Before menopause, there is perimenopause. During this time, women can experience different, often confronting, symptoms in our breasts. Some are normal, some are not, and it’s time we start talking about it, particularly as breast cancer is on the rise in Australia.
Cases have increased from 136 per 100,000 females in 2000 to an estimated 150 cases per 100,000 females in 2023, as per the Australian Institute of Health and Welfare. Breast cancer is the most commonly diagnosed cancer for persons aged 40 to 59. For most women, this age period corresponds with perimenopause.
“This change before the change is a really significant time that is not often talked about, sandwiched as it is between youth and menopause” says Australia’s leading breast cancer surgeon, Associate Professor Sanjay Warrier, who has developed the world’s first Master of Breast Surgery degree.
It is during perimenopause that we must pay extra attention to our breasts and how they are changing.
“Perimenopause is the transitional phase prior to menopause,” adds Professor Warrier. “Often this can range from months to years. On average it lasts four-six years but can last up to ten years. We consider the perimenopausal period to finish one year after the last period. “
This period generally commences from our 40s right up until menopause, typically in our late 40s and early 50s.
What are the symptoms of perimenopause?
While initially, perimenopause may lead to reduction in progesterone, you may not notice any symptoms, says Warrier.
“From there (early 40s) there is often a period where women experience fluctuating levels of oestrogen and progresterone which leads to irregularities in their menstrual cycle, and peaks of hormones can lead to increased sensitivity in the breasts,” the professor explains.
“It is also not uncommon to see an increase in fluid retention and an increase in cysts and lumps around this time. A lot of the time this can be normal. As perimenopause continues, this can lead to a reduction in sensitivity as oestrogen and progresterone levels reduce, often leading to a reduction in the symptoms.”
How to recognise changes in our breasts
First, we need to become familiar with our breasts so we can observe how they respond to variations in hormone levels.
“With these variations the breasts can become very tender and can become enlarged,” says the surgeon. “This can make it very confusing and difficult to elucidate whether there is a concerning change.”
He recommends growing comfortable with your breasts through self-checks. The Look, Lift and Feel method is an easy way to examine your breasts. It takes five minutes, and should be carried out every three months.
- Look: “First of all, look at your breasts to see if there are any obvious changes in your breasts, i.e dimpling or skin retraction, nipple discharge or scaling,” says Warrier.
- Lift: “Next, lift your arms up, focusing on the breasts, lifting the breasts with the other arm and feeling around the breast.”
- Feel: “Finally, feel your breasts for any obvious lumps or bumps. The breasts can be examined systematically, in one of three ways. The first is a circular motion around the breasts, the other method is working down the breast, which is a vertical strip method, and the third is a radial spoke, where you start from the centre of the breast and work outwards. It is important not to forget to feel the outer aspect of the breasts that we call the axillary tail, which is just under the arm.”
If a bump or change is found, Warrier suggests seeing a health professional like a general practitioner (GP) or a breast specialist.
How can we reduce our risk of breast cancer?
When it comes to preventing breast cancer, there are many factors out of our control – including genetics, sex, family history, breast density, race, and so on. However, there are a few lifestyle choices which may help lower our risk of breast cancer.
“Maintaining a healthy lifestyle is important in reducing your general cancer risk such as maintaining a healthy weight, exercising regularly, reducing alcohol intake and smoking cessation,” says Warrier.
“During the period of perimenopause and menopause, consistent exercise can help with symptoms. There have been studies that indicate that exercise reduces estrogen and progesterone levels. Part of this is likely related to weight loss and reduced fat storage.
“We know that there is particular enzyme that converts fat to oestrogen (aromatase enzyme) so reducing fat would assist in reducing the levels. Regular exercise is a great mechanism for stress reduction which also no doubt has an impact on cancer as it can impact the microenvironment of the cancer.”
This article takes health advice from the AIHW and Associate Professor Warrier. Always conduct your own research and seek medical advice specific to your circumstances.