Do You Still Need Mammograms After Menopause?

Your healthcare provider may begin to recommend screening for certain illnesses and conditions once you reach mid-life, and for good reason.

As women age, the risk of certain diseases—like breast cancer— increases.¹ And if there’s a family history or if you fall into the “high risk” category, chances of developing breast cancer may be even higher. 

But what about getting a mammogram during menopause? Are women in the clear once they are postmenopausal, or should we continue on with regular screenings?

According to Bonafide Chief Medical Officer, Dr. Alyssa Dweck “A mammogram is the recommended screening tool for breast cancer. In my practice, I recommend a yearly 3D mammogram with tomosynthesis, if accessible, for my patients with a follow up breast ultrasound for those with dense breasts. Even in the absence of a specific breast complaint during menopause or perimenopause, I recommend a yearly screening mammogram for the average risk individual beginning at age 40.  This recommendation might be modified based on individual circumstances.”

Let’s learn more about the importance of mammograms during menopause, and how they can help with breast cancer prevention, below.

Mammograms and Menopause

First, let’s take a look at what a mammogram is and why they’re so important, specifically during and after menopause.

A mammogram is a screening tool that uses special X-ray images to detect changes or growths in breast tissue.² During a mammogram, a technician compresses each breast in a specialized machine, allowing it to take images from all angles.³ The resulting set of images—called a mammogram—can help to identify lumps or other findings that may not be felt during a physical exam.⁴

While many women find mammograms uncomfortable, they can help to detect cancer early on— when it’s most treatable— and they’re the only test shown to reduce breast cancer deaths.⁵ A mammogram is uniquely important for menopausal women, who are on average between 45 and 55 years old, because breast cancer risk does increase with age.^6,7

When Should Women Start Getting Mammograms?

Mammogram recommendations vary based on age and risk factors. Only a qualified healthcare provider can determine this, so it’s best to seek guidance from a trusted physician who can help you decide the best age to begin mammogram screenings along with their frequency.

Women With Average Breast Cancer Risk

For those with an average risk (and we’ll get into risk factors in a bit) of breast cancer, deciding on when and how often to get a mammogram is very individualized and should be made on a patient to patient basis and determined through a discussion with a healthcare provider.

The guidelines from the American Cancer Association for those at average risk of breast cancer are as follows:⁸

• Women between 40 and 44: have the option to start screening with a mammogram every year
• Women 45 to 54: should schedule a mammogram every year
• Women 55 and older: can switch having a mammogram every other year, or they can choose to continue yearly mammograms. These types of screenings should continue as long as a woman is in good health and is expected to live at least 10 more years

However, recommendations regarding the frequency of getting a mammogram do vary, as providers may choose to abide by different guidelines.

For instance, The American College of Obstetricians and Gynecologists (ACOG) recommends all individuals who have an average risk of breast cancer should begin screening mammography at 40 years of age. They also advise that a screening mammogram should be conducted every one or two years based on discussions and individual decisions made between the patient and their provider.⁹

The U.S. Preventative Services Task Force (USPSTF) also recommends that women who are at an average risk of breast cancer start screenings at age 40 and get one every two years until the age of 74.¹⁰

As you can see, the guidelines around when and how often to get a mammogram do vary, so it’s best to check in with your healthcare provider to see what they specifically recommend.

Women With High Breast Cancer Risk

For those with a high risk of breast cancer, screening recommendations vary greatly. A healthcare provide may determine you have a high-risk status if:¹¹

• Genetic testing shows you have a known BRCA1 or BRCA2 gene mutation¹² (both of which increase the chance of developing breast cancer)
• You have a personal history of breast cancer¹³
• You have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation
• You have had radiation therapy on your chest prior to age 30
• Your lifetime risk of breast cancer is greater than 20% (largely based on family history of breast cancer)
• A breast cancer risk calculator suggests above average risk¹⁴

Women with one or more of these risk factors may be considered “high risk” for developing breast cancer. But much like screening guidelines for average risk patients, guidelines for those with a high-risk of breast cancer are based on individual risk factors. Some guidelines may include:^{14, 15}

• A mammogram with or without breast ultrasound and/or breast MRI at alternating intervals each year beginning at a younger age (if suggested by a healthcare provider). A breast MRI has been shown to significantly outperform mammography in breast cancer detection for high-risk women but might result in false positive results and increased biopsy recommendations.
• Women should discuss their risk factors with their healthcare providers beginning no later than at age 25 if they are considered to be in a high-risk category.
• A clinical breast exam should be considered every 6-12 months.

Again, these guidelines are general, as high-risk recommendations vary widely and are based on the individual and specific reason for the high-risk status. Recommendations around screenings are also nuanced, so if you fall into the high-risk category, be sure to discuss screening frequency and types with your healthcare provider to determine what’s right for you

Can Perimenopause Affect Mammograms?

The short answer is—quite possibly; hormone changes due to perimenopause and menopause can affect breast tissue and mammograms. As estrogen levels decline, breasts may change and therefore influence mammogram results.

Here’s how:

• Breast density changes during menopause. Older women, on average, have lower breast density than in younger women.¹⁶ Hypothetically, decreasing breast density may decrease breast cancer risk—but it doesn’t eliminate it altogether.¹⁷ As a note, breast density refers to the radiologic changes seen on a mammogram in which breast tissue is opaque and thus concerning calcifications may be masked – those with very dense breasts are usually recommended to have an ultrasound.¹⁸
• HRT can do the opposite—aka, make breasts denser. On the contrary, women who take hormone replacement therapy (HRT or HT) during perimenopause and menopause may have more dense breasts, potentially making it more difficult for a mammogram to detect cancer. Also, although the risk of breast cancer in those on HT is much lower than previously reported, it is not zero.¹⁹  
• Menopause may cause mammograms to feel more uncomfortable. Breasts changes like tenderness, achiness, and even a “lumpy” feeling are not uncommon during menopause.²⁰ This may cause mammograms to feel more painful and/or uncomfortable.

How Often Do I Need a Mammogram After Menopause?

Around 80 percent of breast cancer cases happen in women over age 50.²¹ That’s why it’s essential to not only learn your breast cancer risk, but also to follow the screening advice of a trusted healthcare provider.

How often you need a mammogram after menopause depends on your risk status for developing breast cancer. While many women may be able to get a mammogram yearly or bi-yearly after menopause, others may need more frequent screenings. Additionally, it’s important to be consistent with breast self-exams, as well, so you can be more attuned to any changes or abnormalities.

Dr. Dweck recommends, “Prioritize a focus on breast self-awareness rather than strict and religious breast self-exams. This means becoming familiar with what your breasts look and feel like and learning what’s normal for you. You should always check-in with your gynecologist or healthcare provider if you notice a significant change and be sure to speak with them about how often you should ideally be getting a mammogram.”

Talk with your healthcare provider about when and how often to schedule a mammogram— which is key in detecting potential breast cancer in its early stages and prioritizing health.²²

Resources

1. https://www.cdc.gov/breast-cancer/risk-factors/index.html
2. https://www.webmd.com/menopause/guide-mammogram-testing
3. https://www.cdc.gov/breast-cancer/about/mammograms.html
4. https://www.webmd.com/menopause/guide-mammogram-testing
5. https://www.acr.org/Practice-Management-Quality-Informatics/Practice-Toolkit/Patient-Resources/Mammography-Saves-Lives
6. https://www.nia.nih.gov/health/menopause/what-menopause
7. https://www.webmd.com/menopause/guide-mammogram-testing
8. https://www.cancr.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
9. https://www.acog.org/news/news-releases/2024/10/acog-updates-recommendation-when-to-begin-breast-cancer-screening-mammography
10. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#bcei-recommendation-title-area
11. https://www.cancer.org/cancer/types/breast-cancer/risk-and-prevention/breast-cancer-risk-factors-you-cannot-change.html
12. https://www.komen.org/breast-cancer/screening/when-to-screen/high-risk-women/
13. https://www.breastcancer.org/screening-testing/mammograms/recommendations
14. https://www.breastcancer.org/risk/breast-cancer-risk-calculators
15. https://www.komen.org/breast-cancer/screening/when-to-screen/high-risk-women/
16. https://www.acr.org/-/media/ACR/Files/Breast-Imaging-Resources/Care-Toolkit/Provider-Breast-Cancer-Risk-Assessment-Handout.pdf
17. https://www.mayo.edu/research/centers-programs/mayo-mammography-health-study/research/do-changes-breast-density-over-time-influence-breast-cancer-risk
18. https://www.breastcancer.org/risk/risk-factors/dense-breasts
19. https://pmc.ncbi.nlm.nih.gov/articles/PMC5938298/
20. https://www.webmd.com/menopause/breasts-menopause
21. https://breastcancernow.org/about-us/why-we-do-it/breast-cancer-facts-and-statistics
22. https://www.breastcancer.org/screening-testing/mammograms/benefits-risks