Like the other known menopausal changes, these breast changes are a part of the normal aging process. Like most menopausal symptoms, the severity of change may be dramatic for some, while others may only notice a subtle difference. Breasts are made up of glandular, fatty, and connective tissue. The glandular tissue forms lobes and ducts and is responsible for producing milk. Connective tissue gives breasts their shape and supports the internal glands. Fatty tissue in the breasts plays a vital role in secreting growth factors and enzymes and spurs mammary gland development at puberty.
The Role of Estrogen
These menopausal breast changes are due to the body’s response to decreased estrogen levels, the group of hormones necessary for sexual development. Though men have a small amount of estrogen, women have much higher levels, which is associated with female sexual development, as the ovaries produce most of the body’s estrogen. This hormone also helps regulate metabolic functions, such as sensitivity to insulin, glucose metabolism, and body weight regulation. The impact on the breasts comes into play throughout women’s life, as breast tissue is loaded with estrogen receptors and is very sensitive to its presence.
As estrogen regulates the lining of the uterus for menstruation and the early stages of pregnancy, it also controls lactation. A rise in estrogen causes the mammary glands in the breasts to grow in number and size to prepare for milk production during pregnancy. At menopause, the ovaries shut down normal functions and stop producing estrogen. This reduction in estrogen levels is then responsible for several metabolic changes which cause changes to the size and shape of women’s breasts including breast enlargement, breast sagging and lumps in the breast.
Breast Enlargement, and Shrinking
About one in five women experience breast enlargement after menopause. Once estrogen levels diminish, the glandular tissue in the breast begins to atrophy and is replaced by fatty tissue. This increase in extra fat is what causes breast enlargement. Because estrogen also modulates glucose metabolism the decreased estrogen levels are associated with a propensity to gain weight, particularly with fat deposits that settle in the breasts, waist, and hips. Thus, breast enlargement during menopause can be attributed to the replacement of glandular tissue with fatty tissue and may also result from overall weight gain.
A much smaller portion of women, estimated at one in fifty, may see an overall reduction in breast size due to estrogen changes. The shrinkage is also due to atrophy of the glandular tissue in response to low estrogen, however accompanied with a lack of additional fatty tissue replacement.
Because of the chance of breast changes, women should check their bra size frequently during menopause, as a proper bra fit will provide the support necessary to alleviate discomfort in cases of breast enlargement.
The connective tissue in the breasts gives them firmness and shape. Estrogen levels work to increase the collagen level in the connective tissue. Collagen is the most critical load-bearing and most prevalent protein in the human body. This collagen gives the breast tissue the strength and elasticity it needs to hold its form, however with decreased estrogen levels at menopause, collagen decreases and the connective tissue in the breasts loses its strength and elasticity. In addition, the fibrous tissue shrinks, loses elasticity, becomes brittle, and can no longer carry the load. As a result, breasts lose their form and succumb to gravity. Nipples lose height and may point downward. Ptosis is the medical term for sagging breasts, and it is a natural occurrence of aging that all women will experience at some point.
During menopause, some women will develop lumps in their breasts, that are typically cysts or fluid-filled sacs inside the breast’s fibrous tissue. One cyst may form, or there can be multiple cysts. They may be soft, with the consistency of a grape, or may feel firm to the touch. These cysts arise as a result of hormonal changes and are usually harmless and left alone, however if they are causing discomfort, a physician can insert a needle into the cyst to remove the fluid buildup and alleviate pressure.
While post-menopausal breast size and shape changes are typical to the aging process, it is essential to discuss them with a physician as they occur. A physician can help properly monitor these changes at checkups and be on the lookout for any changes that may be worrisome and will help to ensure the normal aging process proceeds in comfort and good health.