"I worked really hard, went to uni and got a first, then did my masters and got a distinction. I climbed the career ladder, bought my own property, and I was working my way up to management. But then endometriosis took over my life, and work just didn't get it," says 33-year-old Bridie Apple, a former program manager in the charity sector, who now runs her own yoga business, Flow. Grow. Glow.
Like 1.5 million women in the UK, Bridie suffers from endometriosis, a condition where cells like the lining of the womb (the endometrium) are found elsewhere in the body, usually around other pelvic organs like the ovaries, fallopian tubes, bladder and bowl. It causes heavy, painful periods, chronic pelvic pain and fatigue, and can lead to infertility, as well as bladder and bowel issues.
A survey published this week by Standard Life also found that women living with endometriosis typically miss out on more than £40,000 in lost earnings while waiting for a diagnosis – which takes 7.5 years on average.
"There's just no understanding in the workplace, and it's really frustrating," Bridie says. "The financial side of women's lives with endo is so neglected, when actually there are some really easy solutions that workplaces and governments could put in place. For me it was either 'woman up, you're just having a bad period' or leave" – which is exactly what she ended up doing.
"I'm now self-employed, and I have to manage my work so that every other day I can rest and recover from the previous day," Bridie explains. "I still don't always succeed – just the other week I was bent over in agony and had to cancel some yoga classes," she adds.
27.year-old Saschan Fearon-Josephs, a project manager in the third sector, also suffers from endometriosis, and says she's always been upfront with employers about her condition and the adjustments she needs to help her do the best possible job. But, when Saschan required two operations in close succession, an unsupportive chief executive in her previous job ultimately used her ill health to push her out.
"They basically took a health condition that I have absolutely no control over and weaponised it against me. They didn't want someone sick working for them," she says. "It was such a tense situation for 12 weeks after I returned to work that it really impacted on my recovery. Instead of getting better after surgery, my endo symptoms were progressively getting worse. I felt so empowered walking out in the end, because I was just fed up with it."
This experience was the catalyst for Saschan taking a new direction with her side business, The Womb Room, which now runs training workshops with companies to educate them about supporting their employees' menstrual and reproductive health.
And endometriosis isn't the only menstrual health issue holding women back in the workplace. A 2015 survey found that women in the UK take 17 million sick days a year because of PMS, and a third of women take at least four sick days a year because of severe discomfort related to their period.
In 2017, another survey revealed that heavy, painful periods account for more than five million sick days each year, costing the British economy £531 million. And both surveys said – unsurprisingly – that the majority of women were too embarrassed to disclose the real reason to their bosses.
For 26-year-old product manager Jilly Neckar, heavy menstrual bleeding (HMB) has directly dictated her career path. Her periods last between 14 and 22 days at a time, and she has to change her tampon and pad as much as once an hour.
"I used to be very good at swimming and actually trained as a lifeguard, but it would have been impossible. I needed to be sat down and to have the flexibility to get to the toilet when necessary, so it definitely drove me towards an office job," she explains. "I know someone with HMB who worked in a shop – she would be bleeding through but wasn't allowed to take breaks to go and change."
In her previous job as a management consultant, Jilly adds: "sometimes I'd be sat in meetings and feel myself leaking, but you can't just walk out of a meeting to change your pad so I'd have to sit there with that horrible feeling, and then the embarrassment of standing up at the end and being covered in blood."
Clare Knox is a business psychologist, who founded consultancy See Her Thrive to raise awareness of menstrual and reproductive health issues in the workplace. She personally lives with pre-menstrual dysphoric disorder (PMDD) – a severe form of PMS that, in its most extreme cases, leaves women feeling suicidally depressed for days or even weeks each month.
"It's thought that around 80 per cent of women will experience unwanted symptoms associated with their menstrual cycle, from heavy bleeding to premenstrual migraines," Clare says. "Many women also live with menstrual and reproductive health conditions – like PMDD or endometriosis – which can have a significant impact on their mental health and wellbeing," she adds.
As a result of the stigma around menstrual health, Clare explains, many women suffer in silence at work, and feel like they have to compensate for lost productivity caused by their period or a related health condition. "Research has shown that this results in women over-working during their 'good' days, which in the long-term can lead to burnout," she says. "However evidence also suggests that, with supportive managers and workplaces, women feel more able to cope."
The trouble is, bosses are often totally clueless. Emma Cox, CEO of charity Endometriosis UK originally trained as a manager and says: "as a manager in the 80s and 90s, I was always told that if someone's taking a day off once a month, they're probably skiving. Hidden conditions like endometriosis are just not understood."
But there are things employers can do to help, and some are already making small changes – from menstrual leave for those who need it, to providing free tampons and pads in the office toilets, as well as policies around flexible and home working, and workspace adjustments.
"It's really important to create an office culture where staff and employers can have these open conversations, and ensure women know what they're entitled to ask for," says Saschan. "It's in the interests of companies' productivity, as well as their staff's wellbeing, to invest in adjustments that support menstrual health in the workplace.