Message in a bottle: alcohol and menopause

Ahead of Alcohol Awareness Week, we bust some of the myths around drinking and menopause 

By Dr Ornella Cappellari  

The menopause can be hard, we know. And while some women sail through it, others may struggle to cope with the severity of their symptoms. That’s where alcohol comes in. It may seem like a solution to your problems. In truth, however, drinking can not only make the situation worse (certainly, the day after), but in menopause it may be even more detrimental to your health.  

Many studies show that heavy drinking (more than 14 units of alcohol per week, according to the NHS) during perimenopause can worsen symptoms. So, if you’re drinking for comfort, maybe seek solace elsewhere (chocolate, anyone?) But it does seem that moderate drinking (no more than 14 units of alcohol per week) can exert some benefits – particularly on your mood. 

Recent findings suggest that in pre- and postmenopausal women, light-to-moderate alcohol consumption may increase blood concentrations of oestrogen and the by-products of oestrogen metabolism – one possible reason for some of the benefits observed.  

We need to bear in mind when talking about alcohol, however, that women have lower tolerance levels than men. One reason for this is size: women are generally smaller. We also have less alcohol dehydrogenase, an enzyme that metabolises alcohol. Plus, that enzyme is relatively inactive in a woman’s liver. Thus, we tend to absorb more alcohol into our blood than men. With ageing, too, our bodies lose water, leaving us less able to “dilute” any alcohol in our system. So in fact, heavy drinking becomes more dangerous as we age.   

Risks associated with heavy drinking  

  • Heart disease
  • Breast cancer and cancers in general
  • Depression
  • Irreversible bone-mass loss 
  • Interactions with medication (we tend to take more medication as we age)
  • Sleep disruption

Benefits associated with moderate drinking 

Moderate drinking is associated with none of the risks listed above. In fact, it appears to have some health benefits: 

  • Slight increase in bone density
  • Lower risk of heart disease and stroke
  • Lower risk of type-2 diabetes
  • Lower risk of dementia

These findings on the benefits of moderate drinking came out of a 2007 study showing that perimenopausal women who drank in moderation had a lower risk of hot flushes than women who drank no alcohol. To understand the phenomenon better, participants’ sex-hormone levels were also measured: they appeared to be unaffected by alcohol consumption. So, it’s not that drinking affects hormone levels in a way that reduces hot flushes, it’s possibly that higher blood-glucose levels are in fact decreasing the flushes – but more research still needs to be done. 

Other studies, however, have shown exactly the opposite: an increased risk of hot flushes and night sweats for women who drink (we’re still talking about moderate drinking here), mostly among postmenopausal women. So, it appears that the effects of drinking on hot flushes may depend on where you are in your menopausal transition.  

Alcohol and breast cancer 

It must be stressed that a number of epidemiological studies have shown that alcohol consumption, possibly even at moderate levels, can be associated with an increased risk of breast cancer. Mortality from breast cancer was found to be higher in women who reported consuming at least one drink per day, compared with non-drinkers. But the mechanism by which alcohol increases women’s risk of breast cancer is still poorly understood.  

In postmenopausal women, the potential increase in breast-cancer risk due to alcohol consumption seems to be exacerbated by concomitant HRT usage (which in itself represents a modest risk factor for breast cancer, though is still very low in comparison to other risk factors). Since drinking impairs the body’s ability to eliminate oestrogens, it’s possible that the breast-cancer risk associated with HRT may be augmented as a result of the two risk factors combined.  

In conclusion  

The current available data suggests that in postmenopausal women, light-to-moderate alcohol consumption may decrease the risk  of coronary heart disease and increase bone-mineral density. However, it may also increase the risk of breast cancer.  

This clinical picture fits with the hypothesis that alcohol consumption increases the concentration of oestrogen in the blood, thus exerting a positive effect on coronary heart disease and osteoporosis, and a negative one on breast cancer.  

Of course, the occasional drink with friends will not have a seriously detrimental effect on your health. But if you’re struggling with a difficult menopause and seeking solace in drink, it might be helpful to see your GP in order to understand better how to tackle it all. And if you are having a rough time, remember: smooth seas don’t make for skilful sailors.

If you need help with a drinking problem, visit www.alcoholics-anonymous.org.uk, phone the national helpline on 0800 9177650 or email help@aamail.org