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.

PAK5, a serine/threonine kinase that has been implicated in various cellular processes, including cell proliferation, migration, and survival, has emerged as a key in understanding the progression of endometriosis. When the endometrial cells migrate and proliferate outside the uterus, they often acquire metabolic adaptations that facilitate their survival in the ectopic environment. The recent studies highlight that PAK5 is instrumental in promoting anaerobic glycolysis in endometriotic cells through its interaction with pyruvate kinase M2 (PKM2). The phosphorylation of PKM2 by PAK5 is a pivotal step that not only stabilizes PKM2 protein levels but also enhances its glycolytic activity, which is critical for supporting the metabolic demands of endometriotic tissues.

As endometriosis advances, the demand for cellular energy increases, necessitating a shift from aerobic respiration to anaerobic glycolysis, even in the presence of oxygen—a phenomenon known as the Warburg effect. The research established that PAK5 enhances this metabolic switch, allowing endometriotic cells to thrive and grow in unfavorable conditions. This finding emphasizes the potential of targeting PAK5 and its associated pathways in treating endometriosis by disrupting the metabolic adaptations that support ectopic tissue survival.

In their investigations, researchers meticulously examined how PAK5 impacts endometrial cellular functions. Utilizing various experimental approaches, including cell culture systems and immunohistochemical techniques, they were able to elucidate the relationship between PAK5 and PKM2. The studies revealed that increased expression of PAK5 correlates with elevated PKM2 levels, reinforcing the notion that PAK5 serves as a positive regulator in the context of endometriosis.

One of the most compelling aspects of this research is the potential implications for therapeutic strategies aimed at endometriosis management. The application of a small-molecule inhibitor for PAK, named GNE 2861, demonstrated a marked reduction in cellular proliferation and migration. This effect suggests that pharmacological inhibition of the PAK5 pathway could yield significant therapeutic benefits, reducing the disease’s progression and alleviating its associated symptoms.

In addition to the molecular focus, the study extensively explored the broader implications of targeting the PAK5-PKM2 axis as a novel therapeutic strategy. By potentially modulating PAK5 activity, clinicians may find a pathway to influence PKM2 activity and glycolysis favorably, ultimately seeking to improve treatment outcomes for women suffering from endometriosis. This approach could provide a critical intervention point in a field that has largely been reliant on managing symptoms rather than altering disease progression.

Moreover, the findings of this research underscore the importance of understanding the pathogenic mechanisms of endometriosis at a cellular level. Authoritative insights into the role of PAK5 contribute substantially to the existing body of knowledge, offering a foundation for future studies aimed at unraveling the complexities of this disorder. As researchers continue to delineate the molecular underpinnings of endometriosis, it is increasingly evident that targeted therapies could radically transform how this condition is treated.

The breadth of research into endometriosis highlights the urgency of developing effective, mechanisms-based treatments. As therapeutic options remain limited, the scientific community’s focus on signaling pathways and metabolic adaptations signals a pivotal shift in addressing this complex condition. The ongoing investigation into PAK5’s role in endometriosis not only provides hope for effective interventions but also reinforces the need for continued exploration in this field.

Overall, this research bridges a significant gap in the current understanding of endometriosis pathophysiology. It positions PAK5 as a promising therapeutic target, with the required mechanistic insights to inform future clinical applications. By further elucidating these pathways, researchers contribute to a growing body of work that aims to enhance the quality of life for women affected by this challenging reproductive disorder.

The ongoing exploration of endometriosis and its underlying mechanisms promises to illuminate new pathways for diagnosis and treatment. As the scientific community continues to engage with and investigate this condition, it is clear that the pioneering work surrounding PAK5 and metabolic regulation will serve as a critical cornerstone for advancements in treating endometriosis effectively.

Through a comprehensive understanding of the molecular interactions at play, the research paves the way for innovative treatment strategies that could significantly alter the future landscape of endometriosis management. The role of PAK5 and PKM2 in modulating glycolysis emphasizes the necessity for targeted therapies that address the root causes of this challenging condition.

In conclusion, this research represents a significant step forward in comprehension and treatment of endometriosis, illustrating how a deeper understanding of disease mechanisms can lead to novel therapeutic approaches. As developments in this area progress, it is anticipated that innovative strategies will emerge, ultimately improving the lives of countless women suffering from endometriosis.

Subject of Research: Not applicable
Article Title: PAK5-mediated PKM2 phosphorylation is critical for anaerobic glycolysis in endometriosis
News Publication Date: 15-Dec-2024
Web References: http://dx.doi.org/10.1007/s11684-024-1069-3
References: Not available
Image Credits: Jiayi Lu, Xiaoyun Wang, Xiaodan Shi, Junyi Jiang, Lan Liu, Lu Liu, Chune Ren, Chao Lu, Zhenhai Yu

Keywords: Health and medicine