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The perimenopause is a time of big changes, and your breasts are no exception. What should every woman approaching the menopause know about breast health?

The lead-up to the menopause, the perimenopause, is nothing if not a time of great change — and your breasts are no exception. Not only might their size and shape change, but many women also have tender breasts and some ladies notice their breasts are lumpier, too. Given the talk about breast cancer during the perimenopause, especially in the context of hormone replacement therapy, you may also be worried that you're at risk. 

What should every woman know about breast health as she approaches the menopause?

Why are your breasts sore and even painful during the perimenopause?

It's quite common for women to have slightly sore and fuller breasts in the days before menstruation, a phenomenon related to the hormones that regulate the cycle. Estrogen and progesterone levels don't just fluctuate greatly during the perimenopause, they're also on a downward path. During periods of higher hormone levels, your breasts can do the same thing they use to before your period was due, but sometimes more intensely. 

Key facts to be aware of if tender and painful breasts are a problem for you are:

  • Hormone replacement therapy doesn't necessarily stop this perimenopause symptom. 
  • Once you've actually entered the menopause — and been period-free for 12 months or more — your body stops making estrogen, and breast soreness should come to an end. 

Is there anything I can do to make my breasts stop hurting in the meantime?

Though tender breasts are a common symptom in perimenopausal women, it's also good to keep in mind that another cause may be the culprit, such as:

  • Some medications, like SSRI antidepressants, diuretics, methyldopa, spironolactone (Aldactone), and digitalis preparations can increase your risk of sore breasts. 
  • Breast infections, cysts within your breast tissue, fibroadenoma, or benign growths, can also be the cause. 
  • have cysts in your breasts
  • Wearing the wrong kind of bra — a properly-fitted sports bra is your best bet
  • Some women gain weight as they approach the menopause, and this could make your breasts bigger, too — in turn making them feel less comfortable
Breast pain can, in some cases, also point to breast cancer. Though this certainly shouldn't be your first thought if you have sore breasts as other causes are much more likely to be behind your uncomfortable symptoms, this possibility is indeed one of the reasons it's always good to get checked out by a doctor. This is especially true if you've also noticed other signs, like a lump, lumps, "orange-peel skin" or (sometimes bloody) discharge from your nipples.

Once you've seen your doctor and established that your sore breasts aren't caused by something other than the perimenopause, you can try the following remedies to alleviate the discomfort:

  • Pharmacological pain relievers like ibuprofen and acetaminophen — talk to your doctor if you find yourself relying on these a lot, though!
  • Nutritional and herbal supplements like B vitamins, vitamin E, omega-3 fatty acid supplements, and evening primrose oil
  • Acupuncture
  • A heating pad or pillow, or a warm bath or shower, can alleviate pain as well 
  • Getting fitted for a proper bra that fits you right and supports your breasts well
  • Some women notice that foods and beverages that contain caffeine (including chocolate, unfortunately) trigger breast pain, so try cutting down. Avoid smoking, too. 

The perimenopause: Why do my breasts look different?

Ever-decreasing estrogen levels are a big part of approaching the menopause — and this also changes the composition of your breasts. Now that your body is aware it won't need to lactate (again), glandular tissues will make up a lower percentage of your breasts, and they'll instead have more fat. All of this often results in:

  • Saggier breasts
  • More "empty-feeling" breasts
  • Smaller breasts — but because you're also likely to gain some weight as you approach the menopause, you're actually more likely to have bigger breasts
  • It may look as if your breasts are "further apart"
  • Your areolae, the darker skin around your nipples, may shrink in size

Is there anything you can do to fight menopause-related breast sagging?

Not really, but working out regularly will certainly tone the muscles all over your body, and also help your breasts look firmer — to achieve this, go for exercises that target the chest, like weight lifting and push-ups. Working out can also reduce your risk of breast cancer. 

Not all exercises are great for better-looking breasts, though — running, especially without a proper sports bra, just bounces them up and down, like ill-placed weights. This can, unsurprisingly when you think about it, damage your connective tissues and ligaments, even leading to saggier breasts. 

Yoga may be a great choice for you, especially poses like the:

  • Triangle Pose
  • Cobra Pose
  • Standing Forward Bend
  • Headstands
  • Inverted Leg Stretch

While wearing a really good bra won't structurally change your breasts, it can sure offer the appearance of firm breasts. If you're still buying off-the-shelf bras that just "seem to be OK", now might be the right time to get fitted professionally — most women, research shows, don't wear the right bra size. 

What do I need to know about breast lumps during the perimenopause?

The hormonal changes your body goes through during the perimenopause are, combined with the normal and expected effects of getting older, the main reason for lumpy-feeling breasts during this stage of life. Lumps can be scary, though, so keep in mind that lumps that decrease in size or disappear over time are probably not breast cancer, while lumps that grow over time or just don't go away require medical attention — which still doesn't mean you have cancer, just that your doctor needs to rule it out. 

Causes of breast lumps besides cancer include:

  • Cysts — fluid-filled sacs that form from the structures within your breasts. Women in their forties and fifties are more likely to develop breast cysts, which can be extremely small but also as large as a marble. They're very common and can be seen on an ultrasound scan, as well as biopsied if necessary. Cysts are more common in the approach to the menopause than after, unless you use hormone replacement therapy. 
  • Fibroadenomas, non-cancerous lumps in the breasts, are more frequently seen in adolescence and early adulthood, but premenpausal women can also develop them. They have a smooth and rubbery texture and can easily be moved around underneath your skin. While they usually go away after the menopause, larger fibrdoadenomas may require surgery. Even if your doctor suspects a fibroadenoma, they may request a biopsy to rule out breast cancer. 
  • Pseudolumps, "clumps" of normal breast tissue with a high density, are seen often in the transition leading up to the menopause. Once again, your doctor will want to rule breast cancer out. 
  • Mastitis, a breast infection, is most commonly associated with breastfeeding, but can also develop during the perimenopause and menopause. 
Although most breast lumps will not turn out to be breast cancer, it's still important to sound the alarm when you notice a lump or multiple lumps, along with other breast changes like skin that resembles that of an orange, nipple discharge, and pain. Your doctor will decide how to go about diagnosing the cause — a process that may include a physical exam, imaging tests like ultrasound, and a biopsy (a tissue sample is taken and examined in a lab).

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