Breast changes during perimenopause and menopause (and the reason you need to keep checking yours)

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It’s completely normal and natural for your breasts to shift in size and shape and/or become more sensitive as your estrogen levels drop. Such changes in breasts during menopause can, however, be disconcerting so it can be helpful to know what you can typically expect, what is potentially cause for concern and why it is so crucial to check yours to pick up on any unusual changes.

We know regular breast examination is important at any age, but it does become more significant around the time of menopause – not least because we know that the average age of women going through it is 51 in the US[1] and two out of three breast cancers are diagnosed in women over 55[2]

Why does perimenopause and menopause affect your breast tissue? 

Breast tissue is particularly sensitive to estrogen, due to there being estrogen receptors within the breast. When estrogen levels drop, breast tissue then becomes less dense and more fatty, which can lead to your breasts looking and/or feeling different.

Common changes:

  1. Tenderness, discomfort and pain

Hormone fluctuations are known to affect breast tissue and, unfortunately, one of the side effects of this is that your boobs can start to feel uncomfortable and possibly hurt. This is often a symptom of high levels of estrogen which is common around the time of perimenopause and can lead to an increase in the size and number of ducts and milk glands (known as lobules) which can cause your breasts to retain water – making them feel increasingly tender and uncomfortable. This can be a more noticeable problem during perimenopause when hormones surge and drop erratically making it happen unpredictably. Many women also report that this discomfort can be different to the kind of breast tenderness they might be used to – like the premenstrual variety generally experienced as a dull ache felt in both breasts. The type of breast pain many women go through during perimenopause or menopause is often described as more of a burning sensation or as a throbbing, stabbing or sharp pain. What also tends to be different is whilst the pain might be felt in both breasts it can equally affect just one of them, or part of one. It might also be felt through the armpit. This can, understandably, make everyday activities painful or uncomfortable, and can get in the way of you sleeping, exercising and/or enjoying sex.

  1. Sagging

Estrogen is known to help keep the connective tissue of the breasts hydrated and elastic and is also instrumental in the production of collagen which helps to keep your skin firm. We start losing around 1 per cent of our collagen stores annually from our mid 20s[3] but going through the perimenopause speeds up that process. As levels of it diminish during perimenopause and menopause this can result in your breasts beginning to sag, change shape, or even get smaller. They may also sit lower than they once did. For many women, this can leave them feeling self-conscious and have a real impact on their self-esteem and self-image. For more insight on how your changing shape can cause self-esteem issues read Whoever stole my body, please return it immediately.

  1. Bigger breasts and swelling

While some women find their breasts shrink, others can find they get bigger. Around one in five women report an increase in their cup size after menopause[4] and it is not uncommon to go up two sizes or more. This is often – but not always – a result of overall weight gain (it has been shown that women put on five pounds on average around the time of menopause)[5] but it is also linked to the changing distribution of fat cells which can lead to you storing more fat around your bust. Several factors are thought to be responsible for this including a process called involution where the milk producing glands shut down and breast tissue is replaced by fat. Lowering levels of the hormone testosterone at this stage of life are also believed to be implicated in changing fat distribution around the body, and it becomes increasingly stored around your waist and bust. This sudden ballooning can cause you to feel like your body is not quite your own anymore and your boobs can potentially feel uncomfortably heavy. If they are not supported well with the right bra this can also put a strain on your neck, back and shoulder muscles.

  1. Itchy breasts

When collagen production dips, the skin around the breasts become thinner, drier, more sensitive and generally prone to itchiness. You might find you become more sensitive to some fabrics or materials, the detergents you normally use, or it could be that as you sweat more during menopause this can lead to irritation between your breasts and your bra. If your bra is not big enough to accommodate your new size this could irritate and chafe the skin, causing itching and/or an eczema-like rash. Some women also describe feeling a sensation of having insects crawling over their skin (technically known as formication) which can cause them to scratch repeatedly at their skin.[6] This condition has also been linked to falling estrogen during perimenopause and menopause.

  1. Lumpy breast tissue

Hormone changes can also potentially cause lumps and swelling of the breast structure. The majority of these are unlikely to be a cause for concern and are due to benign conditions – cysts, fibroadenomas (small lumps that feel like marbles under the skin), and pseudo lumps (dense breast tissue) are all relatively common during menopause and perimenopause. However, it’s important to get to know your breasts and contact your doctor straight away if something seems different.

 

Did you know? If you are taking HT, this contains hormones which can have the side effects of stimulating breast tissue, causing tenderness and an increase in breast size. For more information on HT, Dr Shilpa McQuillan M.D. explains What it is and who it is intended for.

Quick tip: If your breasts are feeling swollen and painful wrap a towel or tea towel around a bag of frozen peas and hold it over them for around 10 minutes to help reduce the swelling and ease discomfort. 

What you can do

Check your breasts

“The key importance of self-examination is that it helps you to know how your breasts look and feel. If you’re regularly checking, you’ll know what’s normal for you, and you’ll notice anything strange or unusual,” says Dr Kate Burns M.D. a doctor with a special interest in menopause. “All woman’s breasts are different, and it’s incredibly important to know what is normal for you. Self-checking helps you to pick up on any worries early, so you can get them dealt with as quickly as possible.”

Though rare, changes to your breasts can potentially be among the first signs of breast cancer[7] so the earlier you can pick up on anything out of the ordinary the better.

How to do a breast self-check

Ideally give them a thorough once-over every month so you can get to know what is normal for you and pick up quickly on anything potentially abnormal. To reassure you that you are doing it right download the free Health & Her perimenopause and menopause app (available on iOS and Android). Try our breast self-check, a simple step-by-step guide with instructions and clear illustrations to help you. Self-examining your breasts on a regular basis can help towards early detection, so a nice feature of the app is the ability to add this activity to your plan and set notification reminders each month.

Below are some simple and initial steps:

  1. Look – Look at your breasts, then look at your armpits, across and beneath your breasts, and up to your collarbone. Do you see any changes in skin texture e.g., puckering/dimpling, swelling in the armpit or around the collarbone or any sudden change in size or shape? Do they look a slightly different color – are they red and inflamed or almost bruised looking?
  2. Feel – Feel each of your breasts from your armpit, across and beneath your breasts, and up to your collarbone. Be alert to any lumps and thickening or constant, unusual pain in your breast or armpit.
  3. Notice your nipples– Look at each of your nipples in turn and check for any changes and differences between the two. Have they changed position and/or are starting to turn inwards, are there any signs of a rash or crusting around the nipple or surrounding area? A normal nipple discharge is usually thin, cloudy, white-ish and almost clear. An abnormal discharge can present itself as grey, brown or yellow. Bloody discharge is not normal.
  4. Make a date– plan time with yourself to do a monthly check or schedule the Breast Self-Check in the plan section of the Health & Her app.

7 ways to keep your breasts healthier

  1. Go for your recommended screenings. As well as examining yourself, all women aged 45 to 54 should get a mammogram annually. After 55 you can choose to have every other year or continue with them yearly.[8] [New US stat here] Be reassured, however, that in about 96 out of every 100 women screened the mammogram will show no signs of cancer and no further tests are needed.[9]
  2. Get fitted for a bra. There is research to suggest a staggering 80 per cent of us are wearing the wrong size.[10]If yours is too tight, has an underwire digging into your skin or generally lacks support this can lead to discomfort and/or also cause skin to become irritated. Many women say wearing a supportive sports bra works best for them and also add that wearing it in bed helps with any pain or discomfort that might be getting in the way of them sleeping. Research published in Breast Journalalso reveals 72 per cent of women who regularly exercise reported exercise-induced breast pain so a well-fitting sports bra should always be worn if you work out or go running.[11]
  3. Keep a lid on caffeine. This is a diuretic, which means it can cause your body to get rid of water and in large quantities will make you pee more. Experts suggest you drink no more than three or four regular sized coffees or teas a day but if you have noticed caffeine (which is also found in energy drinks, cola, and hot chocolate) is exacerbating your breast soreness it might be helpful to try and avoid it and go for decaffeinated alternatives. Research confirms that cutting down on caffeine helps to manage breast pain.[12]
  4. Eat a menopause-friendly diet. There is some evidence to suggest a high fat diet is linked to worsening breast swelling and tenderness.[13]A lower fat, largely plant-based one, on the other hand, appears to help reduce symptoms. Aim to limit the amount of salt in your diet (not just by adding it to food but by checking the amounts in shop-bought meals and products) as too much salt can cause fluid retention which has been linked to breast pain. It can be helpful to log down in a symptom tracker what you eat or drink so you can pinpoint either the onset of pain, or worsening of it, so you can avoid the triggers. Here is more information on menopause nutrition and what to eat for a healthy happy menopause – Menopause nutrition: how to eat for a happier, healthier menopause.
  5. Keep well hydrated. Having hot flashes and night sweats can cause dehydration and potentially leave you with dry, irritated and itchy skin, including around your breasts. Even mild dehydration can also cause fluid retention, which can worsen breast tenderness and pain. Try to drink plenty of water throughout the day and include water-rich foods like fruits and vegetables in your diet. And limit, or stop drinking alcohol – it will dehydrate you and is also linked to an increased risk of breast cancer. For more benefits of not drinking read How does alcohol affect menopause?
  6. Stop smoking. Studies[14]have shown a link between smoking and breast pain – which is yet another reason to cut down, or ideally stop.
  7. Maintain a healthy weight. Being overweight or obese raises your risk of breast cancer. Being overweight also raises the risk of the disease coming back in women who have had it.[15]

 

Sources & references:

[1] https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:~:text=Menopause%20can%20happen%20in%20your,is%20a%20natural%20biological%20process.

[2] breastcancer.org, 2022

[3] https://parjournal.net/article/view/3863

[4] https://pubmed.ncbi.nlm.nih.gov/15223108/

[5] https://joinzoe.com/learn/menopause-weight-gain

[6] https://www.medicalnewstoday.com/articles/321896#causes-of-formication

[7] https://www.cancerresearchuk.org/about-cancer/breast-cancer/symptoms

[8] https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html#:~:text=Women%2045%20to%2054%20should,at%20least%2010%20more%20years.

[9] https://www.gov.uk/government/publications/breast-screening-helping-women-decide/nhs-breast-screening-helping-you-decide

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2275741/

[11] https://pubmed.ncbi.nlm.nih.gov/26661830/

[12] https://pubmed.ncbi.nlm.nih.gov/2927749/

[13] https://pubmed.ncbi.nlm.nih.gov/2899188/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960349/#B2

[15] https://www.breastcancer.org/risk/risk-factors/being-overweight

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Dr Rebeccah Tomlinson

General Practitioner

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