Pam Fichtner, RMT | Breast and Chest Health Educator | Founder, Sephira Healing | Saskatoon, Saskatchewan
TL;DR
Perimenopause and summer heat can be a brutal combination. Hot flashes, swollen breasts, tight rings, irritated skin, exhaustion, sensory overload, and feeling uncomfortable in your own body are all common experiences during this stage of life that many women are never warned about.
This article explains:
• Why hot flashes and heat intolerance happen
• Why breast tenderness and swelling get worse in summer
• Why your rings, ankles, and body suddenly feel puffier
• Why your skin becomes more sensitive and reactive
• Why noise, crowds, heat, and busy days suddenly feel overwhelming
• What actually helps support your body during this transition
Heat feels more intense during perimenopause. You’re hotter. Your breasts ache more. Your rings are tighter in the afternoon. Your skin is reacting to things it never did before. You’re more tired, more sensitive, more easily overwhelmed — and you can’t quite explain it to anyone who isn’t living it.
I’m Pam Fichtner, a Registered Massage Therapist and a breast and chest educator and speaker. I’m the founder of Sephira Healing in Saskatoon and I’ve spent nearly 30 years working with the bodies of people navigating hormonal transitions, and every summer I see a surge of clients coming in and telling me about a new pain or symptom.
I’m going to explain what really happens when perimenopause meets the heat, and what can genuinely help.
Why Heat Feels More Intense During Perimenopause
If you feel like you can’t tolerate the heat like you used to, there’s a physiological reason, and it starts in the brain.
Estrogen affects the part of the brain that controls your body temperature. When estrogen levels are unstable during perimenopause, your body becomes more sensitive to heat and temperature changes.
The result is hot flashes: a sudden surge of heat, often accompanied by flushing, sweating, and sometimes a chill afterward. Research suggests hot flashes affect an estimated 50–80% of people going through the menopause transition.
Night sweats are the nighttime version of hot flashes, and disrupted sleep can make heat intolerance even worse the next day.
Why Your Breasts and Chest Feel More Tender, Swollen, or Sensitive
Breast tenderness is one of the most common and least-discussed symptoms of perimenopause. Research from the Centre for Menstrual Cycle and Ovulation Research (UBC) found that approximately one in three women in early perimenopause experience breast tenderness.
This is because breast tissue contains receptors that are sensitive to both estrogen and progesterone. During perimenopause, estrogen levels don’t simply decline. They spike unpredictably before eventually tapering off. These estrogen surges can cause breast ducts to enlarge and tissue to hold more fluid. Progesterone, which normally helps balance estrogen’s effects, is often lower during this phase, making the breast tissue more sensitive, swollen, and tender.
What you might feel:
• Aching, burning, or stabbing sensations in one or both breasts
• Generalized tenderness or a sense of fullness that doesn’t follow your usual cycle
• Nipple sensitivity that feels new or heightened
• Breast tissue that feels lumpier, denser, or more fibrocystic than before
• Swelling that worsens before a period, in heat, or seemingly at random
In summer, this often gets worse. Heat increases fluid buildup in the tissues, and if the lymphatic system is already slowed down by hormone changes, that extra fluid does not drain as easily. The result can be more swelling, heaviness, and tenderness.
What to watch for: tenderness and cyclical swelling are common in perimenopause and are usually benign. However, a new lump that feels different from surrounding tissue, skin dimpling, nipple discharge, or one-sided symptoms that don’t go away, are important to get checked out by your healthcare provider. Get to know what your normal is so you can recognize changes quickly.
Why Swelling Gets Worse in Hot Weather
You notice it around your ankles at the end of a long day. Your rings are tighter by midafternoon. Your sleeves may feel tighter on one side than the other. Summer swelling is a real thing, and in perimenopause, it’s often worse.
Two things are happening at once.
First, hormones. Fluctuating estrogen can cause the body to hold onto more fluid. It’s the same reason many women feel swollen before a period. During perimenopause, estrogen levels can spike unpredictably, so the swelling can feel random too.
Second, heat. Hot weather causes blood vessels to widen, which pushes more fluid into the surrounding tissues. Your lymphatic system is responsible for moving that fluid back out, but it does not have a pump. It relies on movement, muscle contraction, and deep breathing to keep fluid moving. Heat can slow that process down even more.
The combination of hormone-related fluid retention and slower lymphatic drainage is why summer swelling during perimenopause can feel so intense.
What helps?
• Gentle movement and walking
• Staying hydrated
• Elevating your legs
• Avoiding long periods of sitting or standing in the heat
• Manual lymphatic drainage for more ongoing or significant swelling
Why Your Skin Suddenly Feels More Sensitive in Summer
Estrogen plays a big role in keeping skin strong, hydrated, and resilient. As estrogen levels become more unpredictable during perimenopause, many people notice their skin becoming drier, thinner, more sensitive, and more easily irritated.
You may notice:
• Itching or prickling that seems to come from nowhere (a condition sometimes called pruritus)
• Increased sun sensitivity or faster burning
• Chafing and under-breast irritation from heat and sweat, worsened by tissue sensitivity
• Rashes or heat rashes appearing where they didn’t before
• Products, fabrics, or detergents that previously caused no reaction now causing irritation
The skin under and between breast tissue is especially vulnerable because heat, sweat, friction, and moisture all build up there quickly.
WHAT CAN HELP
• Loose, breathable, moisture-wicking clothing
• Proper bra fitting to reduce friction and pressure under the breasts
• Barrier creams for irritated or chafed skin
• Gentle, fragrance-free products during times of increased sensitivity
• Avoiding tight bra bands and synthetic fabrics during hot weather
Why Summer Can Feel More Overstimulating and Exhausting
This is the symptom most often dismissed, and the one I hear about often from clients.
You used to be able to handle a busy day, a hot afternoon, a social event, or a crowded space. Now those same things can feel overwhelming. You come home depleted in a way that rest doesn’t fully fix. You’re more irritable, less patient, and more sensitive to noise, heat, and sensory input.
Hormone changes during perimenopause affect the nervous system too. Sleep becomes disrupted, stress feels harder to recover from, and summer heat adds even more strain to a body that is already working harder than usual.
“Perimenopause is largely neurological in nature. Neurological symptoms that emerge during perimenopause are indicative of disruption in multiple estrogen-regulated systems, including thermoregulation, sleep, circadian rhythms and sensory processing.” — PMC, 2015
This is all treatable. Your body responds to nervous system support, body-aware care, rest, and reducing stress on the body.
What Actually Helps With Summer Body Stress During Perimenopause
There is no single fix. But there are some practical strategies grounded in physiology that can make a real difference.
For heat and hot flashes
• Layer clothing so you can adjust quickly when a flash hits
• Keep a cold water bottle or cooling cloth accessible, particularly at night
• Lower the thermostat or use a fan at night — sleep environment temperature matters significantly for hot flash frequency
• Avoid known triggers where possible: alcohol, caffeine, spicy foods, and warm rooms can all lower the threshold
• Cold water on the wrists and neck provides rapid cooling when a flash is building
For breast and chest tenderness and swelling
• Choose bras with soft, wide bands and no underwire during periods of heightened tenderness — compression worsens congestion
• Moisture-wicking, breathable fabrics reduce under-breast irritation
• Gentle self-lymphatic massage supports fluid movement — this is something I teach clients directly
• Cold compresses can temporarily reduce acute tenderness
• Breast and chest massage therapy addresses tissue congestion directly and is one of the most underutilized supports for this symptom
For general swelling and fluid retention
• Move regularly — even short walks support lymphatic circulation
• Stay well-hydrated; dehydration paradoxically worsens fluid retention
• Elevate legs during rest periods
• Avoid prolonged sitting, particularly in heat
• Manual lymphatic drainage is clinically effective for significant or persistent swelling
For nervous system overload and sensory overwhelm
• Reduce load deliberately: you don’t have to earn rest
• Slow, diaphragmatic breathing activates the parasympathetic nervous system and is one of the fastest tools for nervous system regulation available to you right now
• Somatic bodywork and craniosacral therapy support the nervous system’s ability to shift out of chronic activation — not by talking about stress, but by working directly with the body’s response to it
• Prioritize sleep environment above almost everything else: temperature, light, and noise control matter more during this transition than at most other times in life
• Stop explaining your capacity to people who aren’t experiencing what you’re experiencing. This is real, and it warrants real accommodation.
When Symptoms Should Be Checked by a Healthcare Provider
Most of what’s described in this blog is uncomfortable but not dangerous. Perimenopause is a biological transition, and many of these symptoms are common during this stage of life.
However, some symptoms should be checked out:
• A new lump in the breast or chest that feels different from surrounding tissue or that doesn’t change with your cycle
• One-sided breast swelling, redness, or warmth that persists and worsens
• Nipple discharge that is new, unexpected, or blood-tinged
• Skin dimpling, puckering, or changes in texture on the breast or chest
• Swelling that is severe, sudden, or significantly asymmetrical
• Hot flashes or night sweats severe enough to significantly disrupt daily functioning or sleep over an extended period — these are treatable, and you don’t have to manage them alone
• Any symptom that feels new, unusual for you, or simply wrong in a way you can’t explain
You Are Not Imagining It
Perimenopause can make us feel almost crazy at times. We doubt ourselves. We downplay things. And it doesn’t help when we’re told these symptoms are “just part of getting older.”
I want to say this clearly. The heat sensitivity is real. The breast tenderness is real. The swelling, exhaustion, and overstimulation are real too.
Perimenopause affects more than hormones. It can affect body temperature, the nervous system, fluid retention, breast tissue, and skin sensitivity all at once. Summer heat can make all of it feel worse.
Understanding what’s happening in your body matters because it helps you support your body differently instead of fighting against it.
If you’d like help navigating swelling, tenderness, or nervous system overwhelm, I’d love to explore some treatment options with you.
https://www.sephirahealing.ca/treatment-options.html#ld
Frequently Asked Questions About Perimenopause and Summer Body Changes
Why am I so hot all the time lately?
If you’re in your late 30s to early 50s and have noticed increased heat sensitivity, you may be in perimenopause. Estrogen plays a direct role in the brain’s temperature regulation system. As estrogen levels become erratic, the hypothalamus becomes hypersensitive to small temperature changes — triggering disproportionate heat responses even in mild warmth. It’s not your imagination, and it’s not “just” hot flashes. It’s a shift in how your nervous system processes temperature.
Why do my breasts hurt more in summer?
Summer heat increases circulation and encourages fluid to move into surrounding tissues. If your lymphatic system is already working harder due to hormonal changes, that fluid has less efficient pathways out. Combine this with the erratic estrogen spikes of perimenopause — which cause breast tissue to retain fluid and become more sensitive — and summer can significantly amplify existing breast tenderness. Breast and chest massage therapy and gentle lymphatic drainage are among the most effective hands-on supports for this.
Is the swelling I notice in summer related to perimenopause or just the heat?
Both. Heat dilates blood vessels and pushes fluid into tissues. But perimenopause adds a hormonal layer: high estrogen levels encourage fluid retention independently. If you notice that your summer swelling is more pronounced than it was in previous years, perimenopause is likely contributing. The combination of the two — thermal and hormonal — is why it can feel so disproportionate.
Why do I feel so easily overwhelmed and exhausted in summer now?
Perimenopause affects the nervous system directly — estrogen and progesterone both play regulatory roles in how the brain handles stress, sensory input, and recovery. When their levels fluctuate, the nervous system becomes more reactive and less resilient. Summer adds additional physiological load: heat stress, disrupted sleep from night sweats, and constant thermoregulatory effort. The result is a system working at or near capacity before the day has even started. This is real, it’s documented, and it warrants real rest and support.
Can massage therapy actually help with perimenopause symptoms?
Yes, for several specific symptoms. Manual lymphatic drainage is clinically supported for reducing swelling and fluid retention. Breast and chest massage therapy can address tissue congestion, tenderness, and the discomfort of fibrocystic changes. Craniosacral therapy and somatic bodywork support the nervous system’s ability to regulate — particularly relevant when perimenopause is producing the kind of exhaustion and overwhelm described above. Massage therapy is not a hormonal treatment and won’t stop perimenopause. But it can meaningfully address several of the physical symptoms that make it harder to live in your body during this transition.
When should I see a doctor about breast changes during perimenopause?
Cyclical tenderness, swelling, and density changes are common in perimenopause and are usually benign. See a healthcare provider if you notice: a new lump that doesn’t change with your cycle, skin dimpling or puckering on the breast, unexpected nipple discharge, one-sided swelling that persists, or any change that feels unusual for your body. Trust your instincts. You know your normal better than anyone.
Pam Fichtner, RMT | Breast and Chest Health Educator | Founder, Sephira Healing | Saskatoon, Saskatchewan
Sources & References
Bhatt DL, et al. (2025). Effects of menopause on temperature regulation. Temperature (Taylor & Francis). https://doi.org/10.1080/23328940.2025.2484499
Brinton RD, et al. (2015). Perimenopause as a neurological transition state. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9934205/
Prior JC. (2014). Progesterone for symptomatic perimenopause treatment. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC3987489/
Bjelland J. (2025, October). Survey results: Perimenopause and menopause in sensitive and neurodivergent women. https://www.juliebjelland.com/hsp-blog/survey-results-perimenopause-and-menopause-in-sensitive-and-neurodivergent-women-by-julie-bjelland-lmft
Cleveland Clinic. (2024, January). Does menopause cause breast pain? https://health.clevelandclinic.org/breast-pain-menopause
HealthyWomen. Perimenopausal breast tenderness. https://www.healthywomen.org/ask-expert/perimenopausal-breast-tenderness
Healthline. (2024, April 3). Menopause breast pain and tenderness: Causes and treatment. https://www.healthline.com/health/menopause/sore-breasts-menopause
Bonafide Health. (2025, July 16). Hot weather and menopause. https://hellobonafide.com/blogs/news/hot-weather-and-menopause
National Sensory Network. Understanding sensory processing and menopause. https://www.nationalsensorynetwork.org/pages/understanding-sensory-processing-and-menopause
A.Vogel. (2024). Sensory overload: What causes it during perimenopause and menopause. https://www.avogel.co.uk/health/menopause/videos/sensory-overload-what-causes-it-during-perimenopause-and-menopause/
