivity lost per year working through menstrual pain (presenteeism). Absence: just 1.3 days.
Schoep et al. — “Productivity loss due to menstruation-related symptoms” · BMJ Open, 2019 (N=32,748)
80.7%
work through their symptoms rather than taking time off.
Schoep et al. — “Productivity loss due to menstruation-related symptoms” · BMJ Open, 2019
−33%
quit rate with hybrid work, with no loss in performance or promotion; largest effect for women.
Bloom et al. — “Hybrid working from home improves retention without damaging performance” · Nature, 2024 (RCT, N=1,612)
And the number leadership can't explain away: 63% of executives whose companies mandated a return to office admit it drove a disproportionate number of women to quit – 62% now struggle to replace them, 57% say productivity fell. The mandate is set overwhelmingly by men: in US big business, 89% of chief executives are men.
Upwork / Workplace Intelligence, 2024 (survey, N=2,500) · Fortune — Women run 11% of the Fortune 500, 2025Flexibility is not a concession to the sick. It is how a system keeps experienced people and draws out the performance they already want to give. Rigid attendance does the opposite – it burns out precisely those who show up regardless.
The evidence base
The lived accounts on this page sit on top of a research record built across three scopes. What girls and women describe in their own words is exactly what the peer-reviewed and public evidence predicts.
The 2025 public inquiry into women's health (NOU 2023:5) and the Directorate of Health's review of care for women with endometriosis both document delayed diagnosis and inadequate follow-up as systemic, not individual, failures.12
Sources: NOU 2023:5; Helsedirektoratet.
Eurofound and the European Patients' Forum document that people with chronic conditions face reduced ability to stay in work and a widespread lack of workplace accommodation — a labour-market problem, not a personal one.34
Sources: Eurofound (2019); European Patients' Forum.
Multi-country studies quantify the cost of endometriosis: the largest share of its total economic burden comes from lost work productivity, not direct healthcare spending, and is measurable across ten-country cohorts.56
Sources: Soliman et al. (2017); Nnoaham et al. (2011).
The missing number is a purchase order, not a gap. Norway's own public inquiry calls for the national cost data on women's health to be produced. When authorities ask for the figure, the absence of that figure is a commission — and TrustHer is built to deliver it.1
Prevalence: high
Women with chronic conditions routinely lose jobs – not once, but repeatedly across their careers – due to illness-related absences that employers treat as conduct failures rather than medical circumstances.
I've lost 4 jobs. 4. I'm in a probationary period at my current part-time job, and I just had laparoscopic surgery to remove endometriosis 2 weeks ago after 4 trips to the emergency room in a month.Original · engelskI've lost 4 jobs. 4. I'm in a probationary period at my current part-time job, and I just had laparoscopic surgery to remove endometriosis 2 weeks ago after 4 trips to the emergency room in a month.
Yes, I have lost so many jobs over the years due to my endo and now 47 and just lost another one, endo has ruined my life – can't have kids, lost my husband and lost jobs that I loved.Original · engelskYes, I have lost so many jobs over the years due to my endo and now 47 and just lost another one, endo has ruined my life – can't have kids, lost my husband and lost jobs that I loved.
Prevalence: high
Employers respond to symptoms by issuing formal warnings for attendance, while the underlying medical cause is either unknown, disbelieved, or treated as irrelevant to the disciplinary process.
I was told my condition makes me unreliable. It's so hard trying to get someone who doesn't understand the full body pain we go through to even begin to wrap their head around it.Original · engelskI was told my condition makes me unreliable. It's so hard trying to get someone who doesn't understand the full body pain we go through to even begin to wrap their head around it.
I was fired because of my attendance. Every job I've had looked into it and said the same – equality act yes, disability act no – despite diagnosis. Even my GP said it's not, but should be.Original · engelskI was fired because of my attendance. Every job I've had looked into it and said the same – equality act yes, disability act no – despite diagnosis. Even my GP said it's not, but should be.
Prevalence: high
Women consistently report that their pain is not believed – by employers, colleagues, and managers – requiring them to perform wellness while visibly suffering and to justify absences they should not have to justify.
The hardest part of endometriosis isn't the pain itself. It's the endless battle to convince others that the pain is real.Original · engelskThe hardest part of endometriosis isn't the pain itself. It's the endless battle to convince others that the pain is real.
I was sent to the ER by employers on numerous occasions only to be sent home with an informational pamphlet on what a menstrual cycle is like – I haven't had one for the past 17 years.Original · engelskI was sent to the ER by employers on numerous occasions only to be sent home with an informational pamphlet on what a menstrual cycle is like – I haven't had one for the past 17 years.
Prevalence: high
Women who cannot sustain formal employment systematically downgrade their careers – moving from skilled roles to gig work, part-time positions, or self-employment – to maintain any income while managing unpredictable symptoms.
I've lost a number of jobs, which has pushed me into zero-hour contracts so I'm not as vulnerable to being let go during flare-ups. Although the flexibility helps, the unpredictability makes it very difficult to consistently cover my bills.Original · engelskI've lost a number of jobs, which has pushed me into zero-hour contracts so I'm not as vulnerable to being let go during flare-ups. Although the flexibility helps, the unpredictability makes it very difficult to consistently cover my bills.
I've been waiting two years for surgery and had to stop working full-time – transitioning from working my dream career to settling for anything that will pay the bills. One of my least favourite parts of all this.Original · engelskI've been waiting two years for surgery and had to stop working full-time – transitioning from working my dream career to settling for anything that will pay the bills. One of my least favourite parts of all this.
Prevalence: high
The psychological cost of managing chronic illness at work – guilt, anxiety, shame, and loss of professional identity – is as disabling as the physical symptoms and is rarely acknowledged as part of the occupational health picture.
Nobody fired me but I preferred to quit because I understood that I was just a burden for the team and it's not fair.Original · engelskNobody fired me but I preferred to quit because I understood that I was just a burden for the team and it's not fair.
Nobody realises the hardship of having to stop working because of this and what that alone does to a person. Changes your whole life, how you see yourself, what you're capable of, the life you dreamed of having.Original · engelskNobody realises the hardship of having to stop working because of this and what that alone does to a person. Changes your whole life, how you see yourself, what you're capable of, the life you dreamed of having.
Prevalence: medium
Women who undergo surgery are routinely pushed back into full duties before recovery is complete, or dismissed during surgical leave – transforming a medical intervention into an employment crisis.
I received no help when I had surgery – was expected back to work full-time on 12-hour shifts just 3 weeks post-surgery. Lost that job. Started a new one and lost that one too last week.Original · engelskI received no help when I had surgery – was expected back to work full-time on 12-hour shifts just 3 weeks post-surgery. Lost that job. Started a new one and lost that one too last week.
I was off for two months then asked for a phased return. My former boss kept making up excuses and just didn't bother letting me know about my job – or telling me I was sacked.Original · engelskI was off for two months then asked for a phased return. My former boss kept making up excuses and just didn't bother letting me know about my job – or telling me I was sacked.
Prevalence: medium
The average 8-year diagnostic delay means women suffer disciplinary consequences for absences caused by an unrecognised condition – losing jobs before they have the medical documentation that might have protected them.
I even don't have a diagnosis and I lost the job because of my pain.Original · engelskI even don't have a diagnosis and I lost the job because of my pain.
10 years with endo, just now got diagnosed. Unfortunately no idea what was going with my body – always with big guilt about why I am always tired and weak.Original · engelsk10 years with endo, just now got diagnosed. Unfortunately no idea what was going with my body – always with big guilt about why I am always tired and weak.
Prevalence: medium
When women do request adjustments – flexible hours, remote work, occupational health referrals – they are frequently ignored, delayed, or offered nominal support that does not match clinical recommendations.
I requested reasonable accommodations and my doctor was working on FMLA paperwork when I was 'terminated effective immediately,' with no actual cause given.Original · engelskI requested reasonable accommodations and my doctor was working on FMLA paperwork when I was 'terminated effective immediately,' with no actual cause given.
I worked for a large employer! They even went against occupational health recommendations. Yes you can take this to court and probably win – but you need the strength, the energy, and the money for a good solicitor.Original · engelskI worked for a large employer! They even went against occupational health recommendations. Yes you can take this to court and probably win – but you need the strength, the energy, and the money for a good solicitor.
Why it happens
The patterns above are not random cruelty. They are the predictable result of documented mechanisms — each one named and studied in research. Naming the mechanism is the first step to holding a system to account for it.
Being wronged specifically as a knower. When a woman's account of her own body is discounted because of who she is, she is denied credibility as a source of knowledge — the core of Miranda Fricker's account of testimonial injustice.7
Applied to illness, it explains why patients are systematically not believed about pain and symptoms they alone can feel.89
Fricker (2007); Carel & Kidd (2014); de Souza Campos & De Luca-Noronha (2025); UK Women's Health Strategy (2022).
The measurable experience of having a condition denied or minimised by others — including clinicians, employers and family. It is distinct enough to have its own validated measurement scale.10
Invalidation is independently associated with worse mental-health outcomes for patients living with chronic pain.12
Kool et al. (2010); pain-invalidation review, J Pain (2022); Woldhuis & Gandy (2024).
Harm caused by the very institution a person depends on and trusts — when a school, employer or health system fails to prevent or respond to a wrong it had a duty to address. Jennifer Freyd's research shows this failure compounds the original harm.13
Smith & Freyd (2014); Smidt, Adams-Clark & Freyd (2023).
Women's pain is systematically taken less seriously than men's, and more readily attributed to psychological rather than physical causes — a documented bias in how pain is assessed and treated.15
Stigma keeps the conditions hidden and diagnosis delayed.18
Samulowitz et al. (2018); endometriosis workplace-disclosure study (2021); Endometriosis UK.
Every pattern on this page traces to a named mechanism
Directly from the women
Not our recommendations — theirs. Aggregated, anonymously, from women who lived it and told us what would have kept them in work. Counts shown only where enough women have said the same thing to protect every individual.
Sector by sector
The picture forms one sector at a time. What women in your field carry at work — the shifts they can't call in sick from, the appointments they hide, the flexibility they never ask for — is not the same as the sector next door. As enough women in a sector tell us, what they say appears here. Until then, this is where you add yours.
Safe and private. Always anonymous — you decide what you share.
Thank you for sharing.
Accounts are always anonymous. Figures for a sector are shown only once enough women in it have spoken to protect every individual — never before.
A shared cause
This page documents a failure — but employers are not the adversary. The ones who choose to act become allies in a women's-health movement, not defendants in it. Getting this right is not only compliance and retained talent; it is a stand on something that has gone unaddressed for generations.
You need one decision: to believe her, and to make it safe to speak up.
≈1 in 10
women of reproductive age have endometriosis alone.19 Add PMDD, PCOS, adenomyosis, bladder pain and ME/CFS — and someone on almost every team is carrying this, often in silence. This is not a rare edge case. It is a tenth of the women you employ.
Culture is set from the top
Most of this page is about the relationship between an employee and her manager. But whether that relationship is safe is decided higher up. Leadership sets the culture — and the single most protective thing a company can say, out loud, is that seeing a doctor is never a problem. When that comes from the top, no one has to spend courage asking permission to be ill.
Normalise care
Say it as policy, not as a favour. When leadership states plainly that medical appointments are expected and unremarkable, attending one stops being a negotiation — and stops costing the person who is already unwell.
Plan the hard periods
Flare-ups, treatment cycles and recovery are predictable in shape even when the timing is not. Agree named windows of extra flexibility in advance, so support is arranged before a crisis — not improvised during one.
Signal safety
Whether a woman feels able to say what she needs is set by the signals leaders send long before she asks. A visibly safe climate is what makes disclosure possible — the burden should never rest on how brave she is.
The research backs this. Institutional courage — an institution deciding to protect the person who depends on it — is a measured buffer against the harm of institutional betrayal, and it is a leadership choice, not an individual one.14 And because women's pain is systematically taken less seriously,15 whether disclosure feels safe is governed by workplace climate rather than the individual's willingness to speak.16 Sources 14–16 · established / emerging.
The conversation
You do not need a diagnosis, a policy binder or the right medical words. The conversation itself is the first accommodation — a signal that she is believed before she has proven anything. Lead with curiosity about what would make the workday easier, not with questions about what is wrong.
An opener that works
"I've noticed some days are heavier than others. You don't owe me an explanation — but if there's anything that would make the workday easier, I'd genuinely like to hear it."
Being believed is the first accommodation. Everything practical follows from it. And when you adjust, ask which doors to keep open — never what she is capable of.
For HR, Managers & Policymakers
The opposite of institutional betrayal is not neutrality — it is institutional courage: an institution that chooses to protect the person who depends on it, even when protecting itself would be easier.14 None of what follows requires a diagnosis, a tribunal, or a large budget. It requires a decision to act before harm becomes irreversible.
What employees need
What goes wrong
What changes outcomes
Career navigation
The evidence on this page is not only a case against employers. It is also information a girl can hold for herself. Pattern 08 — the point where an accommodation is requested and the request decides everything — repeats across the 95 accounts behind this page. Knowing that pattern in advance changes what she can plan for.
This is not about steering her away from anything. It is about making the invisible visible: which environments have flexibility built in, which rights she can invoke, and which structures protect her before she needs protecting.
The goal is never lowered ambition. It is informed ambition: knowing which environments, structures and rights make her ambitions achievable — before the system teaches her the hard way.
Nothing in this section may imply sorting girls into lower tracks. Rights to accommodation come first; choices come second; ambitions stay intact.
The economic case
The same failure carries a price — in dropped-out schooling, lost work, and productivity worked away in silence. Believing her early isn't only the right thing. It's the cheapest.
Every $1 invested in women's health is estimated to return about three in economic growth.
Women who could gain access to full-time work by 2040 if the health gap were closed — around $1 trillion added to the world economy.
Lost productivity from working through pain (presenteeism) typically costs about double the healthcare bill.
A concise briefing built on the law and the research – the costs, the rights, and what employers are obliged to do. To read and share with HR, leadership, and occupational-health and safety reps.
Every claim, one click away
Every claim on this page is linked to its original source. Lived accounts are quoted verbatim; research is cited with its confidence level. Where a finding is still emerging, it is labelled as such rather than presented as settled.
