“You’ve got your whole life ahead of you,” young adults are often told—but that’s of little comfort to the many 20- and 30-somethings who face “adulting” challenges like career uncertainty, overwhelming student loan debt, and relationship difficulties. The uncertainties of this time of life leave many feeling depressed, insecure, and rudderless. The good news is that you’re not alone—there’s a name for this experience: the quarter-life crisis.
“During their early 20s to early 30s young adults may feel either ill-prepared for or trapped by adult roles,” explains Jacob Tebes, PhD, who is a professor of psychiatry (psychology) at Yale School of Medicine and at the Yale Child Study Center. “This may trigger a quarter-life crisis that leads to heightened feelings of stress, as well as anxiety or depression."
Like the better-known midlife crisis, the quarter-life crisis is common—one survey suggests that as many as 70 percent of young adults have them.
“Young adulthood is more challenging than ever, especially when making choices,” explains Dr. Tebes. “The amount of information available in our hyper-connected world makes it very easy to second-guess yourself. Part of the problem is the growing belief that there is a ‘best’ choice to be made—about your relationships, career, commitments, or even downtime. This is an illusion,” he says. “There is no ‘best choice.’ It is what we do after we choose that makes all the difference in how something works out, even when initially things may not turn out so well.”
One good choice you can make, though, is to take care of yourself. Our Yale Medicine doctors discuss health matters to consider as you reach the quarter-life milestone.
Even social drinking can lead to liver cirrhosis.
It’s a common misconception that only people who have been heavy drinkers for decades have to worry about alcohol-related cirrhosis of the liver, a chronic condition in which the organ sustains permanent scarring and impaired function. “The amount of liver cirrhosis we are detecting in young people is increasing dramatically,” says Yale Medicine hepatologist Michael Nathanson, MD. “It’s the most quickly growing group of people dying of cirrhosis in this country.”
Rates of liver cirrhosis deaths from all causes, including hepatitis C, have skyrocketed in the United States in the last two decades, increasing by 65 percent overall for all age groups between 1999 and 2016. The sharpest increase, though, was among young adults, ages 25 to 34. Deaths from liver cirrhosis in this age group rose nearly 11 percent per year, according to The BMJ, which attributes the increase entirely to drinking.
“Certainly, some of the patients we see in their 20s and 30s think they are just drinking socially or because of stresses, and they don’t understand the damage they are doing to their livers and how the damage accumulates quickly,” says Dr. Nathanson. “Drinking, even at their age, could lead to serious health problems and even death, and it isn’t going to take 10, 20, or 30 years in all cases.”
Don’t assume your body will tell you that you’ve had enough, cautions Dr. Nathanson. He often sees patients who had no idea that their social drinking was harmful until the problem became serious. (Early stage liver disease has no symptoms.) He also reminds quarter-lifers that alcohol use in general is one of the leading causes of death (for a variety of reasons, including accidents) and disability for their age bracket.
While Department of Health and Human Services guidelines define moderate drinking as one drink a day for women and two drinks a day for men, the safest course of action is to abstain from drinking altogether. If you take medications (prescription or over-the-counter drugs), ask your doctor or pharmacist about alcohol consumption while on them since many, including acetaminophen, can hypersensitize your liver to the effects of alcohol, Dr. Nathanson explains.
More millennials are being diagnosed with colorectal cancer.
People tend to think that colon and rectal cancers (colorectal cancers) only happen to older adults. But there is a disturbing and ongoing trend of young people being diagnosed with these cancers.
“Colorectal cancer is on the rise in the younger generations,” says Haddon Pantel, MD, a Yale Medicine colorectal surgeon. Research has found that people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people born around 1950. Researchers are still trying to figure out why.
With this in mind, one thing you can do is be aware of symptoms that you should discuss with your doctor. “Even if you're in your 20s or 30s,” Dr. Pantel says, “if you have rectal bleeding, if you have any change in your bowel habits, any change in appetite (like feeling “full” early), weight loss, or abdominal pain that is not explained, you should get checked out.”
Rectal bleeding can be misunderstood, Dr. Pantel adds. “I get a lot of patients referred for hemorrhoids. But even in a young patient, you have to make sure that it's not something more serious,” he says. In certain cases, he may recommend a colonoscopy, the screening test that is used to identify and remove colorectal cancers and precancers.
Using SPF now may help you avoid skin cancer later.
“It is difficult to convince 20-somethings that the tans they bring back from their Caribbean vacations might lead to skin cancer in 30 years,” says dermatologist Kathleen Cook Suozzi, MD, aesthetic director at Yale Medicine Dermatology. According to the American Academy of Dermatology, melanoma is the second most common form of cancer in women under 30.
“Whenever I see a patient younger than 45 for skin cancer surgery,” Dr. Suozzi says, “I ask about their history of tanning bed use, and the correlation is very strong. Recently, state laws have limited minors’ access to tanning beds, and further education about the effects of ultraviolet [UV] damage from indoor or outdoor tanning will hopefully help halt this sobering trend.”
Protecting your youthful appearance can be another motivation to use sunscreen. “The sun damage sustained now will add years to the skin’s apparent age in your 40s,” Dr. Suozzi says. In addition to sunspots, skin conditions like rosacea and melasma are brought on or worsened by UV damage. “While there are lasers and chemical peels to help improve the look of sun-damaged skin, it is much more difficult to erase damage than it is to prevent it,” she says.
Start thinking about your future family.
Having kids may be the furthest thing from your mind right now. “In your 20s, you may be doing everything you can to not get pregnant,” says reproductive endocrinologist David Seifer, MD. “Then in your mid-30s, it's like a role reversal.”
“For women, fertility is not just an on/off switch,” Dr. Seifer says. “It's going to be a gradual decline for every woman on the planet.” Sometime around age 37 to 38, “your fertility declines at an accelerated rate. So, it's important to be conscious of that.”
He advises that young women think about at what point they might consider having children and how many they want to have. “People just think about timing the first one, but sometimes it can be the second or third when things get more difficult,” he says. Dr. Seifer also suggests that women ask their female relatives when menopause started for them.
“Generally, if your mother or your sister went through menopause before the age of 50, you may be genetically predisposed to going through menopause at an earlier age. That itself should probably be one small indication that you might consider having your family earlier than later,” he says.
Even if becoming a parent seems far off now, women and men should be aware of risk factors that can deplete fertility—such as smoking, sexually transmitted diseases, stress, and obesity—and make healthy lifestyle changes as needed.
While young men aren’t under the same time pressure as young women, they should know that sperm quality deteriorates over time, says Yale Medicine urologist Daniel Kellner, MD.
One immediate step young men can take is to avoid steroid use. If you’ve taken them at any point or have been prescribed testosterone for low-testosterone, either can affect sperm quality temporarily—or even permanently, Dr. Kellner says. Heavy alcohol or drug use all negatively impact sperm quality and count, and can even interrupt the brain hormones that control sperm production.
If the time isn’t right, you don’t have to rush, though. It is possible to preserve eggs, embryos, and sperm if you would rather have children in your 40s or 50s—or if you have a health condition such as cancer in which treatment can affect fertility.
Just be mindful that “there is a biological clock—it’s real,” says Dr. Seifer. He recommends those who are delaying having children beyond their mid-30s consider testing (bloodwork and an ultrasound), which can provide a snapshot of your overall fertility.
Make annual check-ups with your doctor.
“While these young adults are among the healthiest age groups, they should get in the habit of having good preventive health care,” says Yale Medicine’s Xavier Llor, MD, medical director of the Smilow Screening & Prevention Program. That means seeing a doctor annually for a check-up and to discuss screening tests that are recommended for their age bracket. According to Dr. Llor, young adults in their mid-20s and 30s should talk to their health care providers about health risks such as tobacco and alcohol use, sun exposure, diet and nutrition, physical exercise, weight, environmental and occupational exposures, and family history. He also recommends that women have pelvic exams and Pap smears every three years starting at age 21 to check for cervical cancer.
In short, find a health care provider you trust, and make (and keep) annual appointments. “It’s tempting to just go to the doctor when you have a sore throat, but the best way to stay healthy at this time of life is good preventive care so if symptoms do crop up, they can be addressed early,” Dr. Llor says.
Good health, they say, is the foundation of success in life. So, as you work through this quarter-life phase, take care of yourself to ensure that the decades ahead are yours for the taking.