A supervisor’s guide to endometriosis

This guidance is designed for first-line supervisors who are supporting a member of their team who has, or is suspected to have, endometriosis. It aims to provide an understanding of the condition, the challenges it can present in the workplace, and the practical steps supervisors can take to support colleagues effectively, compassionately and lawfully.

Endometriosis (pronounced en-doh-mee-tree-oh-sis), often referred to as endo, is a chronic health condition in which tissue similar to the lining of the womb grows elsewhere in the body. It can cause a range of symptoms, including severe pelvic pain, painful and heavy periods, fatigue, bowel and bladder problems, and fertility difficulties. There is currently no cure for endometriosis, although treatments are available to help manage symptoms and improve quality of life.

Endometriosis is common. In the UK, it is estimated to affect 1 in 10 women and those assigned female at birth of reproductive age, which equates to approximately 1.5 million people. Globally, the World Health Organization estimates that around 190 million women and girls are living with the condition.

Despite its prevalence, endometriosis continues to be under-recognised and frequently misunderstood. Many individuals experience significant delays before receiving a diagnosis. Recent research from Endometriosis UK found that the average time to diagnosis in the UK is now 9 years and 4 months, highlighting the importance of awareness and understanding from employers and line managers.

The policing workforce includes a significant proportion of women and individuals assigned female at birth. As of March 2025, women represented more than a third of police officers in England and Wales, and the majority of police staff roles. As a result, there is a strong likelihood that, at some point during your supervisory career, you will manage or support someone who is living with endometriosis.

It is important to recognise that endometriosis does not only affect women. Some transgender men and non-binary people who were assigned female at birth may also experience endometriosis and may require the same understanding, workplace adjustments and support.

As a supervisor, you are not expected to be a medical expert. However, you play a vital role in creating a supportive working environment, encouraging open conversations, considering reasonable workplace adjustments where appropriate, and ensuring that colleagues affected by endometriosis are treated with dignity, respect and understanding. This guide will help you develop the knowledge and confidence needed to provide that support.

Understanding endometriosis

Endometriosis commonly affects areas such as the ovaries, fallopian tubes, bladder, bowel and the lining of the pelvis but can spread further to other parts of the body. 

The exact cause of endometriosis remains unknown, and there is currently no cure. However, a range of medical and surgical treatments are available to help manage symptoms and improve quality of life. Symptoms and their severity can vary significantly from person to person, and the impact on daily activities and work can be substantial. 

Anyone experiencing symptoms that may be associated with endometriosis should seek medical advice from their GP or healthcare professional. Early intervention may help manage symptoms and support access to appropriate treatment. 

Diagnosing endometriosis can be challenging because its symptoms often overlap with those of other conditions, such as irritable bowel syndrome (IBS), pelvic inflammatory disease, adenomyosis and urinary tract disorders. As a result, many individuals experience significant delays before receiving a diagnosis. 

Healthcare professionals may use a combination of symptom assessment, physical examination, ultrasound scans and other imaging techniques to investigate suspected endometriosis. Diagnosis may be based on symptoms, clinical assessment and imaging. While laparoscopy may still be used in some cases, advances in imaging mean that surgery is no longer always required to diagnose or begin treatment for endometriosis.

Endometriosis can affect individuals from the onset of menstruation through to menopause. While symptoms often improve after menopause, this is not always the case. 

Symptoms and impact of endometriosis 

Endometriosis affects individuals in different ways. Symptoms, severity and the impact on everyday life can vary significantly from person to person. Some individuals may experience occasional symptoms that can be managed effectively, while others may live with severe, debilitating symptoms that affect their physical health, mental wellbeing and ability to carry out daily activities. As a supervisor, it is important to recognise that each person’s experience will be unique and that support should be tailored to their individual needs. 

Common symptoms of endometriosis

Symptoms can fluctuate over time and may vary throughout the menstrual cycle. Common symptoms include:

• Pelvic pain, including pain in the lower abdomen, pelvis or lower back, which may worsen during menstruation. 
• Severe period pain that interferes with normal daily activities. 
• Heavy menstrual bleeding or irregular bleeding patterns. 
• Pain during or after sexual intercourse. 
• Pain when using the toilet, particularly during menstruation. 
• Bloating and abdominal discomfort. 
• Nausea or feeling unwell. 
• Constipation, diarrhoea, or other bowel-related symptoms. 
• Persistent fatigue, low energy levels, and poor sleep due to pain. 
• Leg, hip or lower back pain. 
• Difficulty becoming pregnant or infertility issues. 
• Anxiety, stress, or low mood associated with managing a chronic condition. 

The wider impact of endometriosis

Endometriosis is more than a menstrual health condition. For some individuals, it can have a significant impact on many aspects of life, including:

• Chronic or recurring pain. 
• Physical and emotional fatigue. 
• Anxiety, depression, or other mental health challenges. 
• Difficulties in personal relationships and intimacy. 
• Fertility concerns and the emotional impact of fertility treatment. 
• Reduced ability to participate fully in work, social activities, exercise, or family commitments. 

Supervisors should be mindful that a colleague's symptoms may not always be visible. An individual may appear well while experiencing significant pain, fatigue, or discomfort. Open, supportive conversations can help supervisors understand the challenges their colleague is facing and identify adjustments that may help them remain effective at work.

Treatment and symptom management

There is currently no cure for endometriosis. Treatment focuses on managing symptoms, improving quality of life and, where relevant, supporting fertility. Treatment plans vary depending on the individual's symptoms, circumstances and treatment goals. 

Treatment options may include:

• Pain-relief medication to help manage symptoms. 
• Hormonal treatments designed to reduce or suppress endometriosis activity. 
• Surgical procedures to remove or reduce endometriosis tissue. 
• Fertility treatments where endometriosis is contributing to difficulties conceiving.  

As a supervisor, understanding that symptoms may fluctuate, treatment may involve medical appointments or recovery periods, and some individuals may require workplace adjustments will help ensure colleagues receive appropriate support while remaining productive and engaged in the workplace.

Impact in the workplace

Understanding how symptoms can affect work can help supervisors provide timely and appropriate support.

The examples below are not exhaustive but illustrate some of the ways endometriosis may affect an individual's ability to work effectively.

Pain

Pain is one of the most common symptoms of endometriosis, but its severity and location can vary considerably. Some individuals may experience pelvic pain, lower back pain, abdominal pain or leg pain, while others may have more widespread symptoms.

Pain can affect concentration, productivity and wellbeing, and during severe flare-ups may make it difficult to attend work or carry out normal duties. Individuals may benefit from:

• Access to pain relief medication.
• The ability to use heat pads or other symptom-management aids.
• Temporary adjustments to duties or workloads.
• Opportunities to take short breaks when symptoms are particularly severe.

For operational roles, pain may also affect an individual's ability to undertake physical activities, prolonged standing, driving, or other demanding tasks.

Heavy or irregular bleeding

Heavy menstrual bleeding and unpredictable bleeding patterns can cause physical discomfort, embarrassment and anxiety.

Individuals may need:

• More frequent access to toilet facilities.
• Additional comfort breaks.
• Facilities to manage periods discreetly and with dignity.
• Flexibility where symptoms become particularly severe.

This can be especially challenging for employees working in operational, frontline or customer-facing roles where immediate access to facilities may be limited.

Fatigue and reduced energy levels

Many people with endometriosis experience significant fatigue, which can be just as debilitating as pain. Poor sleep, chronic pain and the physical effects of the condition can leave individuals feeling exhausted even after rest.

Fatigue may result in:

• Reduced concentration and focus.
• Slower completion of tasks.
• Difficulty retaining information.
• Increased irritability or frustration.
• Reduced resilience during busy or stressful periods.

Supervisors should recognise that fatigue is a genuine symptom of a chronic health condition and not simply tiredness.

Bowel and bladder symptoms

Endometriosis can cause a range of bowel and bladder symptoms, including bloating, constipation, diarrhoea, nausea and pain when using the toilet.

These symptoms can:

• Cause discomfort and distraction.
• Affect concentration and productivity.
• Lead to anxiety about being away from toilet facilities.
• Require urgent or more frequent access to toilets.

Consideration should be given to working arrangements where access to toilet facilities may otherwise be restricted.

Anxiety, low mood and mental wellbeing

Living with a chronic and often painful condition can have a significant impact on mental wellbeing. The challenges of managing symptoms, navigating lengthy diagnostic pathways, coping with treatment, and balancing work and personal responsibilities can contribute to anxiety, stress and depression.

This may present as:

• Reduced confidence.
• Difficulty concentrating or making decisions.
• Increased anxiety in meetings or social situations.
• Reluctance to take on additional responsibilities.
• Withdrawal from colleagues or workplace activities.

Supportive supervision, regular wellbeing conversations and access to workplace wellbeing services can all play an important role in helping individuals manage these challenges.

Fertility concerns and treatment

Some people with endometriosis may experience fertility difficulties or undergo fertility investigations and treatment.

The emotional impact of fertility issues can be significant and may affect wellbeing, attendance and performance. Individuals may also require time off for medical appointments, procedures or treatment.

Supervisors should approach these conversations with sensitivity and avoid making assumptions about family planning, pregnancy or personal circumstances. They should also be mindful that discussions about pregnancy, children or parenting may be difficult for some individuals.

Impact on attendance and performance

The cumulative impact of pain, fatigue, treatment, medical appointments and psychological wellbeing can affect attendance, performance and productivity. Symptoms may be intermittent and unpredictable, meaning that an individual may have periods of working normally followed by periods where additional support is required.

As a supervisor, it is important to focus on understanding the individual's experience and identifying practical adjustments that will help them remain healthy, engaged and productive at work. Early conversations, regular reviews and a supportive approach can make a significant difference to both wellbeing and workplace performance.

Supporting colleagues 

As a supervisor, you have a responsibility to support the health, safety and wellbeing of your team. The way endometriosis is understood and managed in the workplace can have a significant impact on an individual's wellbeing, attendance and ability to perform their role.

Creating a supportive and inclusive environment is often one of the most valuable things a supervisor can do.

• Foster a culture where colleagues feel comfortable discussing sensitive health issues without fear of judgement.
• Listen with empathy and respect, recognising that everyone's experience of endometriosis is different.
• Avoid making assumptions about symptoms or coping strategies. Instead, ask, "What support would help you most?"
• Challenge stigma or negative attitudes towards women's health conditions, absences related to a medical condition, or workplace adjustments.
• Recognise that living with a chronic condition can affect confidence, wellbeing and self-esteem. Encourage and support individuals to achieve their full potential.
• Information relating to an individual's health should be treated sensitively and shared only where necessary, in accordance with organisational policy and data protection requirements.
• Help raise awareness of endometriosis and other women's health conditions where appropriate, promoting a more informed and supportive workplace culture.

Workplace adjustments

The support required will vary depending on the individual's symptoms, role and circumstances. Flexibility is key, as symptoms can fluctuate over time.

• Workplace adjustments: Consider reasonable adjustments such as easy access to toilet facilities, sanitary products, pain relief, rest areas, or temporary changes to duties. Uniform adaptations may also be required during periods of severe bloating, treatment or recovery from surgery. Temporary redeployment where operational duties are significantly affected could also be considered. Access to rest facilities during severe symptom flare-ups, phased return following surgery/treatment and flexibility around mandatory training dates are other possible considerations.
• Flexible working: Where operationally possible, consider flexible hours, adjusted shifts, remote working or temporary changes to working arrangements during symptom flare-ups, treatment or recovery.
• Occupational Health: Consider an Occupational Health referral to obtain specialist advice on workplace adjustments, fitness for work and ongoing support.
• Access to support services: Signpost colleagues to available support, including HR, staff networks, wellbeing services, staff associations, trade unions and any internal women's health or endometriosis support groups.
• Attendance management: Ensure absences related to endometriosis are recorded accurately and consistently. Work collaboratively with the individual to understand treatment plans, expected absences and any support required.
• Maintain continuity of support: Keep appropriate records of agreed adjustments and support measures to avoid colleagues having to repeatedly explain their condition. Ensure any attendance or performance processes are managed fairly, sensitively and in line with organisational policy.

Effective support is based on open communication, flexibility and a willingness to work with the individual to identify solutions. Small adjustments and supportive management can make a significant difference to someone's experience at work.

Equality Act 2010

Endometriosis may meet the definition of a disability under the Equality Act 2010 where symptoms have a substantial and long-term adverse effect on an individual's ability to carry out normal day-to-day activities. Supervisors should seek advice from HR and Occupational Health where appropriate and consider reasonable adjustments on a case-by-case basis. Attendance, performance and capability procedures should be managed fairly and consistently, taking account of any underlying health condition.