Mental Health During and After Pregnancy

Mental Health During and After Pregnancy

We live in a society that considers itself progressive and open-minded yet when it comes to female health, there still exists a number of loopholes. Endometriosis is one such condition that is often talked about but seldom acknowledged. Women with endometriosis share similar experiences and discrimination, particularly in their workplaces. Despite the growing awareness, they often find it difficult to express their symptoms to their employers.

Do you find navigating chronic conditions such as endometriosis difficult in your workplace? Does it feel awkward to talk to your employer for a few days off because of the pain? If this sounds like something you may struggle with, you’re at the right page.

The pain of Endometriosis can vary from woman to woman, and it can be disabling. Because endometriosis can affect your quality of life and keep you from working effectively, it’s important to know some helpful strategies to bring up the topic at your workplace.

How Endometriosis Can Affect Health and Quality of Life

Endometriosis is a chronic condition where the normal uterine tissue grows in places beyond the uterine cavity. Studies estimate that this condition affects as many as 10% of premenopausal women worldwide.

Endometriosis can develop at any age after puberty, but it is more common in women between 25 to 40 years. The pain of endometriosis is cyclical and connected with your menstrual cycle. Changes in oestrogen levels are responsible for the pain that comes with endometriosis.

The degree of pain severity can vary but many women describe the pain of a disabling cramping and twisting quality. Endometriosis also usually results in longer and heavier menstrual bleeding, and may overtime, cause depression, fatigue, and fertility issues.

Because of the multitude of effects endometriosis can have on the body, this chronic condition can take a toll on your quality of life. The pain can restrict you from functioning optimally and this can reflect in your work as well.

That’s why in order to cope with endometriosis and its symptoms, women are encouraged to be vocal about their symptoms to their supervisors at work.

Should I Tell My Employer That I Have Endometriosis?

The decision of telling your boss about your health condition is entirely yours. Many women debate whether telling their employers about their endometriosis would do them any good. Although your autonomy is important, it’s also a good idea to consider the benefits of informing your employer of your condition before you make the final decision.

If the cyclical pain of endometriosis is clearly affecting your health and quality of life, you should consider opening up to your colleagues and boss about it. Sometimes the pain from endometriosis can become severe and this can lead to a rapid deterioration of your health. If you have already informed your colleagues of your endometriosis and if this unfortunate event occurs at your workplace, they can respond appropriately and provide you with the help that you require.

Endometriosis can also have an impact on your work quality. If you feel that your chronic condition is affecting your ability to work safely, you should consider talking to your boss about it. Sometimes the pain can cause you to become distracted from your job; other times the pain and fatigue could be harmful to other people as well.

That’s why being proactive about your chronic illness is always preferable and should be encouraged.

How Do I Bring Up the Fact That I Have Endometriosis To My Employer?

Talking about reproductive health issues, be it endometriosis or any other condition, is always difficult for any woman. Many women are hesitant to open up about their chronic condition out of the fear of being judged or not fully understood. The symptoms of endometriosis can only be understood by the patient and no one else which is why oftentimes employers and colleagues turn out to be less supportive than you’d want them to be.

One way to speak your boss about endometriosis is to make your conversation as articulate and coherent as possible for them. Because many men and even women do not fully understand what endometriosis feels like, it’s a good idea to provide research-based evidence to your employer to strengthen your case if need be. You can help them understand more about endometriosis by directing them to sources such as the Syrona ELSA app, brochures, and relevant charities, or the Syrona Femsights blog. In addition, you can also get a medical certificate made by your GP about your condition.

You should also be honest and answer any and all questions that your employer may have regarding your symptoms. However, this does not mean you’re required to share any more personal information than what it required to help your employer understand endometriosis. Remember to explain to your employer how endometriosis can potentially affect your work as well.

While you’re having this conversation, you should try to discuss options that could potentially help you. This includes discussing flexible working options or getting paid sick leaves.

Who Should I Speak With About My Endometriosis?

Any chronic health condition such as endometriosis is extremely personal and should only be communicated to the right person in charge. Depending on your workplace management team, you may speak about your condition with the line manager or the HR manager. If your office happens to have a health and safety team, you should talk to them instead. Generally, someone higher up in the organisation should be informed.

If your company has an External Employee Assistance Program, you should try reaching out to them for support and help. Similarly, you can also seek assistance from Citizens Advice Bureau UK, your union council or specialist employment attorneys.

Unless you’re comfortable discussing your condition with a fellow colleague, you need not disclose any personal information to them as long as your supervisor has been informed.

What About My Privacy?

It is unethical to disclose an employee’s personal medical records or conditions be it endometriosis or any other health problem. In fact, disclosing confidential information without the patient’s consent is considered unlawful and can be challenged in the court.

If you have concerns about your privacy, rest assured that your employers do not have the legal right to share your personal medical information to anyone without your approval. You can also make your privacy wishes clear to them.

Returning to Work Post Surgery

The severity of endometriosis can vary from person to person. Sometimes the symptoms of endometriosis are too vague and difficult to diagnose without surgery. In this case a diagnostic surgery may be required. Other times, a therapeutic surgery may be needed to remove diseased tissue. Whatever the reason for surgery is, the post-operative period is never pleasant, and returning to work immediately after surgery can be tough.

The best way to go about it is to have your health care provider or surgeon sign provide a written guidance or a medical certificate that clearly outlines the time off you need from work to allow your post-op body to heal. The letter should also include a list of approved duties or job modifications once you can safely return to work. Any movement restrictions should be informed to your employer.

In order to get a comprehensive letter written, you should provide your doctor with an advance directive to avoid any inconvenience later on.

Can I Be Sacked Because I Have Endo?

According to the law, workplace discrimination based on health conditions is not permissible. You can not be fired for having endometriosis or taking time off because of the pain or the treatment. This would be considered an unfair dismissal.

It is always encouraged to talk to your employer about your rights first. However, if they are not compliant or supportive, you can take your case up with a trade union representative, Citizen Advice Bureau or get legal advice from Civil Legal Advice.

What If My Employer is Behaving Badly?

Unfortunately, sometimes the employer way not be responding appropriately to you and your health. If this is your case, you may seek legal aid regarding discrimination against or harassing a person in their employment because of a disability. The Anti-Discrimination Law clearly outlines the repercussions of such an unfair treatment


Endometriosis is not always an easy diagnosis to deal with. The lack of support at your workplace could make it even harder. That’s why it’s important to understand your rights and discuss your concerns with your employers as soon as possible. Support from your colleagues and supervisor can make all the difference in helping you deal with work-related restrictions caused by endometriosis.

For more helpful resources, download the Syrona ELSA app that can help you track your symptoms and connect with others who have the same diagnosis. You can also read informative articles about endometriosis on our Femsights blog.

Synora also offers professional online cognitive behavioural therapy services for women that require emotional and mental health support.


1.     Eisenberg, VH, Weil, C, Chodick, G, Shalev, V. Epidemiology of endometriosis: a large population‐based database study from a healthcare provider with 2 million members. BJOG 2018; 125: 55– 62.

2.     Endometriosis. John Hopkins Medicine. Available at:

3.     Endometriosis. NHS UK. Available at:

4.     Disability rights, UK. Available at:

CBT to Help With Chronic Pain Associated with Endometriosis

CBT to Help With Chronic Pain Associated with Endometriosis

What is Endometriosis?

Endometriosis happens to 1-in-10 women worldwide and it’s where lesions and endometrial-glands begin to develop outside the uterus. According to the NHS, the tissue which is similar to the womb lining starts to grow in other places, such as the ovaries. Endometriosis diagnosis often involves laparoscopic inspection of the pelvis. The typical clinical symptoms of Endometriosis can be different for each woman, depending on their age.

Some typical symptoms include severe pelvic pain, pain during sex, constipation during your period, and difficulty getting pregnant .For more information, read our blog about understanding endometriosis and its symptoms.


Impact of Endometriosis on Mental Health

A diagnosis of Endometriosis can be challenging for a number of reasons even before a diagnosis is made. According to the NHS, Endometriosis takes on average 7.5 years to be diagnosed with many women often left feeling unheard, with severe pain, and in some cases, infertility issues without actually not knowing what is wrong with them.

According to the Royal College of Obstetricians and Gynaecologists, Endometriosis can be very difficult to diagnose because every woman has different symptoms and presentations that overlap with other health conditions, such as irritable bowel syndrome or pelvic inflammatory disease.

Syrona is working with leaders of Endometriosis around the world to help reduce the time to diagnosis for women with potential Endometriosis. Click here to join the study!

According to the Diagnostic and Statistical Manual of Mental Disorders (2013), anxiety can develop when a person is feeling tensed and on edge constantly. These anxious feelings can worsen to a point where an individual may not be able to do their regular activities, such as going to work. Common anxiety disorders include generalised anxiety disorder, panic disorder and social anxiety disorder. It is estimated that there are 8.2 million individuals who suffer from anxiety .

On the other hand, depression involves feeling sad and low for an extended period, constantly. These feelings are intense, which impact daily life significantly. For example, a person who is depressed may not enjoy the activities they previously enjoyed, may isolate themselves, lose confidence, feel guilty and in some severe cases, suicidal thoughts. It is estimated that around 24 percent of women in England are diagnosed with depression – you’re not alone.

Research has shown that diagnostic delay in Endometriosis among women have led them feeling like they are not ‘normal’. Karen Ballard and colleagues showed that women were told continuously before diagnosis that their symptoms are typical, even though they were in excruciating pain. This made many women lose their self-esteem and confidence, negatively impacting their mental health. 

Research conducted in Australia showed that women who were diagnosed with Endometriosis had moderate levels of clinical anxiety and depression. These women also reported having poor overall well-being, which was worse than the general population who had other chronic conditions such as HIV. Additionally, the results also showed that women aged 25 and under had a more severe impact on their mental health and well-being due to endometriosis. This study shows suggests that mental health problems are prevalent in women who have Endometriosis, and are more severe for younger women.

Another study the factors that affect the mental health of women with long term Endometriosis. The findings from this study showed that pelvic pain, self-esteem, body esteem and emotional self-efficacy predicted the severity of mental health conditions in women. These women reported high anxiety and depression, but rumination was low for women who were in a stable relationship. This was because these women were always told that there is no cure. This made them feel hopeless and severely disheartened. However, there were some factors, such as healthier self-esteem, body esteem, and emotional self-efficacy, which correlated with improved psychological outcomes. Hence, women who have endometriosis can help reduce their mental stress by improving their self-esteem, body esteem and emotional self-efficacy.

But have you ever wondered how this could be done? Continue reading to find out!

Talking Therapies and CBT for Endometriosis

Talking therapies are a set of psychological treatments such as counselling and cognitive behavioural therapies. Here, an individual sits down with a mental health professional to talk about their concerns. The therapist listens to you and helps you come up with solutions without being judgemental. This can be a safe place for an individual to sit, cry, shout or vent who is going through mental health problems. These talking therapies can be helpful for anxiety, depression, eating disorder, and even for chronic conditions such as Endometriosis.

Cognitive-behavioural therapy (CBT) refers to a class of medicines which share the fundamental concept that cognitive factors sustain mental disorders and psychological distress. The core premise of CBT states that negative thoughts contribute to the maintenance of psychological and behavioural problems. According to Beck’s (1970) model, these negative cognitions include beliefs about the world, the self, and the future. Hence, we need therapeutic strategies to change these negative cognitions to reduce emotional distress and problematic behaviours. The overall goal for all CBT protocols is symptom reduction, improvement in functioning and remission.  To achieve this, the client becomes an active participant in a collaborative problem-solving process to test, challenge the validity of negative cognitions and, modify undesirable behavioural patterns with the help of a therapist.

CBT for chronic pain involves changing the way people view their pain. For example, CBT can change the negative thoughts linked with pain, improve coping strategies, and put the discomfort in a healthier context. Allowing people to recognise their pain, which enhances their long term well-being and function. CBT can also help change the pain related response in the brain, as it impacts brain chemicals, norepinephrine and serotonin. This, in return, makes the body’s typical pain relief response more powerful. 

Benefits of CBT in Endometriosis

CBT can be very beneficial in chronic pain treatment for endometriosis. The following are the benefits you can expect during and after your CBT session:

  1. CBT can significantly reduce your anxiety and depression symptoms: research has shown that CBT can help relieve sadness, hopelessness, stress and worry, in both short-term and long-run.

  2. You become aware of the inaccurate and negative thinking responses to pain: an individual will realise that their negative thoughts are due to a physical condition. This will help them come up with rational coping strategies, such as doing some meditation and yoga to help with the pain. Thus, the individual will not feel hopeless in pain, as they will know there is a cause for it.

  3. You learn how to respond to challenging situations more effectively: chronic pain in endometriosis is severe. Once a woman learns healthy coping strategies for such severe pain, she will be able to manage other difficult, stressful situations which may cause her distress in the future. She will also be able to control her anxiety and depression symptoms more effectively.

  4. Encourages a problem-solving attitude: women are taught to overcome their sense of learned helplessness. For example, if they think “there is nothing we can do about this pain”, CBT teaches them to think positively where they feel more in control of their pain.

  5. Helps you keep track of your emotions: CBT involves you doing a lot of homework at home, this may include keeping track of thoughts and feelings related to pain in a journal. These are then reviewed in the session to come up with coping strategies, such as breathing exercises and relaxation.

  6. Foster life skills: CBT overall teaches the client to overcome their problems more healthily. You can use these skills in other situations, for example, childbirth!

Online CBT by Syrona

Overall, the benefits of CBT for Endometriosis are limitless. However, the main one mentioned in this article is that they reduce your anxiety and depression symptoms. They provide you with new healthier coping skills for pain and foster life skills such as resilience and endurance. Furthermore, they help you keep track of your emotions which can help you in the long-run as you develop new habits such as journaling.

If you are someone who struggles with Endometriosis, reach our to our mental health professional online who can help you manage your pain. This online CBT offers can help you with your pain management, teach you healthy coping strategies and also with managing your co-morbid conditions such as anxiety and depression. It is fast, easy and convenient from the comfort of your home.


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