Every HR and Benefits leader knows that unmanaged health conditions cost money. But most organisations are significantly underestimating just how much.
The visible costs, the sick days logged, the roles rehired, the exit interviews filed, are only part of the picture. The larger, harder to measure costs are hiding in plain sight. In the manager who is not performing at full capacity. In the senior woman quietly considering her options. In the man who has not told anyone he has been struggling for months.
When you add it all up, the numbers are not just significant. They are impossible to justify ignoring.
Poor workplace health costs UK employers an estimated £85 billion every year. The average employee takes 7.8 days off sick annually, but that average masks enormous variation across different workforce demographics and health conditions.
What the headline figures do not show is how much of that absence is driven by conditions that are entirely addressable with the right support in place.
Period pain alone causes absence for 23% of women in the last six months. Menopause symptoms, including brain fog, insomnia, anxiety and physical changes, are a leading driver of absence among women aged 45 to 55, one of the most experienced and highest-performing cohorts in any organisation. 1 in 4 women say menopause has had a negative impact on their working life. Fertility treatment, which involves frequent clinic appointments, physical side effects and significant emotional strain, affects more employees than most HR teams realise, with 1 in 6 couples in the UK experiencing fertility challenges.
Men are not immune either. Low testosterone affects 40% of men and is directly linked to fatigue, low mood and reduced cognitive function. Men are also significantly more likely to delay seeking help, meaning conditions that could have been addressed early are instead left to escalate. The result is absence that arrives without warning and lasts longer than it needs to.
The organisations reducing absence most effectively are not doing it through absence management policies. They are doing it by removing the barriers to early support.
Absence figures are the tip of the iceberg. Below the surface, presenteeism is costing employers two to three times more.
Presenteeism is employees showing up while managing a health condition that prevents them from working effectively. They are at their desks. They are in meetings. They are technically present. But they are not performing at anywhere near their potential.
The total cost of presenteeism to UK employers is over £21 billion annually. That figure dwarfs the cost of absence and it barely features in most organisations' workforce health conversations.
The conditions driving presenteeism are the same ones driving absence. Menopause-related cognitive symptoms affect concentration, memory and decision-making. Fertility stress is associated with depression in 90% of people going through it. Perinatal mental health problems affect 1 in 5 women and frequently go undiagnosed and unsupported. Men dealing with low testosterone, stress or unaddressed physical health conditions are less likely to flag the impact on their performance and more likely to simply push through.
Pushing through has a cost. It shows up in slower decision-making, more errors, lower output and reduced leadership effectiveness. It just does not show up on an absence report.
Recruitment is one of the most significant costs a business carries. The average cost of replacing an employee in the UK is estimated at between 50% and 200% of their annual salary, depending on seniority. Losing a senior leader or specialist can cost significantly more when you factor in lost knowledge, team disruption and the time to hire and onboard a replacement.
And the conditions driving attrition are specific, predictable and preventable.
Women aged 45 to 55 represent some of the most experienced talent in any organisation. Yet according to the Fawcett Society, 10% of women have left a job specifically because of menopause symptoms, and a further 14% have reduced their hours. That is not a diversity statistic. That is a capability and pipeline problem sitting inside your current workforce right now.
The fertility picture is equally stark. 1 in 6 couples in the UK experience fertility challenges. The physical demands of treatment, the emotional weight of uncertainty and the practical reality of clinic appointments during working hours all affect performance and attendance. Yet most organisations offer no specialist support whatsoever. With the UK fertility market growing and employee expectations rising, this is fast becoming a deciding factor in where talented people choose to work.
Pregnancy and early parenthood is another critical attrition point. Research from the Equality and Human Rights Commission found that around 54,000 women a year lose their jobs as a result of maternity discrimination. The signal this sends to your workforce about whether the organisation values people through life's biggest transitions is not subtle.
At British Airways, one Peppy user put it plainly: "Perimenopause forced me out of a job I'd been devoted to for years. There was simply no support. Now that I'm back at BA, I can see how Peppy would have changed everything. If they'd been here the first time, I wouldn't have left."
That is one person. Multiply it across a workforce of thousands and the cost becomes extraordinary.
Beyond the direct people costs, there is a growing legal and regulatory dimension that HR leaders cannot afford to overlook.
Employment tribunals citing menopause as a contributing factor have tripled over the past few years. Cases have succeeded on grounds of disability discrimination, sex discrimination and failure to make reasonable adjustments. The reputational damage from a tribunal, quite apart from the financial cost, is significant and increasingly public.
The Employment Rights Act 2025 raises the bar further, increasing employer obligations around employee wellbeing and making it harder for organisations to demonstrate they have fulfilled their duty of care without evidence of proactive, meaningful support.
This is no longer purely an HR conversation. It is a board-level risk conversation.
Most organisations have something in place. An EAP. Private medical insurance. Perhaps a mental health first aider programme. These are not without value, but they share a structural problem: they are designed for people who have already reached a crisis point.
EAP usage rates sit between 3% and 5%. The average NHS wait for mental health support is over 18 weeks. Private medical insurance often excludes pre-existing conditions and requires GP referrals that create their own delays. Mental health first aiders are trained to signpost, not to provide clinical care.
The gap between when someone starts struggling and when they actually receive meaningful support is where the costs accumulate. Absence, productivity loss and attrition are not the problem. They are the symptom of a support gap that standard benefits were never designed to close.
The organisations seeing the strongest returns on health investment share a common approach. They are investing in specialist, clinician-led support that reaches employees earlier, covers the specific conditions driving the highest costs and removes the friction that stops people asking for help.
The results are measurable. Menopause-related work impairment drops by 15% within 90 days of specialist support. Severe menopause symptoms reduce by 58% at 180 days. Employees with access to proactive specialist care are significantly less likely to take time off.
The Nuclear Decommissioning Authority, after implementing specialist health support, was direct: "The cost of the service is insignificant compared to what we spend on absence. It's one of the most effective interventions we've put in place."
Dave Dixon, their Health, Safety and Environment Manager, did not frame this as a wellbeing investment. He framed it as a financial one. That framing matters when you are making the case internally.
The data on absence, attrition and productivity loss is not new. What is changing is the expectation that HR and Benefits leaders will act on it, and the consequences of not doing so.
The organisations that get ahead of this are not spending more. They are spending more precisely. Investing in the right support, at the right life stages, delivered by specialists who understand what employees are actually going through.
The cost of doing nothing is no longer theoretical. It is sitting in your absence data, your attrition figures and your productivity reports right now.
Want to build the internal case for action?
Download Building the Business Case for Employee Health, Peppy's guide for HR and Benefits leaders. It gives you the data, the framing and a standalone internal briefing template ready to share with Finance, Legal and senior leadership. Everything you need to turn the numbers into a decision.
Or book a call with Peppy to see how specialist, clinician-led support reduces absence, improves retention and delivers measurable outcomes across your workforce.
What is the cost of employee absence to UK employers? Sickness absence costs UK employers an estimated £9 billion every year. The average employee takes 7.8 days off sick annually, but the true cost is significantly higher when you account for presenteeism, which costs employers two to three times more than absence and is estimated to cost UK businesses over £15 billion annually.
What health conditions cause the most workplace absence? The conditions driving the highest levels of absence include menopause, women's health conditions such as endometriosis and PCOS, perinatal mental health problems, fertility challenges and men's health conditions including low testosterone and stress. Many of these conditions go unsupported in the workplace because standard benefits are not designed to address them.
How does presenteeism differ from absenteeism? Absenteeism is when employees do not come to work due to illness. Presenteeism is when employees come to work but are not able to perform effectively because of a health condition. Presenteeism is significantly harder to measure but costs employers two to three times more than absenteeism, making it one of the most underestimated costs in workforce health.
Why are women leaving the workforce and what can employers do about it? According to the Fawcett Society, 10% of women have left a job specifically because of menopause symptoms and a further 14% have reduced their hours. 54,000 women a year lose their jobs as a result of maternity discrimination. Employers can reduce this attrition by providing specialist, proactive health support at the key life stages driving these decisions, including fertility, pregnancy and parenthood and menopause.
What is the legal risk of not supporting employee health? Employment tribunals citing menopause as a factor have increased by over 44% in recent years. Cases have been brought on grounds of disability discrimination, sex discrimination and failure to make reasonable adjustments. The Employment Rights Act 2025 further raises employer obligations. Organisations without demonstrable, meaningful health support at key life stages face growing legal and reputational exposure.
How can HR leaders reduce absence and improve retention? The most effective approach is early, specialist support that reaches employees before health conditions escalate. This means removing friction from access to care, providing clinician-led support across key life stages and creating a culture where people feel safe seeking help. Organisations using Peppy see menopause-related work impairment drop by 15% within 90 days and employees are significantly less likely to take time off.