Pink October: Mammograms, Menopause, and Breast Density
October is Breast Cancer Awareness Month: it’s time to talk about breast cancer prevention and the importance of getting a mammogram.
The year 2025 brought a decisive change: organized screening began to include women aged 45 to 74, implemented in phases by municipality. In practice, more women are being screened, and diagnoses tend to be made earlier a difference that can save lives. If you’ve received a letter, text message, or phone call inviting you to a mammogram every two years, this article explains how to prepare, how to understand the key concepts, and what changes with menopause.
Did you know that...
In Europe, are organized programs (with invitations and quality control) preferred over occasional screening because they are more effective and equitable?
What Has Changed in Testing in Portugal
As of January 2025, the screening program has been expanded to include people aged 45–74. Invitations are sent by mail, text message, or phone, and the screening site may be a fixed or mobile facility located at your health center. The procedure remains the same: Biennial mammograms for asymptomatic women at moderate risk. In fact, this organized approach makes it possible to compare images over time, reduce repeat exams, and quickly refer patients if a finding requires further evaluation.
In addition, proper preparation for the exam helps ensure high-quality images, which are crucial for an accurate diagnosis. That’s why we’ll now move from the “why” to the “how.”
Preparing for a Mammogram
A good exam begins before you even enter the exam room. On the day of your exam, avoid using spray deodorant, talcum powder, lotions, or perfumes on your underarms and breasts: the microparticles in these products can appear as microcalcifications and require repeat imaging. Also, wear Two items of clothing (top + pants/skirt) so you only need to remove your top, and bring any previous test results, if you have them, for comparison.
The timing of the appointment also matters; for example, if you still have a menstrual cycle, the week after your period is usually more comfortable, since the breast tissue is less sensitive.
Do you have implants? Always let the team know: there is a specific technique to improve visualization of the tissue.
Finally, if you experienced pain during previous exams, please mention it at the time of the exam, as the pressure and pace can be adjusted.
Quick checklist:
- Do not use deodorant spray, talcum powder, or lotions on the day of the procedure (if you forget, ask for wipes at the facility).
- Bring your ID, invitation, previous test results, and a list of medications and implants.
- Indicate any prior discomfort, pregnancy/breastfeeding, limited mobility, or communication barriers.
You can download the complete checklist here.
Even with thorough preparation, the interpretation of the results also depends on the composition of the breast tissue. This is where the concept of breast tissue density comes into play.
“Dense breasts” — what are they?
The breast density is classified as A through D: from “almost entirely fatty” (A) to “extremely dense” (D). In dense breasts (C/D), the glandular tissue is more abundant and appears white on a mammogram just like many tumors and may mask changes. In addition, high density is associated with a a slightly higher risk over a lifetime.
The report always mentions density because it is useful clinical information; this is no cause for alarm. In some cases, especially when density is combined with other risk factors, the doctor may order an ultrasound or another test as a supplement. Even so, mammography remains the key test in population-based screening.
As we have already seen, breast tissue density changes over the course of a woman’s life and is strongly influenced by the hormones circulating in the body. Therefore, it makes sense to discuss menopause and hormone replacement therapy (HRT) at this point.
Menopause, Bone Density, and HRT — Informed Decisions, Without Sensationalism
With menopause and the resulting drop in estrogen levels, breast density tends to decrease, making it easier to interpret mammograms. On the other hand, Hormone Replacement Therapy (HRT) can increase the density in some women and is associated with a slight increase in risk breast cancer that depends on the type of regime, from the duration and the individual profile.
However, this does not constitute a contraindication for starting HRT. For women symptomatic and no contraindications, European scientific societies consider HRT to be a valid option, above all up to age 60 or over the past 10 years after menopause, provided that there is personalized assessment and regular follow-up. In simple terms: the decision is made on a case-by-case basis, weighing the benefits (hot flashes, sleep, quality of life) and risks (including breast tissue density).
Helpful tips to follow during menopause that also protect breast health:
- Engage in regular physical activity (150–300 minutes per week of moderate-intensity exercise) and maintain a stable weight.
- Adopt a Mediterranean diet (vegetables, fruit, legumes, fatty fish) and get vitamin D through safe sun exposure.
- Maintain a consistent bedtime routine and manage your stress levels.
For more tips, check out our article on menopause.
Even so, despite screening and sound decision-making, it is essential to listen to and pay attention to your body between checkups.
Warning signs that shouldn't wait for the next letter
Search medical evaluation if you notice new node, retraction between the nipple and the skin, bloody discharge, persistent redness or localized pain unusual. Remember that screening It does not replace clinical observation; rather, it is a tool that works alongside it.
Between mammograms, it’s a good idea to perform breast self-exams (also called self-exams) to get to know what’s “normal” for you and spot changes early.
Do this once a month: if you have your period, do it the week after your period; if you are postmenopausal, choose a set day.
Start by looking in the mirror with your arms down and then raised, noting symmetry, skin, nipples, and any retraction. Next, perform a self-exam in the shower using a flat hand and small circular motions that cover the entire breast and armpit, applying 3 levels of pressure (superficial, medium, and deep). Repeat while lying down, with your hand behind your head on the side you’re examining. Finally, gently squeeze the nipple to check for discharge. If you feel new node, hardest area, skin changes (persistent redness, “orange peel” skin), nipple retraction or bloody discharge, seek medical evaluation — even if the last mammogram was recent.
Remember: self-examination is not a substitute for a mammogram; it is a useful supplement for detecting changes between scheduled screenings.
If, during self-examination or between screening appointments, you notice any changes and your doctor recommends additional tests, the next steps usually involve confirmatory imaging (targeted mammography, ultrasound, and sometimes an MRI) and, when necessary, a biopsy to obtain a definitive diagnosis—a procedure that only a doctor can order and interpret. From there, a multidisciplinary team develops a personalized treatment plan that may include surgery, radiation therapy, chemotherapy, hormone therapy, and/or targeted therapies. This is where small, everyday precautions can make a big difference.
During cancer treatment — more sensitive skin
Radiodermatitis is a common skin reaction during radiation therapy—it usually appears around the 2nd–3rd week, may worsen toward the end of the treatment cycle, and improves in the following weeks. The most sensitive areas of the breast are the the armpit, the inframammary fold, and the collarbone area, where there is more friction and moisture. The goal is protect the skin barrier, reduce friction, and relieve itching without interfering with treatment.
A simple daily routine to help manage radiation dermatitis (always follow the guidelines provided by your treatment center):
- Gentle cleansing: warm (not hot) water, unscented soap or gel, and a mild pH. Pat dry gently; do not rub.
- Regular hydration: 2–3 times a day with simple emollients (e.g., with glycerin, ceramides, shea butter or hyaluronic acid). Avoid perfumes, alcohol, menthol, camphor, and essential oils.
- Do not apply creams to the treated area 2 hours before treatment (unless otherwise instructed by your team). Apply them after the session.
- Clothing and friction: Choose soft cotton and bras without underwires or visible seams; avoid friction (such as backpacks on the treated area), adhesive tape, and shaving in that area.
- Heat and water: Avoid direct sunlight, saunas, hot tubs, and swimming pools while your skin is sensitive. When outdoors, stay in the shade and wear protective clothing; use sunscreen appropriate for your medical condition.
- Deodorant: Many treatment units allow for the application of unscented deodorant outside the treated area.
- Itching: Do not scratch; you can apply cold compresses for a few minutes and use a moisturizer.
When the skin “peels” (moist desquamation):
This can occur in skin folds (armpit/groove). Do not disinfect with alcohol or iodine. The treatment team may recommend cleaning with saline solution and non-adhesive dressings (e.g., silicone or foam) to protect the area and promote healing. Avoid using thick barrier creams immediately before sessions; you may apply them after the sessions.
Warning signs that should be discussed with the treatment team:
- Increasing pain, localized warmth, yellowish discharge/odor (suspected infection).
- A wound that does not heal within 1–2 weeks after completing radiation therapy.
- Extensive skin reaction outside the irradiated area (e.g., after starting a new medication).
In short, at Correia Rosa Pharmacies, we are here to:
- Helping You Prepare for Your Mammogram: Checklist, Documents, and Practical Questions;
- Explain general terms and when to talk to your doctor;
- During menopause, to help interpret and manage symptoms and promote adherence to treatment;
- To help you choose skin care products tailored to your skin type and clinical needs.
Are you between the ages of 45 and 74, and have you received or are you expecting the screening letter?
Stop by a Correia Rosa Pharmacy to Preparing for Your Mammogram, review the checklist and align skin care. To results and clinical decisions, always talk to the your doctor.
You can download our Exam Preparation Checklist as a PDF:
FAQs
The program is being rolled out in phases by municipality. If you are between the ages of 45 and 74 and have not yet been notified, check with your USF/ACES. Keep your contact information up to date.
Yes, on a doctor’s recommendation. The population-based screening program is for asymptomatic women; specific situations are evaluated by a doctor.
Always inform the medical team. During pregnancy, an ultrasound is usually the first test. The decision is up to the doctor.
Ideally, no especially if it’s a spray. If you forget, ask for wipes at the clinic and clean the area before the exam.
Yes. Let the team know there are specific techniques (the Eklund maneuver) to get a better view of the breast tissue.
It may be uncomfortable, but it’s quick. If you feel any pain, let the technical staff know; the compression and pace can be adjusted.
Not always. Mammography remains the key screening test. Ultrasound can be used as a supplement when indicated by the doctor, depending on the overall risk.
Under the public health program, it is generally every two years. Outside the program, follow your doctor’s instructions.
New node, retraction skin/nipple, persistent redness, abnormal localized pain or bloody discharge.
Only when and how the team authorizes it. Until then, stick to the shade and wear protective clothing.
I’m 44 years old and have a strong family history of the disease. What now?
