Endometriosis may cost affected women the equivalent of an entire month’s salary every year, according to a large new study from Semmelweis University in Hungary. Researchers found that women living with the chronic gynecological disease lost an average of €1,757 in annual income because of health-related absences from work. The estimate, roughly comparable to one month’s average salary in Hungary, does not include the additional economic burden of reduced productivity while working, medical treatment, diagnostic procedures, or other healthcare expenses. The findings place endometriosis not only among the most disruptive reproductive health conditions, but also among the diseases capable of quietly reshaping women’s careers and financial security.
The study, published in Preventive Medicine Reports, analyzed data from 566 women with endometriosis and 447 women without the condition. Using internationally validated questionnaires, the researchers examined how symptoms affected absenteeism, work productivity, and the ability to perform professional duties. Over a four-week period, women with endometriosis lost an average of 12.7 working hours because of health-related problems. Participants in the control group lost 5.7 hours during the same period. Researchers then used the difference in missed working time to estimate the average annual income loss associated with the disease.
Endometriosis occurs when tissue resembling the lining of the uterus develops outside the uterine cavity. Although this tissue is not identical to normal endometrium, it can respond to hormonal fluctuations during the menstrual cycle, triggering inflammation, bleeding, scar formation, and chronic pain. Lesions may develop around the ovaries, fallopian tubes, pelvic lining, bowel, bladder, or other nearby structures. The disease can cause severe menstrual cramps, persistent pelvic pain, painful intercourse, fatigue, digestive or urinary symptoms, and infertility. Because symptoms vary widely and can overlap with other conditions, diagnosis is often delayed for years, allowing the physical and economic consequences to accumulate.
The new findings reveal how that burden extends beyond individual symptoms. Forty-two percent of women with endometriosis in the study were classified as having poor work ability, compared with 17.9% of women in the control group. Work ability is a multidimensional measure that reflects whether a person’s health, functional capacity, and job demands can be sustained together. A low score does not simply mean that someone misses work. It may indicate difficulty concentrating, maintaining physical performance, completing tasks on schedule, or continuing in the same occupation over the long term. In severe cases, poor work ability can raise the risk of prolonged disability, reduced career progression, or leaving the workforce altogether.
Pain and fatigue appear to be central drivers of this hidden productivity crisis. Acute pelvic pain can make commuting, sitting, standing, lifting, or maintaining attention difficult, depending on the nature of a person’s job. Fatigue can persist even when pain is temporarily controlled, affecting memory, reaction time, decision-making, and endurance. Some employees may remain at work while functioning below their normal capacity, a phenomenon known as presenteeism. The researchers’ estimate of €1,757 reflects time absent from work, meaning it may substantially underestimate the total financial impact of endometriosis. Lost productivity during working hours could represent another major cost for employees, employers, and national economies.
The workplace itself may intensify the effects of the disease. More than half of the respondents, 54%, said their employers had little or no knowledge of endometriosis. Only 17% believed their workplace was sufficiently informed about the condition. This lack of understanding can create a gap between what an employee needs and what an employer recognizes as a legitimate health-related limitation. Menstrual pain may be dismissed as routine discomfort, while fatigue, unpredictable bleeding, or repeated medical appointments can be misinterpreted as poor commitment. Such misunderstandings may discourage employees from requesting adjustments and can push them to conceal symptoms until their health or performance deteriorates.
When participants were asked what forms of support would help most, menstrual leave and flexible work arrangements emerged as the leading responses. Flexible start and finish times could allow employees to work around periods when symptoms are most severe. Remote or hybrid work may reduce the physical burden of commuting and provide easier access to restrooms, medication, heat therapy, or rest during flare-ups. Adjustments to workload, meeting schedules, and break policies could also help employees remain productive without forcing them to choose between their health and their income. These measures are not cures, but they may reduce avoidable absences and help preserve a worker’s connection to employment.
Several European countries have begun treating menstrual health as a workplace and public-policy issue. Spain and Portugal, under certain circumstances, allow menstrual leave, although the details and eligibility requirements differ. The Semmelweis University researchers argue that support policies should be paired with better education for employers and colleagues. Awareness is particularly important because endometriosis is often invisible: a person may appear healthy while experiencing debilitating pain or exhaustion. Recognizing the condition as a chronic disease with fluctuating symptoms could encourage workplaces to adopt individualized accommodations rather than relying on rigid attendance rules.
The study is part of the international FEMaLe, or Finding Endometriosis with Machine Learning, research program, launched in 2020. At Semmelweis University, the project is led by Dr. Attila Bokor and aims to improve understanding of endometriosis, promote earlier diagnosis, and measure the disease’s health, social, and economic effects. Machine-learning approaches in endometriosis research may eventually help identify symptom patterns and clinical signals that are difficult to detect through conventional assessment alone. Earlier recognition could shorten the diagnostic journey, enable treatment sooner, and potentially limit the progression of pain, inflammation, and work-related disability.
Dr. Dóra Balogh, the study’s senior author, said the results show that endometriosis is not only a medical problem but also a major social and economic one. First author Dr. Dominika Miklós emphasized that the finding that nearly half of affected women had poor work ability was particularly striking. Together, the results suggest that treating endometriosis solely through clinical care leaves a significant part of the problem unresolved. The researchers conclude that informed employers, flexible work structures, and practical protections could help women remain in the workforce. As endometriosis affects approximately 10% of women of reproductive age worldwide, the potential impact of such changes extends far beyond the study’s Hungarian participants, touching millions of working women and the economies that depend on their participation.
Subject of Research: The effects of endometriosis on work productivity, absenteeism, work ability, income, and workplace support.
Web References: ScienceDirect article; DOI link.
References: Preventive Medicine Reports, DOI: 10.1016/j.pmedr.2026.103501.
Image Credits: Photo: Bálint Barta, Semmelweis University, Budapest, Hungary. Image shows Dr. Dóra Balogh, Assistant Professor in the Department of Obstetrics and Gynecology at Semmelweis University.
Keywords: Endometriosis, menstrual leave, women’s health, workplace health, work productivity, absenteeism, chronic pain, fatigue, reproductive health, medical economics, health policy, Semmelweis University, FEMaLe.
