Health Conditions / Sexual and Reproductive Health / Polycystic Ovary Syndrome

For many of us, puberty wasn’t especially fun: The acne, emotional roller coasters, and general awkwardness of being 13 years old all pretty much sucked. Obviously, I’m glad that’s in the past… or I was, until I got really nervous when I saw people talk about having a “second puberty” on TikTok.If you haven’t seen these videos pop up on your feed, they largely consist of women in their mid to late 20s talking about physiological changes, like weight fluctuation and adult acne, that remind them of going through puberty. (These posts outline a different phenomenon than when trans people describe going through a “second puberty” after starting a medical transition, especially one including hormone replacement therapy.)As one user wrote in a short video: “Any other ~27~ year old girlies feel like you’re going through a second puberty!? Like my hair won’t grow anymore and my pimples came back… also I’m the heaviest I’ve ever been? It’s all good, just curious wtf is up with my body and hope to recognize myself again soon.” Another user lamented that she’d finally found pants that fit her body well before being hit by what she called her second puberty.These tales of big changes affecting people in their 20s made me wonder: What could be going on with people’s bodies during this time that might make them feel 13 again? For answers, SELF spoke with Alyssa Dweck, MD, FACOG, a New York–based gynecologist.Right off the bat: Dr. Dweck says there’s no such thing as a second puberty—we’re only going to suffer through that once, thank god. But your body is going to naturally change as you get older, and a number of things can mess with your hormones in your 20s and 30s, which might cause puberty-esque symptoms. Before we dive into a series of circumstances that might or might not apply to you, a few quick reminders: There’s truly no way to tell what’s going on with your body without talking to a doctor; this isn’t an exhaustive list of every single thing that could cause puberty-like symptoms; and self-diagnosing is always a bad idea. That said, below you’ll find the most common culprits behind second puberty. (Which is, again, blessedly not a real thing.)Hormonal shiftsOne thing about the concept of second puberty that does ring true: Your body can surprise you through the years. It would be great if your body would just settle down into a normal rhythm permanently, but, unfortunately, that’s not the way it works. “My guess is some of the people relaying their experiences [on TikTok] are going through hormonal shifts,” Dr. Dweck says, adding, “People go through hormonal shifts during various life changes,” like during puberty, pregnancy, menopause, and for a host of other reasons.For example, the pelvic area may continue to widen up until the age of 30 (and perhaps get smaller after 40) for some people, research suggests. This is “likely linked” to the age at which a person is most fertile, which is influenced by hormonal fluctuations, the researchers note. Changes in breast size and shape shouldn’t necessarily cause panic either, as SELF previously reported. A number of factors can affect how your boobs look and feel, including your fitness routine, weight, and age. 

Keke Palmer raised an all-too-common question in an Instagram video yesterday: Why don’t we have a cure for adult acne yet? More specifically, the 28-year-old actor wants to know why plastic surgeons—who, admittedly, perform very involved procedures all the time—haven’t fixed this issue.“Good morning, y’all. I was just thinking about the fact that plastic surgeons are amazing,” Palmer said to her 11.2 million followers. “Okay, they can give you a boob job, above the muscle, under the muscle, liposuction, tummy tuck, BBL, they can even implant muscles—I mean the list goes on. But they cannot figure out how to clear up somebody’s skin. Are you kidding me?”The Nope star then proposed a… skin transplant of sorts: “All of these years and all of these inventions—you can’t figure out how to take the beautiful skin from my ass and put it on my face? I’m tired of it. I’m done with it. People out here with adult acne are struggling and you ain’t figured out that cure? I’m done.”Palmer has spoken out about her acne in the past: In a 2020 post, she said it was a symptom of polycystic ovary syndrome (PCOS), a hormonal disorder, and encouraged her fans also struggling with adult acne to “know you’re not alone”.Instagram contentThis content can also be viewed on the site it originates from.In yesterday’s post, she also urged the medical community to do something, writing, “All these years!! Plastic surgeons, y’all wanna know where the real money at? IN CLEARING UP ACNE. Enough with all the hard work of having to find the PERFECT diet and trying to get an expensive facial every other day. Give us the plastic surgery we’re begging for, and make it possible for Black skin as well…I need the dual love.”

Retinol also isn’t a quick fix. It takes time to see results (possibly a few months), and it’s something you’ll have to keep using to maintain its benefits.DermstoreFirst Aid Beauty FAB Skin Lab Retinol Serum 0.25 Pure ConcentrateSephoraDrunk Elephant A-Passioni Retinol CreamDermstorePCA Skin Intensive Clarity Treatment 0.5 Pure Retinol Night6. RetinalRetinol isn’t the only over-the-counter retinoid out there—or the gentlest. In fact, some experts recommend that those with sensitive skin opt for products containing retinal (also called retinaldehyde) instead of traditional retinol. Like retinol, this compound is a naturally occurring retinoid that the body converts to retinoic acid. And, as SELF explained previously, it has been shown in a few studies to be just as effective as retinol and other retinoids with fewer side effects.Products to try:AmazonMyChelle Dermaceuticals Remarkable Retinal SerumAmazonAvene Retrinal .1 Intensive CreamDermstoreObagi Medical Retivance Skin Rejuvenating Complex7. AdapaleneAdapalene—often known by the brand name Differin—is a synthetic retinoid that used to be available only via a prescription. But it recently became available over-the-counter, which makes it a great, strong acne medication that you can access without a prescription. And because it’s synthetic, it was formulated to be gentler than other prescription acne medications. For those who’ve graduated beyond over-the-counter retinol but aren’t quite ready for the full intensity of a prescription retinoid, adapalene is a perfect choice.Products to try:UltaLa Roche-Posay Effaclar Adapalene GelWarning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and with fragrances to mask the strong scent. You can often find it in masks and spot treatments.Products to try:DermstoreLancer Skincare Clarifying Detox MaskSephoraPeter Thomas Roth Therapeutic Sulfur Acne Treatment Mask9. BakuchiolThis ingredient, which is a plant-based extract often billed as a retinol alternative, is not actually a retinoid at all. But in a few limited studies on Bakuchiol, it did show promise in managing things like skin texture and fine lines—without the side effects we usually associate with retinoids. Today it might show up in a product all on its own or be paired with a low concentration of retinol to help boost the acne-fighting and antiaging effects without increasing the risk for side effects. As a solo ingredient, Dr. Adotama recommends it to those looking for more natural remedies for acne. Bonus: recent research indicates it’s particularly well suited for acne on skin of color.TargetVersed Press Restart Gentle Retinol SerumUltaIndeed Labs Bakuchiol Reface PadsSephoraThe Inkey List Bakuchiol Retinol Alternative MoisturizerAnd here are the best acne treatments for more severe acne (many of these will require a prescription!).10. Dapsone GelOne option your dermatologist might prescribe for acne is dapsone gel, such as the brand-name version Aczone. Dapsone is both antimicrobial and anti-inflammatory, and it’s proven to help get rid of blackheads, whiteheads, and deeper painful pimples. Oftentimes dapsone is used alongside other acne treatments. And as with many of those other remedies, this can cause skin to dry out.11. A Cortisone ShotCortisone is a quick fix for acne emergencies, especially large cystic acne bumps. Go to the dermatologist’s office for a shot of this corticosteroid, and the pimple will dramatically lessen and possibly even disappear in 24 to 48 hours. The treatment works to curb inflammation, which makes it best for cystic breakouts and can be really good at combating hormonal acne flare-ups.However, if done incorrectly, a cortisone shot can leave a small depression in the skin that lasts about eight weeks. “It’s a rare side effect that happens if the dosage of cortisone is too high,” Dr. Linkner explains. “You want to go to someone who knows what they’re doing.” So this method is best saved for those rare emergencies and should not be considered a long-term treatment for your acne.12. Birth Control PillsIf you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. When it comes to hormonal acne, “a sensitivity to the hormones called androgens manifests in the form of cystic acne,” say Dr. Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Combination hormonal birth control, which contains the hormones estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.13. SpironolactoneSometimes birth control alone isn’t enough to really make a difference in hormonal acne. That’s when your doctor might recommend adding in an androgen blocker such as spironolactone. Spiro (as it’s often called) minimizes the amount of androgen hormones in circulation by blocking the receptors that bind with testosterone. When these pills are taken at the same time as an oral contraceptive, many women see an improvement in breakouts, according to Dr. Linkner. The drug is sometimes prescribed to women with polycystic ovarian syndrome (PCOS) to relieve androgen-related symptoms like excessive hair growth, hypertension, oily skin, and acne.14. TazaroteneAlso known by the brand name Tazorac, this is another powerful prescription retinoid, but it’s synthetic. Like other retinoids, it can cause side effects like dryness and irritation, so you should always follow your dermatologist’s instructions for when and how to use it. Interestingly, it can also be used to help manage plaque psoriasis and may be combined with other topical medications, like corticosteroids, to do just that.15. IsotretinoinIsotretinoin (formerly sold as Accutane) is a particularly strong retinoid. It has a mixed reputation, but among dermatologists it’s the finisher for patients with severe acne. “If you have an acne patient that doesn’t respond to anything, [isotretinoin] can really be a game changer,” board-certified dermatologist Adam Friedman, M.D., tells SELF. Commonly referred to as Accutane even though that particular brand was discontinued, isotretinoin is an oral retinoid, and it has all the benefits of a topical retinol but is even more effective.

As you probably know from living life with a vagina, having your period looks nothing like how it does in most tampon commercials. For one, period clots can happen during that lovely time of the month, and the jelly-like glob doesn’t usually come out in a tidy little splash. While it’s expected to have some blood clots during your period, especially if you’re prone to heavy menstrual bleeding, there are certain times when they might be a sign that something is off in your body. Here’s how to tell the difference between what’s normal and what’s not.What causes period blood clots during your cycle?First, a mini-primer on blood clots in general. When you think about clots of blood, you might imagine the kind that come together when you have a cut. Your body springs into action, combining enough platelets (blood cells that adhere to each other) and proteins from plasma (the liquid part of your blood) to plug the injured blood vessel1. This is how clots help to stop bleeding.Blood can also clot in your veins, especially if you have risk factors like being pregnant, which causes hormone changes that increase your blood clot risk, or recently having surgery, because moving less also contributes to this health hazard. These clots can dissipate without harm, but sometimes they can be life-threatening.The blood clots that can emerge from your vagina during your period are a bit different than these other types, though. Menstrual blood clots are comprised of the endometrial lining that builds up in your uterus in preparation for pregnancy, then sloughs off during your period when you don’t conceive.“Clots are normal, but they typically happen when a [person] has a heavy flow,” G. Thomas Ruiz, M.D.2, lead ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells SELF.This is in part because a gushing period prompts your body to form clots so you don’t lose more blood than you should (around two to three tablespoons over the course of your entire period). Also, the opening of your cervix (the narrow passage at the lower end of your uterus) is pretty small. If you have a substantial flow, that allows the blood to build up in your uterus, Dr. Ruiz explains, giving components like platelets and plasma proteins time to congeal.Back to top.How big should period clots be?For the most part, period clots are a completely normal part of menstruation, Mary Jane Minkin, M.D.3, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF.But if you’re seeing clots the size of a quarter or larger, you should visit your doctor, according to the Centers for Disease Control and Prevention (CDC)4.“If someone is passing quarter-size clots, that tells me that there could be something wrong [in] the uterus that needs further investigation,” Dr. Ruiz says. You can even take a picture of what you’re seeing so that your doctor can look during your visit. “It helps show me the magnitude of what’s been going on,” Dr. Ruiz says.Back to top.When should I be concerned about blood clots during my period?Period clots the size of a quarter or larger actually indicate that you’re officially in heavy bleeding territory, also known as menorrhagia. According to the CDC, other menorrhagia symptoms include:You’re soaking through one or more tampons or pads every hour for multiple hours in a row.You need to use two pads at a time.You have to change your pad or tampon during the night.You bleed for more than seven days.Your flow is so heavy that it sometimes prevents you from living your normal life.You regularly experience pelvic pain (especially in your lower abdomen) during your period.You’re constantly fatigued.The reason why all of this matters (other than making your life borderline hell during your period): Having heavy, drawn-out bleeding can lead to anemia, a blood issue that can leave you feeling tired or weak, the CDC says. It can also be a sign of an underlying health condition that requires treatment (but more on that in a sec).Back to top.OK, are large blood clots ever normal during your period?It’s important to remember that “normal” is a relative term for everyone, Christine Greves, M.D.5, a board-certified ob-gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. If your usual is to pass occasional larger clots, then that may simply be your usual, as long as you are not anemic and your quality of life is not affected, she explains.Meaning, if you’ve always had one period clot that you’re tempted to take a photo of or pester your best friend about every month, but you otherwise feel OK and aren’t soaking through tampons or pads like it’s your job, it’s probably nothing to be too stressed about. Still, Dr. Greves says, it’s not a bad idea to bring it up during your next check-up with your ob-gyn, just to get their take. And, remember, if you’re bleeding heavily, are in pain, or have any other symptoms of menorrhagia, you should get it addressed sooner rather than later.