Menopausal breast health: cysts, symptoms and screening

At last, a good reason to start into the menopause: bigger breasts (if you’re not already well endowed), according to actor Helena Bonham Carter, who describes them as “the one benefit about menopause”.

It’s just another in the long list of possible side effects of this hormonal transition in every woman’s life. Although it affects only a minority, bigger breasts can occur in the perimenopause, which can last several years before menopause is said to have taken place.

It’s typical of women in their 40s, says Dr Rachel Mackey of the Women’s Health Clinic in Dún Laoghaire, Co Dublin, and is seen even before periods start to become irregular. This swelling in the glandular part of breast tissue is caused by an “exaggerated imbalance in the premenstrual hormones”, says Mackey.

Some of her patients switch to bras a full cup size bigger at certain times of the month and she advises a firm, non-underwired bra in bed for support. There are a couple of vitamins that she says have been shown to bring about some small relief, along with evening primrose oil. Avoiding tea and coffee, which cause fluid retention, may help too. Sadly, though, if bigger breasts are still present once menopause is reached the cause is actually weight gain.

Women who have been prone to breast cysts, which are also hormonally dependent, may find they develop cysts very quickly at this stage and that can be acutely painful, according to Mackey. Those with fibrocystic breasts and who are used to them feeling lumpy may find their breasts becoming more tender. Even if it’s just breast pain, Mackey would advise women to have it checked out. Every new symptom needs to be checked and not assumed to be the same condition as last time.

Tenderness

Several doctors’ surgeries and women’s health clinics around the country offer menopause health checks. Nancy Murphy, clinic nurse manager at the Women’s Health Clinic in Newcastle West in Co Limerick, says that almost all women complain of breast tenderness and she points out that pain is usually a good sign if women are worried about something sinister.

However, the numbers attending for breast cancer screening have fallen from 77 per cent to 71 per cent in the past four years, with BreastCheck expressing its concern that “women in their early 50s are becoming more likely to not take up their appointment”. The numbers attending screening vary across Europe but also show a drop-off in several countries over time according to figures supplied by the National Screening Service here.

BreastCheck research late last year among those who do and don’t attend showed that the majority were aware of the benefits of screening. There is, however, a minority who talk of fear, anxiety, pain and “the unknown” and who, it says, need support in their decision to participate. There’s also the possibility that some women have noted the ongoing controversy about breast cancer screening and are choosing not to take part.

Dr Caitriona Henchion, medical director of the Irish Family Planning Association, says that some women don't realise that they won't automatically be on a register for BreastCheck. She does notice women who have turned 50 and who haven't been invited yet for a mammogram and encourages them to engage with the service. However, women still need to stay breast aware, and not rely on a mammogram to detect anything.

Loss of oestrogen

One of the features of menopause is that the loss of oestrogen causes a reduction in breast density. Women who are put on hormone replacement therapy (HRT) and whose breasts have become less used to oestrogen may then find they get swelling again, says Henchion.

HRT appears now to carry no more risk of breast cancer for those aged over 50, if taken at the lowest dose for no more than five years. After five years, there is an increased risk but Henchion believes it can be used if necessary beyond this once women are aware of the risks.

Oestrogen-only HRT is associated with no increased risk, but is suitable only for women with no uterus.

Is there enough information out there for women about menopause, which affects thousands of women at any one time?

“Oh no, it’s appalling, it’s absolutely appalling, it’s really badly served,” says Mackey. She echoes what others say of women, that we tend to be hard on ourselves and put up with symptoms such as heavy periods and depression when there is medical help available. Henchion says that many women say they never got the information before about what was causing their symptoms. “It’s not generally coming from medical professionals,” she feels.

A booklet about the menopause is available to download at healthpromotion.ie.

See breastcheck.ie or call 1800 45 45 55. Nancy Murphy's book Preparation for Pregnancy, Birth and Motherhood, which covers many aspects of women's reproductive health, is available from leading bookshops, or from pregnancybirthmotherhoodpreparation.com