Understanding Breast Changes During Menopause

Your gynecologist is often the first stop when a breast concern arises. After all, we are the ones who have always encouraged self-breast exams and helped decorate showers with reminder cards for years.

But times are changing.

While you should stay consistent with your breast self-exams, you should shift more focus to breast self-awareness. This means becoming familiar with what your breasts look and feel like and learning what’s normal for you. While you should always check in with your gynecologist if you notice a significant change, the following are some of the more common breast changes experienced during the menopause transition.

Breast Tenderness and Pain

Many women note general breast tenderness, discomfort, swelling and sensitivity in both breasts as part of the premenstrual experience. This is cyclical and hormonally related and typically resolves with the onset of menstruation. The hormone changes during perimenopause may have similar effects, although they’re less predictable.

Believe it or not, caffeine is another common cause of breast tenderness and pain at any time, including in different menopause stages. Keep track of when you experience breast pain and see if you notice a connection with your caffeine consumption. You can also try reducing or eliminating caffeine outright, to see if it resolves the issue.

A poorly fitting bra, especially with underwire that digs or chafes, can also be the culprit of breast tenderness in perimenopause or menopause. Treat yourself to a proper bra fitting, especially after childbirth, nursing or a notable weight change.

A breast infection during lactation or from plucking hair can be painful as well, but usually this resolves with warm compresses or topical/oral antibiotics.

Even if you’ve pinpointed the cause of your breast pain, be sure to check in with your healthcare provider if it persists or worsens over time. This will ensure you receive a proper work up and understand the best treatment recommendations you perhaps haven’t considered yet.

Other Types of Breast Changes During Menopause Stages

In addition to experiencing breast tenderness or pain during perimenopause or menopause, there are several other breast changes that can occur. While not all breast changes in menopause are cause for concern, it’s important to keep your healthcare provider up to date on any significant or worrisome developments.

Cystic Breasts and Breast Lumps

Nothing causes fear and angst in a woman like a palpable breast lump. In many instances, a benign breast cyst — a fluid-filled sac — is to blame. These cysts often resolve spontaneously, but occasionally may need to be drained. Cystic breasts are common, and often characterized by tender tissue on one or both breasts.

A solid mass, on the other hand, often warrants further investigation. A fibroadenoma is a type of benign solid breast growth. These are often diagnosed by clinical breast exam, or on a mammogram or ultrasound. A biopsy or excision might be recommended by your provider. These specific types of breast changes in perimenopause or menopause must be evaluated by a healthcare provider, and the sooner the better.

Other solid breast masses discovered during  menopause may be more concerning. When in doubt, a complete work-up with an exam, imaging, biopsy and a specialty consultation is in order to evaluate any breast changes in menopause.

Breast Changes in Menopause May Include Nipple Discharge

Needless to say, when there is drainage from one or both nipples, panic can set in. But fear not: clear or milky discharge from the breasts is usually a benign condition. Certain medications can cause this type of milky discharge from the nipple.

Rarely, a milky discharge results from excess prolactin (a hormone made by the pituitary gland) due to a growth in the pituitary gland in the brain, called a prolactinoma. This can be ruled out with a blood test and brain MRI. A green or black nipple discharge typically signifies duct ectasia, a benign condition in which a breast duct gets clogged, inflamed, and secretes trapped fluid.

A bloody nipple discharge or discharge from only one breast may be cause for concern and requires investigation. Be sure to contact your healthcare provider if you are experiencing any unusual discharge or changes in your breast during menopause that are worrying you.

Excess Underarm Tissue

Many women have extra breast tissue in their armpits. In most cases, this painless and prominent tissue is not a health concern. In fact,  this accessory breast tissue may wax and wane during the menstrual cycle, including during perimenopause.

Additionally, from time to time, women might note smooth, moveable, and inflamed lymph nodes as a result of shaving, dental work, or a recent vaccination or infection. Such swelling is typically not a cause for concern. That said, a lump that is fixed in place, persistent, or continuously enlarging in the armpit area should be evaluated by your healthcare provider.

A Word About Breast Imaging for Breast Changes in Menopause

A mammogram is the recommended screening tool for breast cancer. I recommend 3D mammograms for increased screening sensitivity. Even if you’re not experiencing a specific breast issue, I recommend one yearly screening mammogram for the average risk individual beginning at age 40, although other screening regimens exist. A breast ultrasound may be recommended in addition if your breasts are dense and therefore harder to evaluate. MRI scans have proven useful for screening and diagnostic purposes in high-risk populations, but they may prompt more biopsies.

Remember, it’s important to pay attention to breast changes in menopause and note any developments or pain that may be out of the ordinary for you. Consider this to be a form of proactive and consistent self-care, helping to preserve your physical well-being and peace of mind.