4 surprising menopause symptoms — how it can change your breasts

More than half the population will experience it, yet menopause remains one of the most misunderstood and under-discussed topics — sometimes even in the doctor’s office.

In fact, surveys reveal that nearly half of US women feel completely uninformed about menopause, while close to 80% of medical residents admit they feel “barely comfortable” discussing or treating the issue.

That means many women are entering this phase of life uneducated and unsupported, often only bracing for familiar symptoms like hot flashes, night sweats, and fatigue. The Post spoke with two experts to uncover some of the lesser-known signs that fly under the radar of doctors and patients alike.

But first: what is menopause, and how is it different from perimenopause? 

Commonly referred to as “the change,” menopause is divided into three basic stages.

The first stage, perimenopause, is often described as “the mirror image of adolescence,” said Dr. Steven Goldstein, a gynecologist and professor at NYU Grossman School of Medicine.

“Adolescence is the onset of reproductive years. Perimenopause is the exit from them,” he said. 

Perimenopause typically starts in the late 40s and can last for several years. During this time, women experience irregular periods and fluctuating hormone levels, especially estrogen. This is when many of the familiar symptoms, like mood swings and vaginal dryness, tend to occur.

The second phase, menopause, is officially reached when a woman has gone 12 consecutive months without a period, signaling that her ovaries have stopped producing significant amounts of estrogen. The average age of menopause is 51.

“In menopause there should be no bleeding, whereas in perimenopause it’s all over the map,” said Goldstein. 

The third and final stage, postmenopause, begins after that 12-month period and lasts for the rest of a woman’s life. In this stage, estrogen levels remain low, and the ability to get pregnant is gone since the ovaries have stopped releasing eggs.

Now, let’s dive into some of the symptoms you might not know about. 

Breast size surprise

Nearly every part of a woman’s body is affected by menopause — including her chest. 

“A lot of patients will come in and look at me quizzically because they’ll go through menopause and their bra size has gone up a cup,” said Goldstein. 

While that may sound counterintuitive, he explained that it has to do with the redistribution of fat that happens as women undergo the hormonal changes of menopause.

“Normal breast tissue is very dense. As you get older, with a lack of estrogen, a lot of that gets replaced with fat,” said Goldstein. “As a result, women often get an increase in fullness.” 

But the same drop in estrogen can sometimes have the opposite effect. In its absence, the body stops supporting the system that produces breast milk, causing the mammary glands to shrink and the breasts to appear smaller in some women.

Research suggests that about 1 in 5 women will need a new bra size after menopause — mostly larger, though around 2% report needing a smaller size.

Aches and pains

Menopause and achy joints? Not something you hear about often, but it’s more common than you might think.

“Up to 50% of women will experience joint pain,” said Dr. Susan Loeb-Zeitlin, a gynecologist at New York-Presbyterian and the director of the Women’s Midlife Center at Weill Cornell Medicine. 

The symptom typically shows up during perimenopause, and Loeb-Zeitlin notes that it sometimes improves after the menopause transition.

Scientists are still working to understand the exact cause of joint pain during menopause, but the decline in estrogen is believed to play a major role. Estrogen helps protect joints, reduce inflammation, and support our muscles, tendons, and ligaments.

Women going through menopause may also be at a higher risk for osteoarthritis, a degenerative joint disease that affects the cartilage cushioning the ends of bones. This can result in pain, swelling, and stiffness.

Bladder trouble

There are many changes to the vagina that happen during menopause, and they can affect other parts of your body too. 

“The bladder is connected to the vagina, so you can get a lot of urinary symptoms, including the urgency and frequency of urination,” Loeb-Zeitlin said. 

Studies suggest the most common bladder symptoms during menopause include nocturia, or frequent nighttime urination, and incontinence, which is the involuntary loss of urine during activities like coughing, laughing, or exercising.

This likely happens because of the drop in estrogen, which Loeb-Zeitlin said weakens the pelvic floor muscles that help support the bladder.

UTI alert

You might want to stock up on cranberry juice. Loeb-Zeitlin said menopause increases the risk of developing urinary tract infections, or UTIs. 

This is largely due to the decrease in estrogen, which causes the vaginal and urethral lining to thin. When this happens, bacteria can more easily enter and travel to the bladder, increasing the likelihood of infection.

Estrogen also plays a role in maintaining the healthy bacteria in the vagina and bladder that fight off infection-causing bacteria. After menopause, low estrogen levels reduce this defense system, making women more susceptible to UTIs, according to the American College of Obstetricians and gynecologists.