The cost of endometriosis, with Sanju Pal

[00:00:00] I'd been told the day before by a radiologist that I had a cyst, an endometrioma, on my ovary the size of a Coke can, and that I needed to see someone immediately. You're listening to a woman called Sanj Singh, and that urgent situation was a diagnosis of endometriosis. Sanju went on to see a gynecologist.

[00:00:27] Although as I talk about this, I'm getting sweaty palms, I can see Dr. O'Karro sitting there. You're gonna laugh, but I think I treated it as if I was walking into a client's room. And actually this is something he said to me later, he's like, blimey, the way you spoke to me. He was like, I felt like I was, you know, definitely speaking to a management consultant. And that's because Sanju was a management consultant for a company called Accenture.

[00:00:52] She had worked there for nine years and was considered a high-performing employee. And even then, all I could think about was, oh, I hope I'm gonna be okay because I'm meant to be on a really demanding client project that's gonna help me get to the next promotion level. But it was when I met my gynecologist, Dr. Kemi Doll, who, you know, I think the world of has kept me alive.

[00:01:18] When I said to him, it's really important that this doesn't interfere with me and my ambition and career trajectory. And he said, let me be clear. You are unwell. You have a very serious condition. And at the moment, your uterus is at risk of torsion, of twisting. You need to have immediate surgery.

[00:01:45] Can you imagine I was sitting in front of a doctor and I was still talking about trajectory to promotion to senior manager? At the time when it was this moment of, I'm so uncomfortable to have to tell my workplace that I'm going to need time off for surgery and I don't know how long I'm going to be off sick. Isn't it extraordinary that I wouldn't want to put my body first?

[00:02:11] That visit to the gynecologist happened eight years ago in 2018. And it was a moment where Shanju started to come to terms with debilitating endometriosis. She was diagnosed with stage three endometrioma and she did end up telling her employer and asking for time off for surgery, but then coming back to work far too soon.

[00:02:37] Quite quickly, I had to go back off sick again. I started bleeding every single day. I was unable to cope physically and mentally. Not long after that, Shanju Paul was dismissed from her job at Accenture due to what the company called poor performance. But she didn't leave it at that. She took her case to not one, but two employment tribunals in the UK.

[00:03:04] And in January of this year, 2026, Shanju's story made the news. To one woman's story about the impact endometriosis has had on her life. Shanju Paul was dismissed from her job at global consulting firm Accenture in 2019. Shanju Paul had a seemingly brilliant future. She'd set up a charity, had met the late Queen Elizabeth and been invited to 10 Downings.

[00:03:28] We heard how Shanju Paul was sacked after taking time off work for surgery to treat the condition. Since then, many more women have come forward to tell us their health journey. A woman who was sacked by her employer after having surgery for a chronic health condition has won a landmark case at an appeals tribunal. The verdict of the Employment Appeal Tribunal came back last week, ruling in her favour. Her story, in fact, made it all the way to the British Parliament. ...today fought and won.

[00:03:56] I don't see her fight for justice as a victory just for herself. It's for the countless women across the country who talk about their medical health conditions in the workplace, but are ignored. This is Overlooked and I'm Golda Arthur. This is an episode about endometriosis at work. And I talk to Shanju Paul about endo as a disability, losing her job and advocating for herself for the last seven years.

[00:04:24] We have an emotional and honest conversation. What did this transform in you? And what was the cost? Goodness, you don't ask the easy questions, eh? There's a backstory to this episode and you can learn more about it in the Overlooked newsletter. It also has more information and resources on endometriosis, and you can sign up for it at the link in our show notes.

[00:04:53] My conversation with Shanju Paul is coming up in just a minute. Are you curious about what it's like working in healthcare today? Do you believe in the power of storytelling? I'm Dr. Emily Silverman, the host of The Nocturnist Podcast, where healthcare workers share personal stories of joy, sorrow and self-discovery.

[00:05:14] Each episode, whether a compelling performance from one of our live shows, an intimate series of audio diaries from one of our documentaries, or an engaging conversation with guests such as book authors or filmmakers, aims to connect, provoke and inspire. Learn more at thenocturnist.com or subscribe to The Nocturnist wherever you get your podcasts. Welcome to the show, Shanju.

[00:05:42] I'm so happy that you decided to talk to me about this because I know talking about this is not easy. Yeah, and I've got to say thank you to you for inviting me to be able to talk about this in the unique way that you do. Well, let's dive right in here. What is the most overlooked aspect of what we're going to talk about today?

[00:06:07] I, in many ways, I have too many things I could say here, but I'm going to pick something very specific. The noun is advocacy. There was a moment when I was invited to a termination meeting, very brutally, where I didn't have the skills to advocate for myself. And had I, maybe I would have kept my job. But had I, I wouldn't be sitting here talking to you right now.

[00:06:35] And if I'm delving a little bit deeper into what I mean by advocacy, because that's a word that can be very overused. But I mean it quite specifically in terms of knowing your legal rights as an employee in the workplace. And I think that's an area that women in particular can find quite scary and complex. But I say the law is there to protect us.

[00:07:00] And had I, for example, felt courage to be able to say to my employer at the time, I am being disabled by endometriosis. There is the Equality Act 2010, which means that you as an employer have to support me with legal reasonable adjustments. I might have kept my job.

[00:07:21] And so for me, advocating within the framework of the law and knowing our legal rights is something that I think has been so overlooked in the space for women with endometriosis, but indeed any condition with a gynecological source that affects women. I want to roll you back a little bit. But you were a quote unquote high performer at work. What does that mean?

[00:07:50] Oh, my God, those words meant so much to me. They still do. I'll give you a little anecdote. When I left university and I was thinking about what was I going to go on to do? I first of all did the Teach First program, this teaching qualification that I loved, scouring for different organizations. And it was the tagline of Accenture, high performance delivered that drew me in.

[00:08:13] And I still think about that high performer, high performance for me being on top of your game, being an incredible superhuman achiever, being the best at what I could be. And I mean, I'm finding it quite uncomfortable talking about this because it's almost, again, the narrative of, oh, you know, a woman that wants to have it all or is a bit overambitious. But that was kind of me.

[00:08:41] I was running my charity that I set up off the back of doing the Teach First program as a side hustle on top of a full time job as a management consultant. That's how much, rightly or wrongly, high performance meant to me. So tell me about walking into your gynecologist's office and what was going through your mind.

[00:09:02] It was strange because it was the first time I'd been to a medical room where there was, you know, a curtain for him to be able to do the scan in that same room next to where he sat at the desk where he was talking to me as if he was my client and I was a management consultant. And I think very quickly, that's the thing, it felt quite quick. He was like, right, let's get you on the bed and let's do this scan. And it was like, oh, it's an invasive scan. So it was the first time I'd had a transvaginal scan. It's pretty ick, not pleasant, right?

[00:09:31] Over the past now seven and a half years since I've been diagnosed with this condition, the number of transvaginal scans I've had to have, I just have to suck it up and get on with it. But it is horrid. But I don't get to talk about that really ever. And actually it makes me think of how much, you know, within women's health and anyone struggling with a health condition, how much we have to go through these procedures, how traumatic they are.

[00:09:56] But we don't even get the time and space to think about what that's doing to us. We just do it. It's transactional. Move on. Get the outcome. So after he's finished, you know, and I'm coming back to sit opposite him again after he's just done this transvaginal scan and he's like, you have endometriosis. And this is where, you know, language and terminology starts coming out and endometrioma and urgent surgery and torsion. And it was, it was difficult.

[00:10:24] When he told you that and you realized you're there, you're telling him, listen, work is work. Like I got to do work. I have a job. I'm a high performer. I've got to keep performing high. And he's like, no, no, no, no, no, no, you don't understand. When did the penny drop for you that work was not going to be work anymore?

[00:10:45] Oh, God, it's so sad. It was after I had pushed myself to go back to work. I had a month off sick. It was getting to that point where it was like, if I don't go back to work now, I'm going to lose this opportunity to be the lead of this huge inclusion and diversity project, which I thought would be the springboard into the next promotion point.

[00:11:09] And I would struggle into the office. And when I mean struggle, I mean, I was walking at snail's pace, because I was in so much pain. And I was so fatigued.

[00:11:26] And quite quickly, I had to go back off sick again. I started bleeding every single day. I was unable to cope physically and mentally. And I realized, God is giving me sad. I couldn't be a high performer. I'm sorry.

[00:11:52] And I think it's so interesting to talk about this in a way that I haven't before, I'll be honest. I kept pushing myself until then. I still believed. I still believed that there was nothing wrong with me. I'm absolutely fine. I can still do what I used to do. But my body was telling me otherwise.

[00:12:17] And so, yeah, I went back off sick. And it was the turning point for me in terms of my realization. But it was also a turning point for my employer in terms of them realizing, uh-oh, I wasn't really a safe pair of hands anymore.

[00:12:35] I was off sick again for about six weeks. And then I came back to work on a phased return, a very generous phased return of just over two months. And, you know, feeling really supported by the organization. They're easing me in this time. It was quite clear that last time was a shock to the system. But this time I'm coming back phased and I'm going to be okay.

[00:13:00] But then hearing on a Monday that I had been awarded a not-progressing rating. This can't be right. To have a not-progressing rating and then be invited to a meeting where, in the letter it said, you may be dismissed.

[00:13:19] I can remember that moment. Thursday the 6th of June, 2019. At my desk and an email pops up. Invitation to meeting. So complete shock. Complete horror. I was so angry as well as upset.

[00:13:44] Shandra was terminated from her job at Accenture in 2019 after almost 10 years at the company. She lost an internal appeal and then decided to take her case to an employment tribunal. In 2022, the tribunal ruled in her favor in terms of unfair dismissal, but didn't award her any compensation. She appealed that decision and the case went to a second tribunal called the Employment Appeal Tribunal.

[00:14:11] Finally, in January of this year, 2026, the tribunal ruled in her favor seven years after she lost her job. You know, I lent on what I know best, which is you have to fight for your rights. And that's not something that's come just from, you know, running a charity to address educational disadvantage in rural parts of India and deprived parts of the UK.

[00:14:38] That comes from, I think, being a second generation immigrant that has had a very humble upbringing. You have to fight. You have to fight at every moment. And I'm lucky that I've had my parents who've all my life taught me to use my voice. And that's the only thing I thought was my alternative. I have to use my voice here. This is not fair. That's the thing that's kept me going.

[00:15:06] Even on days where, you know, it seems insurmountable. I was so scared about what the outcome was going to be, what lies ahead for me. But I must fight. But I must. I'm losing my job. I think that's the thing that's kept me going. This seven-year journey that you've had is an emotional rollercoaster. It would have been. It still is an emotional rollercoaster. We've talked about shame and we've talked about anger.

[00:15:36] Was there a moment where what you just said, like, you were afraid to speak up, but at the same time you were compelled because the injustice sat so badly within you? Was there a moment that crystallized that? I think the one that stands out to me, it's almost a combination of two moments that connected. So I did have a nine-day hearing in May 2022.

[00:16:04] I was on the stand for two days giving evidence. And I'll be honest, I felt that kind of freedom to say, this is my truth. I'm on the stand saying my truth and it felt amazing. That's that piece around using your voice for tangible change. But then we got the verdict. We got the judgment. And it was horrific. But then I got heard. And in that moment where we were leading up to this appeal hearing in September 2024,

[00:16:35] it was the first time that me and my family realized that we had spent our family earnings on this case and we couldn't do it anymore. And I turned to a platform called Crowdjustice and I wrote my story for the first time and I shared my story for the first time. So concurrently, I had a moment where I was afraid, but I couldn't let that fear stop me anymore

[00:17:03] from sharing what had been going on for me for the previous five and a half years. And at the same time, I had the opportunity to go into an oral hearing at the Royal Courts of Justice in London and speak my appeal. And that for me was probably one of the most important points in this journey because it was suddenly like the empowerment that had been kind of lying dormant.

[00:17:32] It was there, obviously, because it was what was pushing me through every hurdle. But suddenly it was out there in the open and I felt it. And it was sort of the beginning of what has then been the most extraordinary experience for me personally, but also connecting with so many women. So fear mixed with blind faith and optimism for the truth and justice.

[00:17:56] You know, your case has been called a landmark case and it's been in the news in the UK and in so many other places. Anybody who sets a precedent, who kind of leads the wave of change, you know, we use these phrases, right? You transformed something, basically. What did this transform in you? And what was the cost of that transformation?

[00:18:25] Goodness, you don't ask the easy questions, eh? No, I don't. Um, first of all, this word landmark started being used and it's like, what does that actually mean? So I just want to, you know, pick that apart because it's so important. It comes back to the first thing I said about advocacy and I've learned so much about the law over the past seven years.

[00:18:52] And I also put myself through a master's in law because I was so convinced, having worked with my lawyers so closely at every stage, that I might be a solicitor one day. So landmark means that in the high court, it is the first time that this issue, this legal aspect is being brought up. And it's landmark actually on all three points.

[00:19:19] So the fact that you can win on unfair dismissal, but you have your compensation reduced without any evidence to show that you would have been dismissed anyway. This up or out model is actually not legal in relation to the Employment Rights Act in this country. No one's challenged that before. And then the third, endometriosis as a disability.

[00:19:43] So it means so much more when you kind of unpack what that means in terms of a person, a woman on her own, taking that to court and it getting to high court and having gone through seven years and then actually winning. And it's not easy. Oh, my goodness. The amount of paperwork I've had to sift through and I sift through everything. I read everything.

[00:20:12] We had a bundle that was over 3,000 pages. You know, my witness statement was 150 pages. I say this because it's like, I don't think you get the word landmark without doing the work, without really fighting for something in a way that it could be quite unimaginable to some people. I'm so honoured that the people and the community and the support around me has enabled that. But what does that mean now?

[00:20:38] Well, setting legal precedent has really been this motion for change in the UK and perhaps a ripple effect globally as well, just from women who've connected with me, also from the US, which is what I was saying before around. You now have a tangible, legal document that's binding on employers in this country that you can use to advocate for yourself.

[00:21:03] And I'm not sure that I thought that that would be what would happen one day. I think it's so much about being heard and being seen. This is what I'm getting from women who write to me. And there's no greater gift than empathy and solidarity from women. My endo sisters and endo warriors who have just held me literally through the past, in particular, three months,

[00:21:31] because it's what's come with this landmark ruling is a roller coaster of emotions and actions. And, you know, not just being on TV and radio, but getting the chance to go to Parliament and turn this landmark case into something that is going to help positively change legislation in this country.

[00:21:57] I want to draw us to a close and ask you, what if you met someone who was the version of you that walked into that gynecologist's office that was like, hello, I have work to do, like I can't really take time off for a uterus. What would you say to someone like that now?

[00:22:21] I would say I really understand where you're coming from. Because your entire world up until now has been focused on trying to perform and to achieve and be the best you possibly can in the workplace. But of course, the most important thing is you and your health. And we have a society that has not let us as women put that first.

[00:22:49] And let me be someone to tell you that you can. I want to ask, like, how are you now? How's your health now? The honest answer is it's not very good. I'm really at the moment struggling with a flare-up. I am kind of riddled with fatigue, complete loss of appetite, discomfort.

[00:23:16] And I worry about how I'm going to get through the next day. But for the first time in over six years, I am going abroad for a holiday. And I hope that rest is going to help me for this next chapter. I know that I need to nourish my body because that's what my body is telling me. And thank you for asking me that question.

[00:23:46] Because, yeah, it means a lot. Well, thank you for sharing your story with me. And I know it hasn't been easy to go over some of these details again. And best of luck with the next steps in this journey. Thank you so much for having me. Thank you for this extraordinary conversation. Overlooked is here for information and empowerment, but not medical advice. Every person's body is unique.

[00:24:15] So if you have questions, it is best to speak to your doctor or healthcare provider. We're building a community around women's health so that no one is overlooked. If you'd like to be part of it, hit the follow button on this podcast wherever you're listening to this. Or you can show us some love by writing us a review and sharing this episode with someone. Overlooked is written and created by me, Golda Arthur. Jessica Martinez-Tijos is the show's producer.

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