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?
I have this same issue! Just today I am MarieKondo-ing my bras...having accepted that I will never be a B cup again. I can't say I like this change so much...not least because I had some very cute bras that don't fit anymore. I am trying to be accepting of this new situation. My partner likes them...I feel like your art at the top of the post...like I am carrying around two cantaloupes. However, my main hope is that they remain healthy.
I have yet to throw out the old bras. But you’re giving me encouragement. And my partner, too, is not unhappy with this plot twist. But still: I’m hoping to have a meaningful conversation with my provider at my annual physical.
I did talk with my doctor...and she reported that this was fairly common. What was weird was that it seemed to happen suddenly...my doctor was reassuring. It is a plot twist. I had expected the opposite!
Same, same, same!! From a lifelong 34 C to 34DDD, and a pooch, seemingly overnight. Deborah, you make me feel seen, and less crazy. And with a significant history of heart disease on my father’s side, you bet I will be taking this up with my gyno and my primary care provider. Thanks as always for your important, poignant reporting.
I’m so glad you wrote about this as I’ve been wondering what the hell is up with my boobs. They’ve always been large, and while they’re not expanding in cup size (yet), they feel heavier than ever. I also have inflammation in other body parts. I will be talking to my doctor about GLP-1 microdosing. The weight loss would be a bonus as I’ve gained 2 pant sizes since menopause. Otherwise I feel strong and healthy. Thank you, Deb, for personalizing this issue. And what a loving, complicated family history!
Accessibility and insurance coverage of GLP-1 medications could be a topic for a whole book. Insurance companies are rapidly dropping coverage even for patients who truly meet the diagnostic criteria, people who could massively benefit from these life-changing drugs. They are just too expensive.
The brand-name versions cost $500-1000+/month, slightly less for the lowest starting doses. The meds became available via compounding pharmacies and telehealth prescribers during temporary shortages for <$200/month. Right now you can still get compounded semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound), but Novo Nordisk and Eli Lilly are charging hard to shut that down. Lilly is worth almost a trillion dollars at this point.
True “microdosing” (using less than the lowest commercially available dose) is really only possible with compounded meds, which come in multi-use vials that allow you to control your dose. There are ways around using the full dose from a pre-dosed autoinjector or single-use vial, but those methods are not a mainstream solution.
And then there’s the gray market, with cheap “research-only”/"not for human use" drugs coming in from China. Humans are absolutely using them.
Don’t get me started on how problematic VC-funded telehealth is becoming. And med spas with often shady prescribing and dispensing practices. And the grifty menopause/wellness space in general. All absolutely exploiting women, but also meeting a need in the marketplace that mainstream medicine and insurance companies are not satisfying. Does this comment box have a character limit? Lol.
The bright point in all this is that the GLP-1 drug-discovery pipeline is huge and moving fast, with dozens of new meds currently in the works. As new drugs hit the market, we can *hope* that the older ones will become more affordable and accessible. And that as you mentioned, they will be approved for more indications beyond the current ones (diabetes, obesity, obstructive sleep apnea, cardiovascular risk, and MASH so far I believe), and - fingers crossed - eventually covered by insurance.
Someone told me that if you contact Lilly directly, via their website, you can get it for a non-insurance lower cost. I'll have to look into all of this. So frustrating, for sure. Thank you for this long and thoughtful comment. It is so useful for all of us!
Sort of. Zepbound comes in six different dosages. Everyone starts at 2.5mg for four weeks at a minimum, and then titrates up through the dosages as needed to achieve the desired effect while minimizing side effects. Lilly Direct's "Self Pay Journey Program" (no insurance) is $299/mo for the 2.5mg starter dose, $399/mo for the next step up, and $449/mo for the four remaining higher doses. I don't know the numbers, but based on my time in user forums, I'm guessing the vast majority of Lilly Direct users titrate up past the lowest two doses and are paying $449/mo.
But you only get this pricing if you reorder within 45 days. If you try game the system, for example by ordering a higher dose than you're actually using and getting two months out of a one-month order, the price goes up to $699 for the higher doses.
The Lilly self-pay option is still way out of reach for many, if not most, patients.
This is fascinating! I thought I had imagined that my modest top line had grown bigger, then blamed some bouncy weight gain-loss situations in my mid-50s for never finding a bra that fit in my collection of a million sizes. But my weight has stabilized after about 18 months of GLP-1 microdosing and I still have cleavage. (The microdosing is accidental—as a highly sensitive person I also react very strongly to many medications, and a little semagutide goes a very long way with me.)
Thank you. Now I wonder if the red spots ( similar in appreance to hives) that are present as I lose weight are inflamed areas resulting from toxins that are released as the fat cells are metabolized. Losing weight just from eating less. Inflammation has always been a problem. And yes my bust is larger after menopause than it was prior to menapause. I'm 84 now so even menapause was a long time ago...
well this is comforting to hear and also UGH. My story is similar to yours - didn't really gain any weight from about 20-50 and then.....and yes, the boobs are suddenly a D which is crazy (from a small A/B) - I wish there were some other ways to address these changes and inflammation without meds though. While I adore HRT, I'm am not sure I want a life dependent on Big Pharm considering the state our our Health and Health Insurance in this country but thank you for bringing this issue up!
I have this same issue! Just today I am MarieKondo-ing my bras...having accepted that I will never be a B cup again. I can't say I like this change so much...not least because I had some very cute bras that don't fit anymore. I am trying to be accepting of this new situation. My partner likes them...I feel like your art at the top of the post...like I am carrying around two cantaloupes. However, my main hope is that they remain healthy.
I have yet to throw out the old bras. But you’re giving me encouragement. And my partner, too, is not unhappy with this plot twist. But still: I’m hoping to have a meaningful conversation with my provider at my annual physical.
I did talk with my doctor...and she reported that this was fairly common. What was weird was that it seemed to happen suddenly...my doctor was reassuring. It is a plot twist. I had expected the opposite!
Same, same, same!! From a lifelong 34 C to 34DDD, and a pooch, seemingly overnight. Deborah, you make me feel seen, and less crazy. And with a significant history of heart disease on my father’s side, you bet I will be taking this up with my gyno and my primary care provider. Thanks as always for your important, poignant reporting.
Yay!
I’m so glad you wrote about this as I’ve been wondering what the hell is up with my boobs. They’ve always been large, and while they’re not expanding in cup size (yet), they feel heavier than ever. I also have inflammation in other body parts. I will be talking to my doctor about GLP-1 microdosing. The weight loss would be a bonus as I’ve gained 2 pant sizes since menopause. Otherwise I feel strong and healthy. Thank you, Deb, for personalizing this issue. And what a loving, complicated family history!
Thank YOU for this lovely comment.
Accessibility and insurance coverage of GLP-1 medications could be a topic for a whole book. Insurance companies are rapidly dropping coverage even for patients who truly meet the diagnostic criteria, people who could massively benefit from these life-changing drugs. They are just too expensive.
The brand-name versions cost $500-1000+/month, slightly less for the lowest starting doses. The meds became available via compounding pharmacies and telehealth prescribers during temporary shortages for <$200/month. Right now you can still get compounded semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound), but Novo Nordisk and Eli Lilly are charging hard to shut that down. Lilly is worth almost a trillion dollars at this point.
True “microdosing” (using less than the lowest commercially available dose) is really only possible with compounded meds, which come in multi-use vials that allow you to control your dose. There are ways around using the full dose from a pre-dosed autoinjector or single-use vial, but those methods are not a mainstream solution.
And then there’s the gray market, with cheap “research-only”/"not for human use" drugs coming in from China. Humans are absolutely using them.
Don’t get me started on how problematic VC-funded telehealth is becoming. And med spas with often shady prescribing and dispensing practices. And the grifty menopause/wellness space in general. All absolutely exploiting women, but also meeting a need in the marketplace that mainstream medicine and insurance companies are not satisfying. Does this comment box have a character limit? Lol.
The bright point in all this is that the GLP-1 drug-discovery pipeline is huge and moving fast, with dozens of new meds currently in the works. As new drugs hit the market, we can *hope* that the older ones will become more affordable and accessible. And that as you mentioned, they will be approved for more indications beyond the current ones (diabetes, obesity, obstructive sleep apnea, cardiovascular risk, and MASH so far I believe), and - fingers crossed - eventually covered by insurance.
Someone told me that if you contact Lilly directly, via their website, you can get it for a non-insurance lower cost. I'll have to look into all of this. So frustrating, for sure. Thank you for this long and thoughtful comment. It is so useful for all of us!
Sort of. Zepbound comes in six different dosages. Everyone starts at 2.5mg for four weeks at a minimum, and then titrates up through the dosages as needed to achieve the desired effect while minimizing side effects. Lilly Direct's "Self Pay Journey Program" (no insurance) is $299/mo for the 2.5mg starter dose, $399/mo for the next step up, and $449/mo for the four remaining higher doses. I don't know the numbers, but based on my time in user forums, I'm guessing the vast majority of Lilly Direct users titrate up past the lowest two doses and are paying $449/mo.
But you only get this pricing if you reorder within 45 days. If you try game the system, for example by ordering a higher dose than you're actually using and getting two months out of a one-month order, the price goes up to $699 for the higher doses.
The Lilly self-pay option is still way out of reach for many, if not most, patients.
Yeah. That’s pricey for sure. Thank you for this incredibly useful info. Appreciate it.
This is fascinating! I thought I had imagined that my modest top line had grown bigger, then blamed some bouncy weight gain-loss situations in my mid-50s for never finding a bra that fit in my collection of a million sizes. But my weight has stabilized after about 18 months of GLP-1 microdosing and I still have cleavage. (The microdosing is accidental—as a highly sensitive person I also react very strongly to many medications, and a little semagutide goes a very long way with me.)
Oh, fascinating! And yeah: in 1 out of 5 menopausal women, boob escalation is definitely a thing. :)
Thank you. Now I wonder if the red spots ( similar in appreance to hives) that are present as I lose weight are inflamed areas resulting from toxins that are released as the fat cells are metabolized. Losing weight just from eating less. Inflammation has always been a problem. And yes my bust is larger after menopause than it was prior to menapause. I'm 84 now so even menapause was a long time ago...
well this is comforting to hear and also UGH. My story is similar to yours - didn't really gain any weight from about 20-50 and then.....and yes, the boobs are suddenly a D which is crazy (from a small A/B) - I wish there were some other ways to address these changes and inflammation without meds though. While I adore HRT, I'm am not sure I want a life dependent on Big Pharm considering the state our our Health and Health Insurance in this country but thank you for bringing this issue up!
Deb, your Substack is always so illuminating and validating in terms of women's health issues!