The last day at my old job, I couldn't make myself go in.
For months, I'd been quietly burning through sick days — more than I could explain to my manager, more than I knew how to explain to myself. I was 25, running product at a tech company, trying to build something that looked like a career while privately unraveling. Two trips to the ER. A procession of specialists. More than one doctor suggested, gently, that my symptoms were probably psychological.
Eventually, I got a name for what was happening: autoimmune disease — a condition in which the immune system turns against the body's own tissue. An estimated 50 million Americans live with one. Women account for 80 percent of those diagnosed.
We talk a lot about what holds women back at work. Caregiving burdens. Workplace bias. The penalties of motherhood. What rarely enters the conversation is chronic illness — even though far more people in the workforce are managing it than most employers realize. For many women with autoimmune disease, something else is quietly shaping their careers.
I've come to call it the autoimmune career ceiling.
Unlike the glass ceiling, this one doesn't appear in a policy or a performance review. It lives in private calculations women make alone, often without naming what's driving them. Do you take the promotion that means longer hours? Pursue the role that requires travel? Leave for a better opportunity and risk losing the health insurance you can't afford to lose?
To put numbers to what many women experience, WellTheory partnered with Wakefield Research and the Autoimmune Association to survey 250 working women in the U.S. living with autoimmune disease. The findings were stark. Seventy percent said their disease had limited their career potential. Nearly two in five had reduced their hours. Almost a third had moved to less demanding roles. And two out of three had stayed in a job they would otherwise have left — not because they wanted to, but because they couldn't afford to lose their coverage.
Each of those is a decision made in private, invisible to the people around them. A job with steadier benefits quietly wins out over one with a higher salary. A promotion becomes unrealistic when it means longer hours and more travel, and symptoms that don't follow a schedule.
What makes this so difficult to address is that autoimmune disease is largely invisible. Fatigue, chronic pain, brain fog — none of these announce themselves in a meeting. The survey found that 61 percent of women say their symptoms interfere with their ability to function at work every day or most days. Yet that same share — 61 percent — hasn't disclosed their diagnosis to their employer. Of those who haven't, most worry about being judged, seen as unreliable, or passed over, especially in competitive environments.
This is a workplace problem, not just a personal one. And once we're willing to name it, the solutions aren't complicated.
Flexibility and remote work meaningfully change the calculus for someone managing an unpredictable condition. So does a culture where disclosing a health challenge doesn't feel like a professional risk. In our work with employers at WellTheory, we've seen that when people have access to care that actually helps them manage their condition, they're far more able to stay engaged — and most report fewer symptoms interfering with their work.
But support only matters if employees feel safe using it. More than a third of women in the survey who needed an accommodation either didn't ask for one or didn't receive it. That's a gap organizations can close.
For employers willing to go further, investing in chronic care that addresses root causes — rather than just managing symptoms — tends to pay off in both directions. Better employee health and lower claims move together. It's one of the few places in benefits where doing right by people and managing costs aren't in tension.
I think often about the woman who called in sick on her last day, sitting alone with something she didn't yet have words for. That was me. She is everywhere — quietly adjusting her professional future to fit a body the people around her can't see struggling.
Until we name that, we can't change it.