The impact of endometriosis on work-related outcomes: a systematic review

Abstract

Abstract Background Endometriosis is a systemic disease that affects women of reproductive age and is characterized by chronic pelvic pain, dysmenorrhea, fatigue, and infertility. Its debilitating symptoms may significantly impair professional functioning, yet evidence on work-related outcomes remains fragmented and underexplored in current literature. Methods A systematic review was conducted following PRISMA. The review protocol was registered at OSF (DOI:10.17605/OSF.IO/8K2VT). PubMed, Scopus and Web of Science databases were searched from inception to Dec 2025. Quality was assessed using the Newcastle-Ottawa Scale. Results Eleven observational studies comparing work-related outcomes in women with endometriosis versus controls were included, covering absenteeism, presenteeism, work productivity, sick leave, work ability, employment status, salary growth, disability days, working years lost, and occupational progression. Despite methodological heterogeneity precluding meta-analysis, findings consistently showed that women with endometriosis experience significantly higher absenteeism, presenteeism, and overall productivity loss compared to controls. Sick leave frequency was elevated across all studies. Work ability was significantly reduced, with fatigue and chronic pain identified as the strongest predictors. Employment trajectories were negatively affected, with increased risk of workforce exit following diagnosis and slower wage growth over a five-year period. Career progression was hindered, particularly regarding access to managerial and senior roles, with pain identified as a key mediating factor. Conclusions Endometriosis negatively impacts multiple dimensions of working life. Governments should recognize it as a potential functional disability, ensuring legal protections, and facilitating access to flexible working arrangements. Longitudinal national registry data are urgently needed to strengthen the evidence base. Key messages • Endometriosis significantly increases absenteeism, presenteeism, and productivity loss, reduces work ability, and hinders career progression, including access to managerial roles. • Governments should recognize endometriosis as a functional disability, ensuring legal protections, flexible work arrangements, and corporate support protocols to reduce occupational harm.