Pause & Effect

No fluff. No fear. No judgement. Just the knowledge you need to make the best decisions for yourself.

Don't Skip the Squish

menopause 101 menopause self-care menopause symptoms menopause treatment menopause wellness Oct 17, 2025

Nobody wakes up excited about getting their boobs pancaked between two cold plates of plastic. But with today being National Mammography Day, I want to talk about why this slightly uncomfortable procedure is one of the most important things you can do for yourself during and after menopause.

I'll explain the whole "who, what, when, why, and how" without making you feel like you're reading a medical textbook as well as give you an action plan for today.

But if you only take one thing away from this, it’s that mammograms have saved lives. They've saved the lives of women I know, women you know, and quite possibly will save yours or mine.

So, let's talk about why scheduling that appointment matters, especially now that we're in this fabulous second act of life.

What Is a Mammogram?

It's a specialized X-ray of your breast tissue designed to catch abnormalities (including potential cancer) before you or your doctor can feel them
The machine uses low-dose radiation at about the same amount you'd get from background radiation in three months
Modern mammograms are digital, which means clearer images, faster results, and less time wondering if everything's okay

A mammogram is essentially your breasts' version of a security checkpoint. The technologist (who has seen thousands of breasts and won't bat an eye at yours) will position each breast on a platform, then lower a compression paddle to flatten the tissue.

Yeah, "flatten" is the word we're using here. And yes, it sucks, particularly if you are part of the itty-bitty club, but flattening your breast tissue allows the X-ray to see through all the layers clearly, separates overlapping tissue that could hide something suspicious, and requires less radiation because the X-ray doesn't have to penetrate as deeply.

The whole process takes about 20-30 minutes, but your breast is actually compressed for only 10-15 seconds per image. Most women need two images per breast: one from top to bottom and one from side to side. If you have breast implants, you'll need eight images instead of four, but don't let that stop you from going.

Bottom line: Yes, it's uncomfortable. No, it doesn't take long. And the temporary squish is worth the peace of mind and early detection if something's there.

Who Needs Mammograms?

Short answer: pretty much all of us over 40.
Long answer: it depends on who you ask. Different organizations have different recommendations:
- The U.S. Preventive Services Task Force says to start at 40, get screened every two years until 74
- American College of Obstetricians & Gynecologists (ACOG) says to start annually at 40 and continue until 75 and after that should be based on discussion with your doctor
- The American Cancer Society says to start annually at 45, then switch to every two years at 55
- Your doctor might say to start earlier if you have risk factors

So, which is correct? Well, these guidelines are just that: guidelines. Your personal situation matters. If you have a family history of breast cancer, especially in a first-degree relative (mother, sister, daughter) who was diagnosed before 50, your doctor will likely recommend starting mammograms earlier, often 10 years before the age your relative was diagnosed.

Other factors that might mean you need earlier, or more frequent screening include having dense breasts (which about half of us do), a personal history of breast cancer, genetic mutations like BRCA1 or BRCA2, or previous radiation therapy to your chest before age 30. And if you are a Black women, the earlier the better. Black women have higher mortality rates from breast cancer than their white counterparts.

Bottom line: The general rule is to start at 40, but your personal health history might mean starting earlier or screening more frequently. Have a conversation with your doctor, the earlier the better.

When Should You Get a Mammogram?

Timing matters for two reasons: when in your life to start, and when during the month to schedule.

Life timing

As I mentioned above, most experts now agree that 40 is the magic number for average-risk women. The previous recommendation was 50, but they changed it because breast cancer diagnoses in women in their 40s have been increasing by about 2% per year. Not great news, but at least the screening guidelines caught up to reality.

Monthly timing

If you're still getting periods, schedule your mammogram for about a week after your period starts. Your breasts are less likely to be tender then, which makes the compression more bearable. If you're fully postmenopausal and your periods are a distant memory, you can schedule anytime, just pick a consistent time of year so you don't forget.

What does this mean for you? If you're perimenopausal or still having periods, consider annual mammograms. If you're fully postmenopausal, every two years might be fine, though many doctors still recommend annual screening and insurance typically covers it. Talk to your doctor about what makes sense for your situation.

Bottom line: Start at 40 (or earlier if you have risk factors) and consider your menopausal status when deciding between annual and biennial screening.

Why Mammograms Matter During & After Menopause

Eight out of ten breast cancer cases occur in women over 50 who have been through menopause. Your risk of developing breast cancer increases with age. That's not meant to scare you, it's meant to empower you to take action.

Here's what happens to your breasts during the menopause transition that affects both your breast cancer risk and your mammogram experience:

Your Breast Tissue Changes

As estrogen levels decline, your breast tissue becomes less dense and more fatty. This is actually good news for mammograms because fatty tissue shows up differently on X-rays than dense tissue, making it easier to spot abnormalities. Younger women with denser breasts can have a harder time getting clear mammogram results, but postmenopause, your images become clearer.

Your Hormone Exposure Timeline Matters

If you started your period before age 12 or went through menopause after age 55, you had more years of hormone exposure, which increases breast cancer risk. There's nothing you can do about that now, but it's another reason screening is so important.

Your Hormone Levels Play a Role

Postmenopausal women with higher levels of naturally circulating estrogen have about twice the risk of breast cancer compared to those with lower levels. And if you're carrying extra weight after menopause, your risk goes up even more, about 30% higher if you're obese compared to women at a healthy weight.

Menopause Hormone Therapy (aka Hormone Replacement Therapy or HRT)

If you're taking HRT for menopause symptoms, you need to know this affects your breast cancer risk, though the degree depends on what type you're taking and for how long. Estrogen-only HRT has little to no increased risk of breast cancer and is usually only given to women who've had a hysterectomy. Combined HRT (estrogen plus progestin) slightly increases breast cancer risk when used for five or more years, but the benefits often outweigh the risks for many women under 60.

The key word here is "slightly.” We're talking about three additional cases of invasive breast cancer per 1,000 women who took combination HRT for five years. Context matters. If you're taking HRT, continue your regular mammograms and have honest conversations with your doctor about your risk factors.

Here's something that might surprise you: experiencing severe menopausal symptoms, particularly hot flashes, might actually be associated with lower breast cancer risk. Some research suggests that women with more intense hot flashes have lower rates of certain types of breast cancer. The theory is that severe symptoms indicate a more dramatic drop in estrogen, which paradoxically might be protective.

Bottom line: Your risk increases with age, your breast tissue becomes easier to image after menopause, and regular screening is your best defense for catching any problems early when they're most treatable.

How to Prepare for Your Mammogram

Okay, let's get practical. Here's how to make your mammogram experience as smooth and comfortable as possible:

Before You Schedule

Pick a facility that specializes in mammography and does many mammograms daily (they'll be more efficient and have better equipment)
Try to go to the same facility each time so your mammograms can be easily compared year to year
If it's your first time at a facility, bring a list of previous mammograms with dates and locations, or better yet, get those records sent ahead

When Scheduling

Avoid the week before your period if you still get one (less breast tenderness = more comfortable compression)
Pick a consistent time each year so you don't forget, like scheduling it near a memorable date

The Day Before & Day Of

Skip the deodorant, powder, lotion, perfume, or any products on your breasts or underarms
Wear a two-piece outfit (you'll only need to remove your top)
Leave your good jewelry at home
Bring deodorant with you to apply after if you're not going straight home
Consider taking an over-the-counter pain reliever 30-60 minutes before if you're worried about discomfort
Cut back on caffeine and salt for a few days before, both can make your breasts more tender

What To Tell the Technologist

Any breast changes or symptoms you've noticed
If you have breast implants (they'll need to take more images)
If you think you might be pregnant or are breastfeeding
Your health history, including previous breast surgeries, biopsies, or cancer

During The Mammogram

Relax (yeah, easier said than done, but tense muscles make positioning harder)
Breathe normally
Speak up if you're experiencing pain, the technologist can sometimes adjust the compression slightly
Remember that the compression only lasts 10-15 seconds per image

Bottom line: A little preparation makes a big difference in comfort and image quality. Don't let fear of discomfort keep you from going.

What Happens Next?

After your mammogram, a radiologist will review your images and compare them to previous mammograms if available. You should receive your results within two weeks, if you haven't heard back, call them. Do not assume no news is good news. Here's what might happen:

Normal Results

Congratulations! Schedule your next mammogram for one or two years from now depending on your screening plan and continue with breast self-awareness.

Callback For Additional Imaging

About 10% of women will be called back for additional views, ultrasound, or other imaging. Before you panic, know this: only 2-4 mammograms out of every 1,000 lead to a diagnosis of cancer. Most callbacks are just because something needs a closer look, maybe tissue is overlapping in a weird way, or they need a different angle to see clearly.

If you're called back, you'll likely have a diagnostic mammogram, which is similar to a screening mammogram but with more images focused on the area of concern. They might do "spot views" or "magnification views" to get a better look.

Biopsy Recommended

About 8-10% of women who get called back will need a biopsy, and 80% of those biopsies will NOT show cancer. Even if you need a biopsy, the odds are still in your favor.

Dense Breast Tissue Notification

As of 2024, mammography facilities are required to tell you if you have dense breasts and recommend you discuss it with your doctor. Dense breasts are normal (about half of women have them), but they slightly increase breast cancer risk and can make mammograms harder to read. Your doctor might recommend supplemental screening like ultrasound or MRI.

Bottom line: Most mammogram results are normal, and even abnormal results usually don't mean cancer. But waiting for results can be anxiety-inducing, so practice self-care during that waiting period.

Why Early Detection Actually Matters

Let me give you some numbers that make the case for mammograms better than I ever could:

When breast cancer is detected early, in the localized stage before it spreads, the five-year survival rate is 99%. In late-stage breast cancer the survival rate drops to 27%.

Mammograms can detect changes in your breast tissue up to two years before you or your doctor can feel a lump. Two years. That's the difference between catching a tiny, highly treatable tumor and dealing with something that's had time to grow and potentially spread.

Early detection also means less aggressive treatment. Finding cancer when it's small might mean a lumpectomy instead of a mastectomy, fewer rounds of chemo, better outcomes, and less financial burden.

Screening mammography has cut the risk of dying from breast cancer by nearly 50%. Those aren't numbers to dismiss.

Bottom line: Mammograms save lives by catching cancer when it's most treatable.

Final Thoughts: Just Schedule the Damn Appointment

Look, I know there are a thousand things competing for your time and attention. I know mammograms aren't fun. I know waiting for results is stressful. I know that flattening your breast tissue between two plates sounds about as appealing as stepping on a Lego in the dark.

But here's the thing: you matter. Your health matters. The people who love you want you around for a long time, and you deserve to be here living your best postmenopausal life.

Mammograms are one of the few screening tests that have definitively been shown to reduce cancer deaths. They work. They save lives. And yes, they're slightly uncomfortable for a few seconds, but so is traffic and we still get up and go to work every day.

Here Are Your Key Takeaways:

Schedule your mammogram if you're 40 or older, or younger if you have risk factors
Go annually or every two years depending on your menopausal status and your doctor's recommendation
Don't skip it because of fear or discomfort, the procedure is quick, and the benefits far outweigh the temporary discomfort
Know your risk factors including family history, breast density, and hormone exposure
Continue screening even after menopause, remember eight out of ten breast cancers occur in women over 50

And while we're at it, practice breast self-awareness. The American Cancer Society no longer recommends formal monthly self-exams, but they do recommend being familiar with how your breasts normally look and feel. Know your normal so you can spot changes. Any new lumps, nipple discharge, changes in size or shape, skin changes, or persistent pain should be reported to your doctor right away.

This National Mammography Day, do something radical: prioritize yourself. Schedule that appointment. Encourage your friends to schedule theirs. Wear pink if that's your thing. Share this post if it resonated with you. And remember that taking care of yourself isn't selfish, it's necessary.

Your body has carried you through decades of periods, maybe pregnancy and childbirth, definitely perimenopause and menopause with all their delightful symptoms. It deserves your time, your attention, and yes, occasionally getting squished between two plates so you can live a long, healthy, badass life.

Now stop reading and go schedule that mammogram.