breast changes in perimenopause

Breast Changes in Perimenopause: Understanding Normal Variations and Symptoms

Breast Changes in Perimenopause

Perimenopause is the transition phase leading up to your final menstrual period, which marks menopause. Yes, menopause is just one day. After that one day, you are in postmenopause. Though technically perimenopause describes both the menopause transition and the one year after your final menstrual period. Perhaps because you don’t know you’ve achieved your final menstrual period until you’ve gone one year without one.

Characterized by significant hormonal shifts that can affect your body in diverse ways, perimenopause can come with a variety of changes. Most people think of hot flashes and moodiness. However there are over 30 recognized symptoms. And changes to your breasts are on this list. These changes can include increased breast tenderness, a shift in breast size, and changes in breast density.

Being aware of and recognizing the normalcy of these alterations is key in navigating this stage with confidence and assurance.

Hormonal Fluctuations and Their Impact

During perimenopause, your estrogen levels fluctuate wildly as your ovaries gradually reduce their estrogen production. This hormone is responsible for regulating menstrual cycles and also impacts many other systems in your body. As estrogen levels rise and fall, you may experience symptoms such as hot flashes, sleep disturbances, mood swings, and changes in breast tissue. Progesterone, another key hormone, also declines during this phase, which can lead to irregular periods and other perimenopausal symptoms like breast tenderness.

Breast Changes and Symptoms

Even before perimenopause, sore breasts are very common. Your menstrual cycle and pregnancy can both cause breast pain due to the hormonal changes associated with these events. If you’ve already experienced breast pain related to your cycle, known as cyclical mastalgia, you may notice a worsening of your symptoms. You could also notice new or different breast pain during perimenopause.

It’s important to note that you can have cyclical pain even after your periods have stopped. And while noncyclical pain can also occur due to hormonal changes, particularly after you’ve achieved menopause, it’s important to have breast pain that is constant evaluated by your doctor.

According to a study by Women Living Better, the return or onset of sore breasts before your period can signal the beginning of perimenopause. The good news is that sore breasts is a symptom that typically decreases across perimenopause, as you get closer to your final menstrual period.

While fluctuating hormones are usually at play when it comes to breast changes,  it’s important for you to recognize what’s typical and what may require a closer look.

Typical Breast Changes

Your breasts are composed of lobules, ducts, connective tissue, and fatty tissue. As you approach perimenopause, changes in these components can lead to:

  • Size and shape alterations: Hormonal shifts can cause your breasts to change in size and shape, potentially leading to swelling or sagging. You may experience breast growth. (We’re still hoping for this one to happen!) And you might experience the opposite. Loss of fullness and sagging are common due to declining estrogen.
  • Breast tenderness: Fluctuating estrogen levels often result in breast tenderness or pain. For some, it feels like a dull, aching pain while others can experience a heaviness, tightness, or burning. In some people only one breast is affected, while others experience similar symptoms in both breasts. Often this tenderness or pain can be worse than what you used to experience just before your period. It can also be a different type of pain than what you felt prior to perimenopause.
  • Fibrocystic changes: These are noncancerous changes that can make breast tissue feel lumpy or rope-like in texture.

Hormone therapy can also impact your breasts, causing cysts and/or increasing breast density.

An understanding of these transformations can help you distinguish between normal changes and those that warrant medical attention.

Breast changes that need to be seen by your doctor.

Recognizing Symptoms and Anomalies

While most breast changes are benign, you should be vigilant about certain symptoms that may necessitate a consult with your healthcare provider. Examples of changes that should be evaluated by your doctor include:

  • Lumps: A new lump or persistent lump in your breast or under your arm should be evaluated.
  • Nipple discharge: Any unexplained discharge, particularly if it’s bloody or clear, could be a sign of a problem.
  • Continued pain: Breast pain that doesn’t ebb with your menstrual cycle should be assessed.
  • Skin changes: dimples, puckering or thickening should all be evaluated.

For a comprehensive check list of symptoms that should be evaluated, visit This initiative was created to improve early detection. You’ll find detailed information about the 12 symptoms of breast cancer. They also have a breast health self-exam app. Use it to learn how to do a proper self-exam, understand your risk factors, and create a custom screening plan for yourself.

Screening and Prevention

Regular screening and preventive measures can play a crucial role in your overall well-being during perimenopause. They are key to early detection and reducing the risks associated with breast cancer.

Experts suggest that women start annual mammogram screening at age 40. Some suggest getting a baseline at age 35.

A mammogram is the only way to determine your breast density. Those with dense breasts have a greater risk of developing breast cancer. They should also have supplemental ultrasound screening as a mammogram cannot always detect cancer in dense breast tissue.

Discussing your risk factors, including breast density, family history and ethnicity, is important to ensure you have a screening plan that is right for you.

Lifestyle and Preventive Measures

To reduce risks of breast cancer, consider the following lifestyle changes:

  • Maintain a healthy weight: Obesity can increase your risk of breast cancer, especially after menopause.
  • Exercise regularly: Aim for at least 150 minutes of moderate-intensity or 75 minutes of high-intensity exercise each week.
  • Limit alcohol consumption: Alcohol can increase the risk of breast cancer.

Managing Breast Pain

If you are experiencing breast pain in perimenopause, here are some suggestions:

Apply heat: using a heating pad or a warm bath can be helpful in reducing breast pain.

Medication: an anti-inflammatory medication like ibuprofen can help reduce swelling and pain.

Is it HRT?: Hormone replacement therapy can sometimes cause sore breasts. Although this symptom will often subside with time, a different formulation or adjustment to your prescription could help if your breast pain persists.

How’s your bra?: a lack of proper support can cause breast pain. And if you have experienced a change in shape, if may be a good time to get professionally fitted to ensure your bras fit you properly.

Reduce alcohol and caffeine: limiting caffeine and alcohol intake can reduce breast tenderness.

Know Your Lemons

The best course of action is to learn about your breasts so that you can monitor for any changes. It’s always important to seek help from a qualified medical provider to assess any new symptoms that seem unusual. And everyone should start screening at age 40, and have a screening plan that is based on their specific risk profile. Breast density, your ethnicity, and family history all impact your risk of breast cancer.

Breast pain is very common and usually there is no need for concern. And the good news is that this pain typically improves postmenopause. As with any symptom in perimenopause, don’t just assume you need to grin and bear the discomfort. Understanding your body and what perimenopause can bring will help you better navigate this time in your life. Remember, it should be about thriving, not just surviving.