Workplaces must wake up to the harmful invisibility of endometriosis
In a country grappling with gender equity, rising workplace absenteeism, and the push for inclusive labour policies under the Basic Conditions of Employment Act (BCEA), endometriosis remains an overlooked crisis, one that silently undermines South Africa's efforts to create humane, productive and equitable workplaces.
'You don't look sick,' is a phrase women with endometriosis hear way too often at work, at home, in doctors' offices and sometimes from themselves.
In conversations with others navigating endometriosis, a recurring theme emerges: the overwhelming burden of managing pain in silence, often while trying to meet workplace expectations. Many speak of being expected to justify absences long before receiving a diagnosis, as if their health problems were inconveniences rather than legitimate concerns.
These experiences show how invisible endometriosis remains in the workplace, not just in terms of physical pain, but also the stigma and lack of accommodations that quietly shape career trajectories. And behind that invisibility lies one of the most debilitating and misunderstood health crises affecting working women today.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. It affects roughly one in 10 women globally. That's millions silently battling chronic pain, fatigue and infertility. In South Africa, where access to specialist care is uneven and healthcare resources are strained, many women face even longer delays in diagnosis and appropriate treatment.
Research shows that it takes seven to 10 years to get a diagnosis. During that time, many women are gaslit, misdiagnosed or dismissed. The consequence? Careers cut short, dignity eroded, jobs lost and health quietly sacrificed on the altar of workplace performance.
This structural mismatch between what employees need and what workplaces demand creates a dynamic where women feel pressured to mask their pain to avoid stigma, job loss or being labelled as unreliable. This is especially damaging in sectors where sick leave is tightly controlled, or in precarious work environments with little room for flexibility.
The unpredictable nature of endometriosis flare-ups makes consistent attendance and productivity difficult. Missed promotions, unfair performance reviews, or job losses are not
uncommon. This undermines employment equity, not only along gender lines but also class and health lines.
At many workplaces, 'diversity and inclusion' is reduced to a wellness day or a motivational speaker. But for employees doubled over in pain, that kind of tokenism is not support, it's avoidance. Chronic illness remains the elephant in the boardroom.
South Africa's progress toward workplace transformation, through broad-based black economic empowerment and equity laws is commendable. But to be truly inclusive, policies must also account for the experiences of those managing chronic, often invisible health conditions such as endometriosis. This gap signals the need for a more intersectional approach to workplace equity.
A framework for change
To end this cycle, here is a four-part framework South African workplace can adopt immediately
1.
Policy reform:
Recognise chronic illness in HR and organisational policies. Review BCEA provisions in relation to long-term, fluctuating conditions like endometriosis.
2.
Flexible work options:
Enable remote work, adjustable schedules, and rest breaks during flare-ups, especially important in South Africa's mixed rural-urban labour economy.
3.
Manager education:
Train supervisors to replace scepticism with empathy. Awareness reduces stigma and improves productivity.
4.
Support systems:
Create access to mental health resources, safe disclosure channels, and peer support groups. These are low-cost interventions that are effective.
I explore this framework in detail in my recent article which you can read
When flare-ups hit, routine tasks become mountains. Without proper support, women are forced to choose between health and income. For South Africa, where high unemployment, youth joblessness and gender inequality already intersect, this is an unacceptable trade-off.
Endometriosis is not just a medical condition, it's a workplace issue. One that demands recognition under policies and labour codes, and inclusion in discussions around productivity and well-being.
If we claim to care about transformation, dignity, and decent work, we must move beyond superficial gestures. It's time to stop brushing off pain that doesn't show on a scan and start building workplaces that are compassionate, inclusive, and prepared for reality.
Endometriosis is real. Women's pain is real. It's time our policies, leaders, and workplace cultures responded like it.
Zimkhitha Juqu is a researcher, published and cited author interested in gender, health equity and workplace inclusion.
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