Menopause is a stressful time in a woman's life. Changes in sex hormones can evoke a myriad of troublesome, life-altering symptoms like depression, hot flashes, headaches, sleep disruption, brain fog, gastrointestinal issues, and loss of libido. At the same time, a woman has the most responsibility she's ever had at work, has children leaving home, and often is responsible for elderly parents. In response to this onslaught of physical and emotional turmoil, some women increase their alcohol consumption. And although it may seem to take the edge off at first, alcohol exacerbates many of the symptoms women are already struggling with and increases the risk of more serious health conditions.
Women of all ages produce lower levels of the enzymes that break down alcohol than men do. Add the fact that women are usually smaller than men and have lower body water volume to dilute the alcohol, and it's no wonder women are less able to handle alcohol than men. As women age, the problem gets worse. Enzyme levels fall even lower, and body water volume is reduced, in part due to decreased muscle mass which absorbs and dilutes alcohol better than fat.
Before we continue, let's make sure we are using the same language. 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), or 1.5 fluid ounces of 80 proof distilled spirits (40% alcohol) count as one alcoholic drink. Moderate drinking is described as 1 drink per day for women. Binge drinking is defined as 4+ drinks in one day. Heavy drinking is defined as consuming 8+ drinks per week or binge drinking 5+ days per month. Pay particular attention when at bars and restaurants since many pours contain more than 1 serving of alcohol. For example, beers served in a pint glass are 16 oz, not 12 oz, and many glasses of wine are closer to 6-7 oz than 5 oz. Additionally, many craft beers are higher than 5% alcohol by volume - Dogfish Head's 120 Minute IPA clocks in at 15-20% alcohol.
Any amount of alcohol consumption has been associated with an increase in breast cancer in menopausal women, but the risk rises to 1.5x in women who drink moderately. Heavy drinking increases the risk of all cancers, heart disease, organ damage (particularly liver and brain), osteoporosis, depression, and sleep disruption. Heavy drinkers also have a higher fall risk which can result in bone fractures in older women. Menopausal women already have an increased risk of all of those conditions. As women age, they also take more medications, and alcohol use has a negative interaction with many drugs used commonly for conditions like arthritis, indigestion or heartburn, high cholesterol, high blood pressure, and more. On the flip side, there are documented potential benefits of low (less than 1 drink/day) consumption of alcohol on cardiovascular disease, bone health, dementia, and type 2 diabetes. However, the potential benefits are not significant enough to recommend that someone who does not currently drink alcohol start doing so.
Menopausal women are often concerned about weight gain, which can be caused by a myriad of factors, but it's clear that alcohol consumption can contribute. If you treat yourself to half of a bottle of rosé wine after work, you'll have consumed as many calories as you would have gotten in 2.3 burgers. You can quickly increase your daily calories by 400-500 with a few beers at happy hour. And since your body will burn alcohol before using sugar or fat, regularly consuming alcohol makes it more difficult to lose, or maintain, weight. Alcohol also causes cortisol levels to spike. We've discussed previously that menopausal women are less capable of managing stress, in part because estrogen is no longer regulating cortisol. High levels of cortisol can cause weight gain, high blood sugar/diabetes, high blood pressure, excessive hair growth, muscle weakness, and bone fractures. Women who drink heavily also have higher levels of visceral fat, which increases their risk of cardiovascular disease, Alzheimer’s, type 2 diabetes, stroke, and high cholesterol. Menopausal women should eat a balanced diet with lots of fruits, vegetable, and lean proteins, exercise regularly, and manage their stress to maintain a healthy weight.
A significant component of alcohol use in the United States is social. Happy hour is a bonding time with our co-workers. Alcohol is part of some religious practices. We toast to promotions, weddings, anniversaries, new babies, and other significant events in our lives. We glamorize alcohol consumption in our movies and other media. We also use alcohol as a stress reliever. Alcohol is a depressant, but it has no effect on anxiety and can cause/worsen depression. It may seem that alcohol is relaxing in the moment, but it's not an effective treatment for mood disorders. Talk with your doctor about more effective options. Menopausal women can help themselves with stress relief by turning to exercise, meditation, yoga, or spending time with a friend instead of grabbing a glass of wine. Alcohol use by women also can be a habit. If you grab a drink every day after work, think about why. You may be able to replace that alcoholic drink with a fancy mocktail, a non-alcoholic beer, or even sparkling water served in a fancy glass and find that it's the ritual that you enjoy, not the alcohol.
The Menopause Society recommends that menopausal women not exceed low to moderate consumption of alcohol - that is, no more than 7 drinks per week and no binge drinking. If you are at higher risk of breast cancer, it would be prudent to limit yourself to low alcohol consumption. Conversely, women at higher risk for cardiovascular disease might benefit from a more moderate approach to their alcohol consumption. As mentioned previously, there are no data supporting health benefits sufficient for women who are non-drinkers to start drinking.
If you want to reduce or eliminate alcohol from your diet, you're in luck. The non-alcoholic drink market is expanding rapidly, sales are up 120% in the last three years, and that bodes well for those of us looking to reduce our alcohol consumption without giving up the taste of our favorite beverages. New companies are popping up and established ones are joining the movement. There's spiritless bourbon to make your Old Fashioneds, alcohol-removed wines from Napa Valley, zero-proof margaritas, botanical Bloody Marys, and award-winning non-alcoholic IPAs. Add your favorite tonic to Pentire Adrift, and you'll be surprised how much it tastes like a gin and tonic.
Talk to your doctor or a therapist who specializes in substance use disorders if you can answer yes to 2 or more questions posed at this website. It's far better to get treatment for alcohol abuse today than deal with the medical consequences tomorrow.