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Don’t just sweep it under the rug if you’re victim of heavy periods – it’s best to seek professional opinion because you could have endometriosis. According to research by National University Hospital (NUH), seven in 10 Singaporean women who suffered heavy menstruation also had late stage endometriosis.

More disturbingly, 80 per cent of those studied waited for as long as two years before seeking treatment. “These findings point to a general lack of awareness of the condition and the prevalent misconception that even severe menstrual cramps are part of ‘growing up’,” says Dr Fong Yoke Fai, head and senior consultant, Benign Gynaecology Division in the Department of Obstetrics and Gynaecology at NUH.

So when does “normal” PMS go from benign to malignant? The experts answer.

Period pains vs Endometriosis

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Normal:  Tolerable abdominal discomfort.

Abnormal: Heavy periods accompanied by intense pain that interferes with your work or social activities.

The next time you call in sick because of those dastardly cramps, do yourself a favour and see a gynae. Endometriosis could be the cause for that excruciating pelvic pain before and during your period. This happens when cells lining the womb implant and grow outside of it. Known as endometrial implants, these growths can occur on the ovaries, bowel, rectum, bladder, on the lining of the pelvic area, as well as other parts of the body.

Endometriosis is a progressive condition that tends to deteriorate with time, so it can lead to ovulation problems and even infertility. And don’t even think of trying to will the pain away. Such unbearable cramps will only worsen with time as the implanted cells will continue to grow and release pain-inducing chemicals with each menstrual cycle, explains Dr Fong.

There is no cure for endometriosis, but there is an effective, safe treatment with medication and/or surgery that can help to relieve pain and prevent progression of the disease.

Low mood vs Depression

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Normal: Slight irritability and mood swings just before menstruation.

Abnormal: Low mood for two weeks or more.

It’s all about the timing, says Dr Lim Yun Chin, consultant psychiatrist at Raffles Counselling Centre, Raffles Hospital. He elaborates: “What distinguishes PMS-related depression from other forms of depression is the timing of the symptoms. Specifically, they occur two weeks prior to the onset of menses, around the time of ovulation. And they subside once the period begins.”

On the other hand, clinical depression, lasts for more than two weeks, and is often associated with feelings of helplessness and hopelessness. One might also feel incapable of performing daily tasks and interacting socially. Plus, one might lose interest in activities that were previously enjoyable, he adds.

Keep a mood chart, suggests Dr Lim. It’ll help you determine if PMS is at the root of your blues. But if you feel constantly down or feel the strain in your work life or relationships, get professional help. Psychological intervention, such as cognitive behaviour therapy – a form of mental health counselling that helps you develop the skills needed to cope with negativity – can be useful.

Bad Skin vs Polycystic Ovary Syndrome (PCOS)

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Normal: A pimple outbreak that usually occurs 10 days before period.

Abnormal: Chronic acne accompanied by symptoms like irregular menses, excessive facial hair growth and dark patches on the skin.

You can rest easy if angry flare-ups only occur when you’re expecting your period. However, if you have the above signs and/or have a strong family history of PCOS, it’s probably best to seek a doctor’s advice. The condition occurs when male sex hormones levels are elevated in the body.

Besides causing persistently clogged pores and skin inflammation on the face, jawline, chest and/or back, it also affects the menstrual cycle, egg production and hence fertility, says Dr Seng Shay Way, specialist in Obstetrics and consultant at Raffles Women’s Centre, Raffles Hospital.

Women who have PCOS are also likely to have insulin resistance, meaning the body responds more slowly to the hormone that regulates the levels of glucose in the bloodstream. “These women have a higher risk of developing diabetes and high cholesterol problems,” he warns.

As many women with PCOS show few or no symptoms, many don’t realise they might have it until they try – and fail – to get pregnant, reports the US National Institutes of Health. Get a medical check-up as soon as you suspect it to be the source of your troubles. With treatment, women with early stage PCOS may have a shot at childbearing – and keeping the condition under control.

Bloating vs Ovarian cancer

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Normal: Tenderness along the abdomen leading up to and during menses.

Abnormal: Persistent swelling of the abdomen, increased urinary frequency, lumps in the abdomen, chronic irregular menses, constipation, and pelvic pain.

It’s common to feel puffy during that time of the month, but watch out if you’re also showing other signs. They may be caused by a tumour in your midsection. Ovarian cancer is the fourth most common cancer among local women, and is known as a silent killer because most of its symptoms tend to be non-specific. (Read: You might dismiss them for something less severe.)

Moreover, unlike breast or cervical cancer, there is no cost-effective method to screen for the disease, making it harder to catch at an early stage, says Dr Timothy Lim, senior consultant and head of the Pre-Invasive Direase & Screening Unit at KK Women’s And Children’s Hospital. He adds: “That’s why it’s so important to be aware of the symptoms and seek immediate medical attention if you experience any of them.”

Having a strong family history of ovarian or breast cancer – sometimes caused by the same defective gene – puts you at a higher risk. If a tumour is detected, immediate treatment is needed. This may mean having to remove the uterus, fallopian tubes, one or both ovaries as well as other organs affected by the cancer.

Heavy Flow vs Uterine Fibroids

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Normal: Up to four changes of sanitary pads.

Abnormal: Five or more changes of pads, accompanied by large clots (bigger than a 20-cent coin), a swollen lower belly, or lumps in the abdomen that you can feel.

Heavy menstrual flow is one of the classic signs of uterine fibroids (non-cancerous tumours in the womb), a condition that affects up to one in five women during their childbearing years, says Dr Fong. It occurs when a fibroid grows to a point (more than 5 cm) where it starts to distort and/or enlarge the uterus it resides in.

While the exact cause is unknown, high levels of oestrogen and progesterone in the body are said to fuel its growth, reports the US Office on Women’s Health. That’s why fibroids tend to grow rapidly during pregnancy when hormone levels are high, and stop growing or shrink once a woman hits menopause.

According to the US National Women’s Health Information Center, treatment can range from simple pelvic scans to monitor the growth to birth control pills and short-term hormonal therapy that help to control heavy bleeding. In more serious cases, it might be necessary to go under the knife to remove individual fibroids and/or the entire uterus.

This article was first published on Shape.