Background: Women are under-represented in the most prestigious roles at medical conferences, a pattern linked to the glass ceiling and glass escalator. Palliative care is among the most feminised specialties in healthcare, yet only one congress has been studied in depth, in Europe, with no comparable study in Latin America.Aim: To examine gender representation across all programme roles at two leading international palliative care congresses, and to assess whether roles filled by invitation carry fewer women than those selected by blind peer review.Design: Cross-sectional observational study of two complete scientific programmes, analysed as a census rather than a sample. The unit of analysis was the participation slot, a single appearance of a person in one role within one session.Setting/participants: The European Association for Palliative Care Congress (Prague, May 2026) and the Asociación Latinoamericana de Cuidados Paliativos Congress (São Paulo, March 2026), comprising 2569 slots across all programme roles.Results: Women were the majority at both congresses, holding 73.7% of 1502 classifiable slots at the European congress and 76.4% of 1063 at the Latin American one. Representation fell as role prestige rose (p<0.001 for both). Taking blind-reviewed roles as the reference, a role filled by invitation was 20% and 26% less likely to be held by a woman (risk ratios 0.80 and 0.74).Conclusions: Across two continents, women less often held invited than blind-reviewed roles. The gap arose from the invitation process, not scientific output. Organisers and associations should prioritise gender equity in speaker selection.