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Quarter life crisis? Managing “second puberty in women”

The teenage years are commonly thought of as the time of major physical, emotional, and psychological changes – puberty. However, many women experience symptoms (weight gain, acne, hair, and menstruation changes) in their 20s that some have dubbed a “second puberty in women.” This transitional period involves just as many profound shifts as adolescence, but without the comforting narrative we have for teenage struggles.

So, is “second puberty” real?

Tryon Medical Partners gynecology and sexual health specialist Dr. Stone weighs in with information on what changes in our bodies during our 20s and how to best navigate the changes that surface. 


What is “second puberty”?

Dr. Stone shares that the bodily changes many experience in their 20s are caused by a combination of lifestyle changes and the natural process of aging. 

In terms of lifestyle, 20-somethings are often undergoing cosmic shifts in their day-to-day life, whether they’re going off to college or graduate school, starting a new job, or settling into their first serious partnership. These massive changes in lifestyle can be accompanied by physical changes, like weight gain from an altered diet or acne from increased stress at school or work. 

These lifestyle changes work alongside the natural aging process of the body. In your 20s, your hormones, namely estrogen and progesterone, continue to increase until they reach their peak. With your hormones at their highest level, bodily changes surface. Additionally, although you may be treated like a fully-formed adult in your 20s, you’re still not finished developing. Most people are still developing some tissue, such as brain and breast tissue, up until 25. 

Dr. Stone encourages patients to think about the unique physical advantages of being in your 20s: “While some symptoms can be frustrating, it’s actually an empowering decade,” Dr. Stone notes. “Your bones are the strongest they’ll ever be and you’re at peak fertility, so you can take advantage of that before your 30s when bone density and fertility will naturally decline.” 


How can I address “second puberty” symptoms or mitigate their impacts?

Dr. Stone approaches managing each symptom differently: 

  • ​​Weight gain. If you’re putting on some pounds in your 20s, Dr. Stone encourages you to ask yourself some questions: What has changed that might be contributing? In any decade, weight is largely a product of calories going in and calories being burned. Dr. Stone suggests:
    • Weight training as an exercise to control body fluctuations and take advantage of your peak strength before estrogen begins to decrease. 
    • Consistent sleep, which plays a large role in not just weight management but bone, skin, and overall hormonal health. Aim for eight hours a night and practice good sleep hygiene.
  • Acne. Changes in your skin, like increased acne formation, is a natural part of your hormones (mostly progesterone) spiking in your 20s. To manage any breakouts, Dr. Stone encourages: 
    • A reliable cleaning routine in the morning and the evening to make sure your skin is given the best foundation to stay pimple-free. 
    • Visiting the dermatologist for additional treatment options. If you have a solid routine and you still are struggling with breakouts, there are several options you can pursue. 
  • Hair changes. In your 20s, estrogen is at its height, which means your hair is likely the thickest and healthiest it will be. As you get into your late 20s and estrogen begins to go down, you may experience some thinning. Dr. Stone endorses: 
    • Taking a supplement, like a multivitamin or biotin supplement, to keep your hair strong and thick.
  • Menstruation shifts. Sometimes in their 20s, people experience shifts in the menstrual cycle they’ve experienced for about a decade. Dr. Stone recommends:
    • Start tracking your cycle to make sure it’s happening once a month, every 21 to 34 days, and the bleeding is within the realm of normal. 
    • Visit your primary care clinician or gynecologist if the changes are very different from what you’ve experienced in the past and let them know how your cycle has changed. 

Although it’s often not a problem in your 20s when bone health is at its peak, Dr. Stone also suggests taking advantage of this by making sure people are getting in their 800 IUs of vitamin D and 1200 milligrams of calcium to build up bone density as much as possible. 

“One item that I also recommend in your 20s is focusing on bone health,” Dr. Stone encourages. “I wish more patients would proactively consider this. It’s so important to keep your bones as strong as possible while your hormones are still supporting that density.” 


When should I see a doctor for “second puberty” symptoms? 

Dr. Stone notes that by the time patients are in her office, they have a list of issues. But focusing on any changes in menstruation is the most important. Some of these symptoms, including changes in menstruation, body hair, and mood, can be a sign of more than just natural shifts in your 20s. They could be signs of other hormonal changes caused by a chronic, underlying illness like thyroid disorders so it’s very important to rule those out first. 

Dr. Stone also encourages her patients to come see her (or another member of their healthcare team) if any physical changes are distressing to them, for ways to address or mitigate them. 

“If you look in the mirror and something is causing stress, anxiety, or depression, it’s important to speak up,” Dr. Stone says. “Talk to whoever you feel most comfortable with, whether it’s your primary care clinician or gynecologist. We’re here for you throughout the transitions.” 

If you want to learn more about “second puberty” in women, the changes happening in your 20s, and how to address them, use MedChat to schedule an appointment with a Tryon clinician today.