Half of us don’t have a “normal” period. Here’s when to stop brushing it off

Half of us don’t even have a “normal” period. According to Her World’s What Women Want 2026 survey, only 1 in 2 women describe their menstrual cycle as regular. The rest? They are living with some degree of irregularity, such as fatigue, mood swings, headaches, heavy or unpredictable bleeding, and pelvic pain. And, more often than not, these symptoms are silently accepted as part of being a woman.

The numbers are telling. Fatigue and physical weakness top the list, affecting 78.5 per cent of women surveyed, followed by mood changes at 69 per cent. Headaches or migraines affect 37 per cent, while 30 per cent experience heavy menstrual flow. Another 24.5 per cent of women experience irregular or unpredictable bleeding.

And yet, only 1 in 3 women has ever consulted a doctor or gynaecologist about these symptoms. When asked why not, the answers weren’t about cost, access or embarrassment. In fact, they were about perception. The vast majority, 71 per cent, said their symptoms simply felt “normal” or manageable, which causes them to just sweep it under the carpet. Another 27.5 per cent said they genuinely weren’t sure how serious their symptoms were.

Put those numbers together, and you get a sobering picture: Almost everyone who’s staying away from the doctor isn’t doing it out of choice. They’re doing it because nobody ever taught them where the line is.

We ask Dr Michelle Lim, an obstetrician and gynaecologist at Mount Elizabeth Novena Hospital, exactly what separates a period that’s just uncomfortable from one that’s trying to tell you something more serious. More specifically, when it comes to two conditions that are chronically underdiagnosed in women: polyendocrine metabolic ovarian syndrome (PMOS) and endometriosis.

No Single Red Flag

Dr Lim is quick to point out that there’s no neat checklist for “when to worry”. Menstrual symptoms, she explains, are physiological. They reflect the natural ebb and flow of our hormones, and some discomfort is simply part of that. But that doesn’t mean everything should be tolerated in silence. 

When asked about visiting the doctor, her guidance is refreshingly simple: “While menstrual symptoms may be common, and there is no definitive threshold that determines when a woman should seek gynaecological evaluation.”

The trouble, she says, is that conditions like PMOS and endometriosis tend to develop gradually. Early symptoms can be subtle, making them easy to write off or normalise. 

From PCOS to PMOS 

If you’ve heard of polycystic ovary syndrome (PCOS), you’ve probably pictured ovarian cysts and fertility struggles. But last year, the condition was formally renamed to polyendocrine metabolic ovarian syndrome. It was a shift documented in medical journal The Lancet and led by Australian endocrinologist Dr Helena Teede. 

The new name reflects something doctors have understood for a while, but patients often haven’t. This condition is never just about your reproductive system; it’s a whole-body metabolic and endocrine disorder – one that can affect blood sugar, cholesterol and cardiovascular health over a lifetime, not just periods and pregnancy. 

Dr Teede has said that misconceptions about the condition being “just about cysts” likely led to delayed diagnoses and even misdiagnoses over the course of her career, which is part of why the renaming happened, after more than a decade of advocacy involving over 22,000 patients and clinicians worldwide. 

That disconnect between name and reality has real consequences. The World Health Organisation estimates that PMOS affects 10 to 13 per cent of women of reproductive age globally, which is around 1 in 6 women in Singapore. Despite the prevalence, roughly 70 per cent of women with the condition don’t know they have it. 

Marie E., 25, was diagnosed with what doctors called “mild PCOS” in 2024, after experiencing irregular periods. This was because her ovarian follicle count was lower and she still menstruated, so her case was framed as less serious, even though she continued to struggle with acne, spotting and excess hair growth. But looking back, she says her relief at her fertility being unaffected meant she overlooked other health risks tied to the condition, like insulin resistance. For her, the old terminology shaped how seriously she – and possibly her doctors – took the diagnosis.

So what should you actually be watching for? According to Dr Lim, the flags for PMOS go well beyond your period. We’re talking about irregular or infrequent cycles, persistent acne or oily skin that lingers past your teenage years, increased facial or body hair, thinning hair at the scalp, and unexplained weight gain that’s hard to shift (especially around the abdomen). Diagnosis typically follows the Rotterdam criteria, which means you’ll need two of three markers like irregular ovulation, signs of excess androgens (steroid hormones, like testosterone), or polycystic ovarian appearance on ultrasound.

What You Need To Know About Endometriosis

“Endometriosis affects around 1 in 10 women of reproductive age, yet many people wait years before receiving a diagnosis,” says Dr Lim. The reasons are layered, because painful periods are so normalised that many women simply tolerate them. The condition’s symptoms also vary wildly from person to person, and to make things more difficult, there’s no simple blood test to catch it.

Dr Lim shares: “While an ultrasound scan detects certain forms of endometriosis, it may miss the more subtle or superficial endometriosis. This means a normal scan does not rule the condition out.”

Perhaps most importantly, Dr Lim stresses that pain intensity alone doesn’t reliably indicate endometriosis. Some women with severe pain turn out to have minimal visible disease, while others with extensive disease report surprisingly little pain. What’s more telling, she says, is the pattern. For instance, cramping that begins a few years after your first period and steadily worsens over time, often alongside bloating or loose stools during your cycle. In more advanced cases, the pain can shift from occasional to daily, and may come with pain during sex, bowel movements or urination. 

This is where Bianca’s story becomes a stark illustration of exactly what Dr Lim describes. In a 2024 episode of How to Build a Singaporean Woman, a docu-series by Her World, Bianca, who is now in her 30s, shared that her periods became so heavy during her university years that she went through at least seven pads a day. Over the years that followed, she was diagnosed with polyps, given birth control, found to have fibroids more than 5cm thick, and hospitalised for kidney infections. 

Finally, after a few visits to the clinic, a gynaecologist confirmed endometriosis via surgery, and discovered that Bianca’s uterus had become stuck to her large intestine. Eventually, she had to have part of her rectum removed. 

“People don’t find out about it until like 10 to 20 years later from the beginning of their periods, which is very long, compared to any other disease,” she shared. 

Dr Lim describes this as the core problem: Endometriosis doesn’t always announce itself clearly, and both patients and doctors can miss it for years, even when symptoms are actively worsening. 

Listen To The Pattern, Not The Pain 

The key takeaway from all of this is that “normal” is the wrong question to be asking about your period. Nearly every woman’s cycle looks a little different, and many common symptoms don’t require urgent investigation. The real question is, are your symptoms severe, persistent, progressive, or getting in the way of your life? And are they changing over time? 

Dr Lim’s advice for anyone unsure whether something is worth mentioning at a check-up is straightforward: Nothing is too small or too embarrassing to bring up. You know your body best, and even symptoms that feel minor can help a doctor recognise a pattern worth investigating.