Hormones—blamed for everything from mood swings to acne, hot flashes to painful periods. But while they’ve become a mainstream scapegoat for all the symptoms, your hormones are actually a key part to the delicate ecosystem that helps your body flourish.

But what’s actually “normal” and how should you expect your body to change as you age? In this series, we’re diving into the details of each decade, to give you insight into how hormones fluctuate during key points of your life, starting with your 20s.

What to Expect: Hormones in Your 20s

A woman’s 20s are full of vibrance and self exploration. By now, you’ve left the awkward growth spurts and extreme body changes. In this decade, a woman is most fertile and has her highest peak in female sex hormones. Your 20s should be filled with excitement and more confidence about our menstrual cycles, our body, and what makes us sexually aroused. 

What’s Normal in Your 20s

Regular, Pain-Free Menstrual Cycles

The key in the length of your regular, pain-free menstrual cycles is consistency. A 28-day cycle is normal, but the “normal” range can be anywhere from 26 to 32 days—as long as it’s consistent!

Three to seven days of bleeding is average, as is mild cramping. Small clots that are less than a quarter in size also fall into the normal range.

Your energy levels, especially on the first and second day of bleeding, are likely to be lower—needing a short nap isn’t out of the ordinary.

Sexual Exploration

Whether family planning is on your mind or you’re interested building a healthy sexual bond with your loved one—both are completely normal! Each and every one of us comes from a different background with different timelines, goals, dreams, and aspirations. Either way, sex should be playful and pain-free. 

Healthy Body & Mind 

If you haven’t already, this is a great time to establish healthy habits. There are several biometric markers that have been developed as guidelines to reduce risk for disease and mortality. These are recommended to be checked regularly by your naturopathic doctor, primary care physician, or school clinic. 

Consider these normal ranges when getting your annual check-ups or having a check-in with your doctor.

• Blood Pressure: Less than 120/80
• Fasting Glucose: <100 mg/dL
• HbA1c (mean blood sugar over the past 3 months): <5.7%
• BMI (Body Mass Index based on weight & height): 18.5 – 24.9
• LDL (Low density lipoproteins): <100 mg/dL
• HDL (high density lipoproteins): > 50 mg/dL
• Triglycerides: <150 mg/dL
• Daily bowel movements

When You Should See Your Doctor In Your 20s

Period Problems

Are your periods inconsistent? You may need to be evaluated for hypothyroidism or PCOS. 

Do you experience periods that are greater than 7 days in length or heavy? Or maybe you are the opposite, and have periods shorter than 3 days in length or have been non-existent? 

Do you have cramps that are painful and debilitating or require pain medications? Cramps that make you stay home from school or work could be an indicator of endometriosis.

Clots greater than a quarter in size? This might be due to fibroids and may require a pelvic ultrasound. 

Feeling extremely exhausted or struggling to get out of bed? These are signs that adrenals or thyroid might need some attention.

Any of these symptoms that you experience on an ongoing basis are worthy of checking in with your doctor during your 20s.

Fertility 

Looking to start your own family? Preconception counseling is the perfect way to prepare for a successful pregnancy. For some individuals, this may mean a discussion on ways to safely discontinue birth control use and balance the normal brain-ovary connections that are needed for ovulation. Others may want counseling on ways to optimize nutrients, reduce blood sugar spikes, and build healthy habits prior to pregnancy. 

Gut Complaints

Gut issues, which encompass a wide range of symptom, can be an indicator that you should check in with your doctor. Don’t dismiss what your gut is telling you—ongoing digestive issues are not normal!

Constipation, diarrhea, or not having daily bowel movements? Nausea or loss of appetite? Do you have abdominal pain shortly after a meal?

Are you experiencing bloating with the first bite of food? Struggling with lots of gas or burping? Do you feel like you have a “food baby” or have to wear larger clothes to compensate for the amount of bloating?

Are you struggling with frustrating attempts to deal with any of the following?

• Low energy 
• Difficulty sleeping
• Hair loss
• Acne
• Undetermined weight gain or loss

Any of these are reasons to ask your doctor what could be going on.

Other Concerns

Other concerns you should see your doctor about in your 20s:

• Pain with sex
• Vaginal discharge or itchiness
• Pain with urination 
• Breast tenderness
• Moodiness

Need a PAP? The American Cancer Society 2020 Guidelines for PAP Screenings have changed. The new recommendation is to start screening at the age of 25 with primary HPV testing every 5 years. This recommendation applies only to FDA-approved swabs. Don’t have access to HPV testing? then PAP smear alone should be repeated every 3 years. 

Feeling great and have no complaints? It’s still recommended that you get a well-women’s examination yearly! Regular check-ins are a great preventative measure to your health.

Dr. April Jones

Dr. Jones graduated from the National University of Natural Medicine in Portland, Oregon as a Doctor of Naturopathic Medicine and with a Master of Science in Nutrition degree. She believes that the most important part of any treatment plan is first establishing a solid foundation of health. This looks different for each patient and changes over time, and Dr. Jones’ guidance on your health journey will depend on your needs.

Dr. Danielle Vogler-Bos

Dr. Danielle Vogler-Bos is a Naturopathic Doctor, registered and licensed in both Minnesota and Arizona. Her passion is educating and empowering her patients to take back their health, partnering with them to find the root cause of their struggles, and helping them feel better, faster. After graduating from Gustavus Adolphus College with a Bachelors of Arts in Biology, Dr. Vogler-Bos earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine, a fully accredited and nationally recognized institution in Phoenix, AZ.

During her clinical training, Dr. Vogler-Bos completed a rigorous internship gaining experience in the diagnosis and treatment of hormonal imbalances, thyroid disorders, and adrenal fatigue using both traditional naturopathic medicine and bio-identical hormone therapies.