Alcohol and Menopause: How Drinking Affects Symptoms

Women and men process alcohol differently. One key reason is that women produce less alcohol dehydrogenase, the enzyme responsible for metabolizing alcohol in the body. Compared to men, women also tend to weigh less, have greater amounts of body fat, and have less body water. This collectively causes women’s blood alcohol concentration to increase at a faster rate, making them more susceptible to the inebriating effects of alcohol.⁽¹⁾

Alcohol can also affect hormone levels, which naturally fluctuate during menopause. This article will explore how alcohol may influence menopausal symptoms and offer strategies for moderating alcohol consumption during this phase of life.

The Relationship Between Alcohol and Menopause

Alcohol may influence menopausal health in different ways, including the age at which a woman reaches menopause. In the United States, most women reach menopause at the age of 52. If a woman experiences menopause between the ages of 40 and 45, it’s referred to as early menopause. Women who go through early menopause may be at a greater risk for certain health conditions, such as heart disease, osteoporosis, and early death.⁽²⁾

The findings on the relationship between alcohol consumption and age at natural menopause are mixed. One study published in the American Journal of Epidemiology found that women who consumed one or fewer alcoholic drinks daily (defined as moderate alcohol consumption⁽³⁾) were less likely to experience early menopause than women who did not drink alcohol. White wine showed the strongest association with a reduced risk of early menopause. Risk reduction was also observed with red wine and liquor. However, this relationship was not found with beer or in women who consumed higher amounts of alcohol.⁽⁴⁾ 

A relationship may also exist between alcohol and menopausal symptoms, particularly hot flashes, sleep disturbances, psychological distress, sexual function, and changes in bone mineral density.⁽⁵⁾ Understanding the ways in which alcohol may influence women’s experience of menopause can help them make informed decisions about alcohol consumption.

How Alcohol Affects Hormonal Changes During Menopause

Alcohol’s effects on menopausal symptoms and early menopause risk are believed to be linked to hormone changes. Throughout the menopause transition, levels of estrogen fluctuate and decline, reaching a new low in postmenopause. While age at natural menopause is influenced by many factors, some research suggests that alcohol may raise estrogen levels, potentially delaying menopause onset.⁽⁴⁾

These increases in estrogen may be due to alcohol’s ethanol content, a chemical compound that promotes the body’s conversion of androgens to estrogen. Testosterone, the primary sex steroid hormone in males, is the most abundant type of androgen. While estrogen is the primary sex steroid hormone in females, both men and women produce varying amounts of testosterone and estrogen. In addition to ethanol’s effects on hormones, certain types of alcohol, such as red wine, also contain antioxidants, which may support ovarian health by decreasing oxidative stress.⁽⁴⁾

While moderate alcohol use may provide some menopausal health benefits, excessive alcohol consumption can disrupt endocrine function, causing hormone imbalances.⁽⁶⁾

Alcohol and Common Menopausal Symptoms

Alcohol consumption at different levels may impact common menopausal symptoms in the following ways:

• Hot Flashes: A hot flash is a sudden rush of heat in the upper body, often affecting the face or neck. Many menopausal women also experience sweating or chills. Study outcomes have been inconsistent, but some research indicates a link between alcohol consumption and an increased risk of vasomotor symptoms. Other studies suggest a decreased risk of hot flashes or find no significant relationship between alcohol and hot flashes.⁽⁷⁾

• Sleep Disturbances: Many women have trouble sleeping during the menopause transition due to night sweats. Drinking alcohol may increase sleep disturbances, as alcohol has been linked to insomnia and disruptions in the body’s sleep-wake cycle. It may also exacerbate nighttime breathing issues like snoring.⁽⁸⁾

• Changes in Mood and Mental Health: Psychological symptoms are common during menopause, including an increased risk of stress, anxiety, and depression. Alcohol slows down the central nervous system, which can further affect mental health.⁽⁹⁾

• Weight Gain: Hormone fluctuations during the menopause transition can cause an increase in abdominal fat. Excessive alcohol consumption can also lead to weight gain. However, some studies indicate that moderate alcohol use may lower the risk of overweight and obesity in postmenopausal women, although more research is needed. One study found that the greater risk reduction was associated with wine, while liquor was also shown to have protective effects. Beer, on the other hand, showed the smallest degree of risk reduction.⁽¹⁰⁾

• Headaches and Migraine: Some women may experience headaches or migraine during menopause due to hormonal changes. Similarly, alcohol can also trigger migraines and different types of headaches, although it’s not well understood why this occurs.⁽¹¹⁾

• Changes in Bone Mineral Density: As estrogen levels decrease during menopause, so does bone mineral density. This can lead to an increased risk of fractures. Heavy alcohol consumption can make adults more vulnerable to osteoporosis. However, a study found that women who drank less than one alcoholic beverage daily around the time of menopause had higher bone mineral density than women who did not drink alcohol.⁽¹²⁾

Changes in Alcohol Tolerance During Menopause and Perimenopause

Some women report that they develop alcohol intolerance during menopause. Alcohol intolerance is a hereditary metabolic disorder, which is different from experiencing changes in alcohol tolerance.⁽¹³⁾ Throughout perimenopause and menopause, some women may find they no longer tolerate the effects of alcohol as well as they did when they were younger.

Women may feel the effects of alcohol more quickly or intensely as they age. These effects may include impaired balance, reduced coordination, or drowsiness. Age-related physiological changes, such as a loss of muscle mass, (which commonly occurs during menopause), can cause a greater rise in blood alcohol concentration in older adults compared to younger individuals, even if they drink an equal amount of alcohol.⁽¹⁴⁾

Should women stop drinking alcohol during menopause?

Some women may decide not to drink alcohol if it triggers or worsens menopausal symptoms. Others may choose to reduce their intake. It’s important to note that there are risks associated with any amount of alcohol use, although moderate alcohol consumption may offer benefits for some women during menopause. However, there are other factors that may contribute to these benefits. For example, individuals who keep their alcohol intake to a minimum may also be more likely to engage in other healthy habits, such as exercising or not smoking.

When deciding whether or not to drink alcohol during menopause, it’s helpful to know the difference between moderate and excessive consumption. For women, the U.S. Centers for Disease Control and Prevention (CDC) defines excessive alcohol use as drinking four or more alcoholic beverages on a single occasion or having eight or more drinks in one week. Excessive alcohol consumption can increase the risk of various health conditions, including cancer, heart disease, mental health disorders, and alcohol use disorder (AUD), among other issues.⁽¹⁵⁾

Tips for Reducing or Eliminating Alcohol During Menopause

For menopausal women who want to minimize their alcohol consumption or stop drinking altogether, the following strategies can help:

• Being Mindful of Alcohol Intake: Choosing to stick to one or fewer alcoholic beverages a day can help women enjoy alcohol in moderation.

• Giving the Body a Break: Limiting alcohol consumption to certain days of the week can help reduce overall alcohol intake. Some people may decide to go a week or even a month without alcohol.

• Eating a Meal: Alcohol is absorbed more quickly into the body when drinking on an empty stomach. Eating food beforehand can help prevent blood alcohol levels from rising too quickly.⁽¹⁶⁾

• Diluting Alcoholic Beverages: Carbonated alcoholic drinks, like vodka soda, accelerate alcohol absorption. Diluting a beverage by adding extra ice or water can help lessen the effects of alcohol.⁽¹⁶⁾

• Reducing Stress in Other Ways: If drinking alcohol is a form of stress relief, enjoyable activities like gardening, listening to music, or journaling can serve as an alternative to drinking. Eating a healthy diet, exercising regularly, and getting enough sleep can also help reduce stress levels and relieve menopausal symptoms.

• Planning Alcohol-Free Social Events: Some people are more likely to drink alcohol in social situations. Instead of venturing out to a restaurant or bar, individuals can consider activities like hiking or spending an afternoon at a museum. These options allow them to enjoy time with friends without alcohol.

• Drinking Alcohol-Free Beverages: Opting for non-alcoholic beer, sparkling ciders, or mocktails can help reduce alcohol consumption.