What's the deal with menopause boobs?

Like most issues in women's health, research is scant re the one out of five women whose breast size increases during menopause. But could rapidly enlarging boobs signal more serious metabolic issues?

My grandmother Kate and her sisters, Ruth and Gussie, all wore the kinds of 1950s-era bullet bras that turned their ample bosoms into, well, not really bullets per se but more like torpedos. I couldn’t wait to have a similarly large and pointy pair of my own.

Grandma Kate never knew me with breasts, as she died young of a heart attack when I was nine. Great Aunt Ruthie went next, felled by a broken hip. At Aunt Ruthie’s funeral, Gussie stood over her sister’s freshly dug grave—right as the casket was being lowered into the ground, and the rabbi was reciting Kaddish—and began to shout. “Wait a minute! Wait a minute! That’s my hole! I’m supposed to be buried next to Milton.” Her boob shelf was so large at that point, and she was standing so close to the edge of the grave, I was worried she’d topple straight into the hole. Which, as the rabbi patiently explained, was definitely her sister’s, not hers.

“See, look,” he said, “Milton’s head is over here, and his feet are here.” Milton was Aunt Gussie’s first husband. Ruth had been married, but only for a week. Her husband had brought his mother along on the honeymoon, and that was the end of that. Gussie wanted to be buried next to Milton, and she finally would be, a few years later. But for the next fifteen minutes or so, Gussie remained convinced that her sister was stealing her rightful place next to Milton.

At this point in our story—getting back to boobs—my breasts were a modest size 32B. Oh, well, I thought, glancing around at my well-endowed female relatives, most of them holding their mouths, trying not to laugh. I got the short end of the family boob stick. When we’re all together, you can really see it. We are shtetl people: short, stocky, with a low center of gravity, and well-built for yanking potatoes out of the ground and running from Cossacks.

Fast forward to my late twenties. After having nursed my first child, my breasts settled into a 34C, which is where they stayed, uneventfully, except when I was nursing babies #2 and #3. Then, a couple of years ago, around age 58¹ or so, I started noticing changes in the size and contours of my body without any significant changes to my diet. My once effortlessly flat belly grew a soft and spongy pooch. The number on my scale, which had remained steady for three decades, slowly crept up, month by month—a pound here, another pound there— from 112 lbs to 129. Yes, I was happy by age 58, and when I’m happy I eat instead of skipping meals from anhedonia and apathy. Yes, I’d started lifting heavy weights during that period, so let’s estimate between 5-10 of those extra pounds were due to new muscle mass. But the rest of that gain, I knew, was due to the metabolic changes in menopause, meaning a slowed metabolism and the redistribution of fat throughout the body.

Then I started noticing that my bras—four of which I’d just purchased, and not cheaply—no longer fit. My 34C breasts had now inflated to a 34D.

I started asking women my age, “Are your boobs getting bigger?” Many of my friends said yes, their boobs were getting bigger. (Only one of my friends, in my small sample size of around 20, complained that hers were getting smaller.) Another friend’s once average-sized bosom had grown so large and so cumbersome in menopause, the straps of her running bra—the only bra she could now wear—started carving large divots into her shoulders. Her back pain finally became so untenable from the added weight that she recently underwent a breast reduction.

What the hell was going on?, I wondered. In all of my research into menopause and its symptoms, why had I never heard about inflatable boobs? I did some digging, and as with most things concerning women’s health and menopause, there was scant research. I found one paper from 2004 entitled, “Increase in breast size after menopause: prevalence and determinants.” The conclusion? “About one in five women experienced an increase in breast size after menopause. The most important factor associated with such an increase was found to be weight gain.” Okay. Sure. Another paper, from 2015, tried to connect the loss of dense breast tissue, the gain of fatty breast tissue, and an increase incidence of breast cancer, but it was inconclusive. “Whether an increase in nondense area, or breast fat tissue, has a role in breast cancer risk separately from general high weight or weight gain deserves further investigation.”

I did not find any further investigations.

I also wondered whether the 20% of women whose boobs get bigger and fattier in menopause should see them not just as an interesting turn of events but rather as a harbinger of health challenges to come. Grandma Kate died young of a heart attack. I now looked strikingly like her. What were my boobs trying to tell me?

Then, a couple of weeks ago, I spoke on a women’s health panel at Princeton University organized by Aly Cohen MD, whom I’d recently interviewed for this publication. So I decided to take advantage of having all of those doctors and clinical knowledge at my fingertips to ask several physicians at the summit about my rapidly expanding boobs. Again and again, I was told that yes, adipose tissue finds its way into our breasts in menopause; that yes, fat creates its own hormones, and not necessarily the kind I want circulating in my body; and yes, my boobs are telling me something I need to know about my risk for heart disease, particularly since every single one of my grandparents died of a heart attack.

One doctor at the summit, Dr. Jennifer Ashton, gave a lecture in which she said she believes that adding a GLP-1, in combination with estrogen—albeit off-label, at this point, until research catches up with reality in an estimated five to seven years—might prove to be one of the keys to preventing heart disease in women after the menopause transition. In fact, she thinks that, once the data is finally in, women like me, who are in menopause and at risk for heart disease, will be prescribed GLP-1s along with estrogen as a matter of course.

She stressed that this was not a cosmetic issue. Rather, it is a metabolic issue of counteracting the kind of inflammation the menopausal body undergoes after menopause. Here’s Dr. Ashton herself, explaining this reasoning:

Inflammation, over the course of my life, has been one of my greatest health challenges. Adenomyosis, appendicitis, hearing loss, POTS, and so many of the other ailments I wrote about both here and in my most recent book can be traced back to chronic inflammation. Dr. Ashton agreed and said that she’d started herself on a microdose of GLP1 as well for that same reason. She is tall and thin, a woman who does not need to lose weight. But skinny does not mean inflammation free. She simply wants the third act of her life to be a healthy one. In fact longevity, she said in her lecture, should not be our main goal. What we should all be focusing on is doing what we can to keep our bodies as healthy as possible—and yes, that means free of inflammation—with whatever time we have left.

Had Grandma Kate, with her post-menopausal shelf of boobs, had access to a GLP-1 when she hit menopause, might she have lived a bit longer? Pictures I’ve seen of her when she was younger, before I was born, show the kind of smaller-to-medium sized breasts I once had. Meaning her boobs, like mine, also grew in menopause and may have been a harbinger of the deadly inflammation lurking inside her. Heart disease is the leading cause of death in women. So yes. You better believe I’ll be discussing adding a GLP-1 to my cocktail of supplements at my next annual physical in June. The challenge will be convincing my insurance to cover it since my BMI is normal. Prevention is not our strong suit in the U.S., as I’ve written about again and again. Insurance would rather patch you back together after you’re broken or do nothing at all rather than prevent you from breaking apart in the first place.

I hope Aunt Gussie and Uncle Milton are enjoying their side-by-side forevers. I wish Aunt Ruth had been taught to lift heavy weights instead of succumbing to a hip fracture. I’m sad I missed out on years of my grandmother’s love. And I hope one day medicine will invest real research dollars into the study of women’s bodies so that we’re not left wondering why the hell our boobs have become giant Hindenburgs, what that signals, and what we need to do about it to live well in our golden years.

1. I went through surgical menopause at age 46, due to a hysterectomy, but I’m pretty sure my ovaries kept plugging along until around recently, when I first started noticing these other physical changes.