Navigating the Workplace with Endometriosis

When Christian Worley asked to work from home one or two days a month to manage the worst of her endometriosis symptoms, not only was her request denied, she was threatened with termination if she asked again. Her employers’ response was a clear message: not only was she unwelcome to advocate for herself, but being honest about her pain was a professional liability. Worley, a former North Carolina juvenile justice counselor, is now suing the state, arguing that endometriosis should be recognized as a disability under federal law. 

Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining grows outside of the uterus, leading to symptoms like severe pelvic pain during and in between one’s menstrual cycle, crushing fatigue, and sometimes infertility. Worley has described her pain as feeling like a  “rusty machete going in and out of you.”

According to the World Health Organization (WHO), endometriosis affects 1 in 10 people with uteruses worldwide, nearly 190 million individuals. Due to the fact that it can take 10 years for someone to be diagnosed, many could be living with the disease and not even know it. Racial disparities only complicate the journey to diagnosis: Black women are 50% less likely to receive a diagnosis compared to white women due to false assumptions that the disease is less common in Black people.  

In August 2025, a federal judge determined Worley’s condition does qualify as a disability under the American Disabilities Act (ADA), a first-of-its-kind ruling that will allow her disability discrimination case to move forward. Such a ruling is an early but significant signal that the legal system may be starting to take chronic and invisible illnesses more seriously. Disability rights advocates say the case could be “groundbreaking” and could reshape how the ADA is applied to conditions like endometriosis.

Christian Worley’s case arrives at a moment of growing conversation around what disability looks like, especially when they aren’t  outwardly seen. 58% of workers in the United States report having chronic health conditions, and many are forced to structure their lives around a system that was never built to accommodate them. Their struggles expose the flaws of a labor culture built on uninterrupted productivity—and the human cost of forcing chronically ill people to choose between silent suffering or speaking up and risking their livelihood.

Endometriosis is often dismissed, even by medical professionals, as a painful but manageable “women’s issue.” In reality, it’s far more serious, with consequences that are both profound and measurable. A 2017 study found that people with endometriosis lost an average of 6.3 work hours per week due to their symptoms. Most of this loss came not from taking sick days, but from attempting to work through the pain. According to the study, presenteeism –the act of pushing through sickness or pain to meet workplace expectations– accounted for roughly 83% of total productivity loss. 

This issue is not unique to the United States. In Australia, 1 in 3 women with endometriosis report being passed over for promotions due to having to manage their endometriosis symptoms, and 1 in 6 report being fired for lack of productivity due to their symptoms. In a study conducted on women in Switzerland, Germany and Austria, 50% of women with endometriosis experience a decreased ability to work, and they estimate 66-75% of the total costs of managing endometriosis come from a reduced ability to work rather than direct costs of treatment. 

While statistics can measure lost productivity, they can’t capture the emotional toll of being forced to push through a workday in pain. On online forums like Reddit’s r/endometrosis that hosts almost two hundred thousand visitors a week, threads titled “How to work through flare-ups?” and “How to get accommodations for endo” are posted frequently, and such posts are flooded with comments from others sharing support and expressing their own fears of workplace retaliation. 

One user describes a day at work where their pain was so severe they had to crawl into an empty meeting room and wait for it to pass. Another wrote about their struggle to comply with a new workplace rule that requires twelve hours’ notice to call in sick, an impossible standard for a disease whose flare-ups can strike without warning. Others confessed to masking their pain, forcing smiles through severe cramps because of how they feel their pain is belittled and dismissed. 

“I always feel like I need to pretend nothing is wrong because it’s ‘just a period,’” one comment reads. “Do people with other chronic pain pretend too? I feel like we need discussion on how to accommodate chronic pain in the workplace in general.”

Individual interviews with forum users paint a similar picture. Lily, a woman who works in the clinical psychology field, lost her last job due to her symptom flare-ups that were so severe that they were affecting her bladder function. “I kept trying to take sick days to see my doctor and I was eventually fired because of it,” She said. “I was finally diagnosed a year later while I was unemployed as my disease progressed. For a period of time, I was stuck in bed in near constant pain, unable to take care of myself and my home.” 

Lily believes her disease progressed as fast and aggressively as it did because her employers threatened her with termination if she tried to take time off to seek medical intervention. “I was told I had to ignore it for 1 year before being allowed sick leave. Not being able to seek help destroyed my health for a long time. I’ve honestly lost all hope for my career to progress at this point.” She was punished for temporarily sacrificing workplace productivity in order to take care of her health. 

Such stories are heartbreakingly common. For every headline-grabbing lawsuit like Christian Worley’s, thousands of people are navigating similar struggles in silence, having to carefully consider whether honesty about their pain is worth the professional risk. 

The modern workplace still idolizes the concept of the “ideal worker” – someone who is always available, never asks for time off, and who focuses on uninterrupted labor to a robotic extent. This ideal was originally designed for healthy, male bodies unencumbered by reproductive or caregiving demands, let alone the demands of a chronic illness. People afflicted by endometriosis, an unpredictable disease that harms female bodies, do not fit into that standard. The result of this disconnect is a culture where accommodations are viewed as burdensome and disability is treated as an individual exception rather than a predictable feature of the workforce. When employers treat pain and disability as a personal failing rather than a structural concern, they perpetuate a culture where the act of pushing through pain is mistaken for commitment and professionalism. 

Some organizations are starting to challenge this paradigm. Endometriosis UK  offers ways for employers to affirm “their commitment to developing a work environment and culture that enable employees with endometriosis to thrive at work.” Scholars have written about “Endo-Inclusive Workplace Models,” a structured framework designed to support employees with endometriosis and ensure they “can participate fully and fairly in the workforce.” The research and tools are there; what’s missing is a widespread cultural shift. 

Even if Worley’s case transforms disability law as we know it and sets new legal precedence, a truly equitable system will require much more from workplaces than reactive compliance with the law. It requires reimagining productivity itself and redefining what it means to be a “good worker” to reflect the full range of human experience. It means adopting a framework that recognizes workers will sometimes need flexibility—and that chronic illness is not a personal failing. Initiatives like Endometriosis UK’s Endo-Friendly Employer program demonstrate that such change is not only possible but mutually beneficial, as workplaces that fully accommodate chronic illness are not lowering their standards, but are instead choosing to evolve them, aligning productivity with empathy and humanity. 

Ultimately, Christian Worley’s case raises a simple question with far-reaching implications: whose bodies are workplaces built for, and whose pain is deemed worthy of belief? The answer will shape not only the future of disability rights, but the moral architecture of labor itself. Whether the legal system and employers respond to that question with empathy and understanding will determine whether cases like Worley’s can spark long-overdue change.