Introduction
Endometriosis is an invisible chronic disease but this handicap affects about one in ten women of childbearing age (INSERM, n.d.). Despite its high prevalence, the disease isn’t widely broadcasted and the associated gynecological pain can be normalized by family, friends and health professionals, confused with simple menstrual pain. The difficulties are plentiful and lead scientific literature to examine the quality of life of women with endometriosis. Furthermore, endometriosis reduces quality of life in a wide range of field, with a significant psychological impact. However, this literature review will focus mainly on the professional difficulties met by women with endometriosis. Indeed, many studies highlighted impacts on women’s daily life, but few studies are interested in quality of work life. The pathology sometimes widen the inequalities that women experience in their career, which justifies the interest for this subject. Jobs and organizations are often unable to offer working conditions adapted to chronic pain, so, endometriosic women excluded of the labour market. It seems important to investigate this inadequacy in order to identify the factors which weaken employment and to reflect on the improvement possibilities in order to enable women with endometriosis to take part in their jobs effectively.
What is endometriosis?
Endometriosis is a chronic inflammatory disease affecting the female reproductive organs. This disease is characterized by the growth of endometrial tissue (endometrial glands and stoma) outside the uterine cavity (Bourdel & coll., 2020). It’s a diffuse disease and any part of the body can be affected, the pelvic region being the most affected (Victory & coll., 2007 cited by Wenger & coll., 2009). Women with endometriosis may be asymptomatic or have a variety of symptoms such as chronic pelvic pain, dysmenorrhoea, dyspareunia and infertility (Bourdel & coll., 2020). In advanced forms, symptoms can be digestive disorders, urinary disorders and chest disorders (Chanavaz-Lacheray & coll., 2018). However, suffering isn’t always perceived as a pathological phenomenon because it’s normal to have a stomach ache during menstruation (Chanavaz-Lacheray & coll., 2018). Yet, pain is regularly presented as a central and destructive feature of endometriosis and several studies report a negative correlation between pain and quality of life (Sepulcri & do Amaral., 2009; Nnoaham & coll, 2011; Souza & coll, 2011; Tripoli & coll, 2011).
Psychological effects of endometriosis
The chronic pain and sense of incomprehension that patients may felt have a significant psychological impact (Leroy & coll., 2016). Moradi & coll. (2014) demonstraded that most women experienced feelings of anger, uncertainty, weakness, helplessness, hopelessness, defeat, disappointment, frustration, and exhaustion. They demonstraded a negative effect of the disease on their self-esteem and self-confidence. In addition, several authors highlighted the endometriosis impact on the social life of women. Petrelluzzi & coll. (2008n cited in Culley & coll., 2013) noticed that women with endometriosis and moderate chronic pelvic pain had lower quality of life on the social functioning dimension than a control group. Gilmour, Huntington and Wilson (2008) reported a reduction of social activities due to pain, fatigue and anxiety feeling during pain phases. The social difficulties experienced by women with endometriosis can extend to employment. The disease invisibility can have consequences on work relationships, and leads researchers to questioning about the quality of work life.
Quality of work life and endometriosis
The endometriosis symptoms seem to be a private matter, which makes it difficult to disclose diagnosis in the workplace. The feeling having to hide illness will have an impact on the quality of work life for these women. Indeed, women with endometriosis feeling physical pain that can be disabling during performance of their professional activities and the lack of understanding by their colleagues and superiors makes it difficult professional fulfillment. But, endometriosis consequences on work doesn’t concern only social aspect. In fact, the jobs unsuitability for people with a chronic disease leads to obvious difficulties to execute their tasks. Fourquet & coll. (2011) noticed a loss of working time due to endometriosis symptoms (average loss of 7.41 hours over seven days), with patients losing an average of 13% of their working time. In addition, a significant proportion of participants report that symptoms would significantly affect their work productivity. Gilmour & coll (2008) found that many women couldn’t manage full-time employment due difficulties to take sickness leave and work environments that not designed for their needs. Endometriosis can also have a significant impact on the career development opportunities of patients. Indeed, women with endometriosis are less likely to be promoted or to receive a bonus for excellence (Fourquet & coll., 2010). The willingness of women with endometriosis to work, despite the symptoms, question the need to adapt jobs. Indeed, already victims of their pathology, they are often victims of a labour market rejection (forced or chosen) which stems from inadequacy between their pathology and their employement. Yet, work can be a powerful social and resilience tool facing of the disease. It seems important to put these women back at the heart of problem, and to try to understand it from the inadequacy of employment for people with chronic disease. We must seize the opportunity to break up idea, integrated by the women with endometriosis themselves, that they are unfit and strive for improving the working conditions for better professional fulfilment.
Conclusion
In this paper, a review of the literature presented the endometriosis impact on the women life. This disease has a global impact on their life, affecting their social life, their relationship and their professional life and lead to significant psychological distress. The psychological distress felt by these women is widely reported for the personal and intimate sphere of their lives, but isn’t very exhaustive for the professional sphere. However, previous results showed importance to study the subject of chronically illness women and their relationship with their jobs. The authors clearly highlight the difficulties that women with endometriosis meet in the workplace and the need to make this a public health issue.
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