How are workplace policies, organizational dysfunction, and lack of accommodations for employees with endometriosis associated with fertility-related needs, absenteeism, and productivity in the workforce? A scoping review

Background: Endometriosis is a chronic inflammatory condition that affects many women of reproductive age and can disrupt work participation and fertility-related care. Objective: To map and synthesize evidence on how workplace policies, organizational factors, and accommodations are associated with fertility-related needs and work outcomes among employees with endometriosis. Eligibility criteria: We included empirical quantitative, qualitative, and mixed-methods studies and economic evaluations involving employed people with endometriosis (clinically diagnosed and/or self-reported), aged ≥18 years, reporting work-related outcomes (e.g., absenteeism, presenteeism, work ability, career outcomes) and/or fertility-related work implications. Any sector/country was eligible; full-text publications were required. Sources of evidence: PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, and CINAHL were searched from inception to 29 July 2025, supplemented by Google Scholar (first 200 results) and targeted searches of organizational repositories (including, but not limited to, WHO, ILO, and EU-OSHA). Charting methods: Two authors independently screened titles/abstracts and full texts. Two reviewers independently charted data using a piloted form capturing study characteristics, workplace context/policies, accommodations and disclosure practices, and work and fertility-related outcomes; discrepancies were resolved through discussion, with third-reviewer adjudication when needed. Findings were summarized through descriptive mapping and narrative synthesis across three domains (workplace environment/policy; economic/productivity; health/fertility). Results: Twenty-eight studies were included. Evidence indicates endometriosis is associated with higher absenteeism and presenteeism and may constrain career progression. Flexible work arrangements, leave options, and supportive leadership were linked to better symptom management and retention, but implementation was inconsistent. Economic studies reported substantial indirect costs and productivity losses. Evidence directly linking workplace conditions to fertility-related outcomes was limited and was reported mainly through treatment logistics, leave needs, and job-security concerns. Key gaps include limited intervention evaluations, inconsistent measurement, and under-representation of diverse occupations and regions. Conclusions: More consistent workplace accommodations and supportive organizational practices, aligned with timely clinical pathways, may help reduce productivity losses and better support fertility-related needs. Future research should evaluate policy implementation and interventions using validated outcome measures and should more directly investigate the workplace–fertility interface.