During perimenopause — the years before your periods stop — you’ll start to notice changes in the size and shape of your breasts.

You may also notice that they feel tender and ache at unexpected times. Or they may be lumpier than they used to be.

There are three common ways menopause and perimenopause can affect your breasts.

1. Tenderness or pain.

Why It Happens: Before your period, fluid builds up in your breasts, making them feel more swollen, tender, or painful than other times of the month.

Because the hormonal changes of perimenopause make your cycle irregular, breast soreness can strike unpredictably.

What You Can Do About It: If your breasts hurt, wearing the right bra can make a big difference: 85% of women with breast pain gained relief when they wore a well-fitted sports bra, according to a 2014 study.

The same researchers found that relaxation techniques or massaging aching breasts was helpful for up to 60% of women.

If breast pain is severe or won’t go away, talk to your doctor.

2. Changes in breast size and shape

Why It Happens: As you near menopause, your levels of oestrogen drop dramatically. As your milk system starts to shut down, glandular tissue in your breasts shrinks.

That causes them to become less dense and more fatty, which can lead to sagging. You may also notice that your breasts aren’t as full as they used to be, and their size may change.

What You Can Do About It: Although there’s no proven way to reverse sagging, exercise makes your breasts look better by developing and toning the muscles underneath.

Good ways to tone your chest muscles include pushups and lifting weights.

After menopause, you may need to go big when you shop for bras: A recent study found that 1 in 5 women went up a bra size after menopause (typically due to weight gain), but only 1 in 50 needed a smaller bra.

3. Lumpy Breasts

Why It Happens:  There are several reasons why this can happen during perimenopause, including normal aging and hormonal changes.

Just like at any age, though, you’ll need to see your doctor to find out what the lumps are.

You could have cysts, fluid-filled sacs that are very common. They can feel like grapes and aren’t cancerous. Many women, of all ages, have them.

Sometimes they go away after menopause, but they can stick around, especially if you take hormone replacement therapy (HRT).

Fibrocystic changes are another common reason for lumpy, painful breasts and areas that feel rubbery to the touch. They don’t make you more likely to get breast cancer. Nor do cysts.

What You Can Do About It: Some women find when they cut down on caffeine, their breasts are less tender. You can also apply heat — try a warm compress — to the painful area or use over-the-counter pain relievers.

When to Check With Your Doctor

Most midlife breast changes are normal. But you can’t be sure on your own. Talk to your doctor if you notice any of these problems:

•  A lump or a firm or thick area in your breast or under your arm.
• Nipple discharge fluid or changes, such as a nipple that becomes sunken into the breast, also called “inverted.”
• Skin changes, such as redness, dimpling, puckering, or ridges that look like orange peel.
• Unexplained swelling or shrinkage of the breast, especially on one side only.

Most of the time, breast changes are not cancer, but it’s important to get any new or unusual symptom checked out quickly.

Also talk to your doctor about how often you should get mammograms, since guidelines vary and you may need to start sooner if you’re at high risk due to a family history of risk for example.