With new equality reporting rules on the horizon, employers who overlook endometriosis risk legal, financial and reputational consequences — and early action will matter, warns Jemma Forrest.

Endometriosis affects one in 10 women. Yet in many workplaces, it is barely part of the conversation.

However, with employers already facing legal scrutiny, any business waiting for legislation to prompt action is taking what could be a costly risk, both financially and reputationally. A recent London tribunal highlighted that organisations can be held accountable when long-term health conditions are not properly recognised or supported, particularly where they may meet the legal definition of disability.

Currently, BSI standards set the expectation on employers' approach to menstruation and menopause at work, and legislation is on the way in the wake of the Employment Rights Act - with Equality Action Plans for businesses with more than 250 employees due to come into force from April 2027.

The plans require organisations to outline how they are tackling gender equality in the workplace, including the gender pay gap and support for employees managing health conditions such as endometriosis.

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Voluntary adoption of Equality Action Plans begins this April, and employers getting ahead of the game will be in the best position when the legislation comes into force - especially if they ensure endometriosis is given the same credence as more recognised conditions.

With 54% of people not knowing what the condition is, endometriosis is still too often dismissed as “bad period pain”. In reality, the NHS is clear that symptoms - including chronic inflammation - can interfere with everyday activities, and work is no exception.

Public awareness is beginning to shift, however, with online searches for endometriosis rising steadily over the past decade, and public figures from Molly-Mae Hague to Baby Spice speaking openly about their diagnoses.

Workplaces, however, are not keeping pace. While menopause and fertility support have begun to enter mainstream workplace discussions - with companies like ASDA and Tesco introducing paid leave for IVF treatment - endometriosis remains largely overlooked.

If organisations are comfortable running menopause awareness sessions or incorporating these topics into leadership or sensitivity training, there is little reason endometriosis should remain absent from wellbeing education. Partnering with specialist charities and including the topic in management training helps normalise the conversation and removes some of the stigma that still surrounds the condition.

For many, the hardest part of managing endometriosis at work is not the symptoms but deciding whether to say anything at all - with just 10% saying they feel comfortable discussing menstrual health at work.

Concerns about being labelled "unreliable" or "difficult" still shape how women talk about health in professional environments can affect confidence, wellbeing and career progression.

This is where managers make a huge difference. Encouraging conversations about health conditions before absences or performance reviews can prevent small issues becoming bigger ones. Employers should ensure line managers are properly trained to recognise the signs, understand the right language to use and know how to ask supportive, practical questions.

Managers also need reassurance that supporting employees through health challenges is not lowering expectations, it is simply good management. It also helps when senior leaders speak openly about health. When that tone is set from the top, it becomes far easier for employees to ask for help without fearing career consequences.

One of the biggest challenges for employers is that endometriosis does not behave in predictable ways. Symptoms can fluctuate significantly, with flare-ups bringing severe pain and fatigue, among other complications that make normal working patterns difficult.

What works one week may not work the next which is why rigid and standard frameworks rarely accommodate that reality.

HR bodies such as the CIPD have long advocated flexible, individualised support for employees managing long-term health conditions, particularly those disproportionately affecting women. In practice that might mean temporary workload adjustments, hybrid working arrangements, flexible hours during flare-ups or simply removing the stigma around stepping away from a desk when symptoms become unmanageable.

Small adjustments can make the difference between someone remaining in work and feeling forced to step back from their career.

Perhaps the most important step is getting the basics right, by reviewing absence triggers and performance management frameworks to ensure they do not inadvertently penalise employees managing chronic conditions. Standardised systems often assume predictable health conditions and a linear working pattern. Endometriosis does not fit neatly into either.

Equality Action Plans offer an opportunity to look again at whether policies reflect lived experience. Waiting until they become mandatory risks sending the message that compliance matters more than people.

From a business perspective, while there will be no automatic, fixed fine for failing to publish a plan, mandatory reporting will be enforced by the Equality and Human Rights Commission (EHRC). Not having an equality action plan could lead to formal investigations, compliance orders and court enforcement – with potential unlimited fines if ignored.

And with the potential for the government to publicly name employers who fail to comply, any business on that list could face reputational risks and indirect commercial impact, from public procurement eligibility to equality or discrimination claims.

Employers would be wise to start reviewing their policies now, as the expectation will be a credible plan backed by data – and analysis at this level takes time. Embedding deeper cultural change can take even longer. Seeking advice from experienced employment law specialists can help organisations assess their readiness, identify potential gaps and ensure they are prepared well before the regulations take effect.

Jemma Forrest is a director in the Employment, Immigration and Pensions team at Scottish law firm Anderson Strathern

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