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Why Alcohol Affects Women More in Menopause

Studies are starting to confirm what many women have long suspected

With Jodi Flaws MD

There is mounting evidence that alcohol, and wine in particular, triggers hot flashes.

The mood swings. The sleepless nights. The public hot flashes. The experience of perimenopause can be so stressful, who could blame us for wanting to decompress with a glass of wine… or two? But anecdotally, many women say that drinking actually makes those mood swings, hot flashes, and insomnia worse. And doctors warn that alcohol can be more dangerous the older you get, especially for women. Now why would wine do you like that, just when you need it the most?

This may be hard to hear, but it may be time to re-think drinking through perimenopause. Don’t worry, it’s not all bad news. Here’s what you need to know about alcohol and the midlife transition.

Age plus gender makes drinking more dangerous

On the whole, men still drink more than women do; but we’re well on our way to catching up. Alcohol use is growing among women of all ages. But what’s especially concerning is that the prevalence of binge drinking is rising among post-menopausal women.

As it is, women are less alcohol tolerant than men are. This is partly because our bodies are smaller. But we also have less alcohol dehydrogenase, an enzyme that metabolizes alcohol in the stomach. Plus, that enzyme is relatively inactive in the liver of women. As a result, we tend to absorb far more alcohol into our bloodstream than men.

Meanwhile, as we age, our bodies lose water volume. As a result, we are less able to dilute any alcohol in our systems. That makes us that much more vulnerable to its effects.

Risks of heavy drinking

The National Institute on Alcohol Abuse and Alcoholism (NIAA) defines high-risk drinking as more than 7 drinks a week, or more than 3 on a given day. They break it down by types of alcohol:

  • 1 glass of wine (5 oz) at 12% ABV
  • 1 can of beer (12 oz) at 5% ABV
  • 1 shot (1.5 oz) of 80-proof distilled alcohol such as whiskey or gin

Note that a single cocktail may go over these daily amounts. For example, a small martini is equal to 1.5 drinks, while a margarita may be the equivalent of two drinks. So, if you enjoy a cocktail one day, consider abstaining the following day or two.

Heavy drinking is more dangerous as we age. It’s associated with the following health risks:

  • All cancers, especially breast cancer
  • Heart disease
  • Organ damage, including brain, nerve, heart, and liver
  • Irreversible bone mass loss
  • Depression, even for people who were not previously depressed
  • Interactions with medications (and we tend to take more meds as we age)
  • Accidents leading to bone fractures
  • Sleep disruption

Alcohol has been known to disrupt the sleep of both genders. But women appear to be even more susceptible to insomnia after drinking than men.

Benefits of moderate drinking

So that’s heavy drinking. But what about moderate drinking? There appear to be a few health benefits:

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

The type of alcohol could also make a difference. In a 2011 study of men and women ages 51-81, low-alcohol beer was found to be bone protective for women. (In contrast, distilled spirits seem to lower men’s bone density, but red wine seems to minimize their bone loss.)

Does alcohol trigger hot flashes?

The effect of alcohol on hot flashes is more complex. Many women say drinking alcohol – especially red wine – triggers hot flashes, and there are a number of small studies that seem to hold up to that claim. But where you are in your transition seems to matter.

Surprisingly, a 2007 study showed that perimenopausal women who drink had a lower risk for hot flashes compared with women who never drink alcohol. The researchers measured the participants’ sex hormone levels and noticed that they were not affected by alcohol use. So, it’s not that drinking changes hormone levels in a way that reduces hot flashes. Rather, it could be that higher blood glucose levels are decreasing the hot flashes.

“We initially thought it could be because alcohol is inducing enzymes that metabolize estrogen, causing low estrogen, which is a risk factor for hot flashes,” says Dr. Jodi Flaws, a professor in comparative biosciences at the University of Illinois. “However, our analysis doesn’t support this concept.” She says alcohol could be affecting other hormones besides estrogen. “It is also possible that the alcohol is causing dilation of blood vessels, which could be linked to hot flashes.”

Other studies have shown the opposite – increased risk for hot flashes and night sweats for women who drink, especially among postmenopausal women. So, the effects of drinking on hot flashes may depend on where you are in your menopause transition. If you’re postmenopausal and wondering why you’re still having hot flashes, alcohol could at least partially be at fault.

Regardless, whether alcohol triggers hot flashes varies widely by individual. You may have already figured this out for yourself.

Low and No-ABV Drinking

If you’re thinking of cutting back, or even quitting altogether, you have plenty of alternatives besides the same old soda or cranberry spritzer. Non-alcoholic cocktails and beverages are on the rise. These new drinks offer more sophisticated, adult flavor profiles and are often low in sugar. You can also order many of these options online.

Now might be a good time to get into craft beer, especially since it may be bone protective. Keep an eye out for brews on the lower-ABV scale, and check out the new generation of non-alcoholic beers, such as those from Athletic Brewing Company. We’ve come a long way from O’Doul’s.

Aperitif culture is also on the rise. Aperitifs are a class of drinks low in alcohol and sugar traditionally enjoyed before dinner; their counterparts, digestifs, are enjoyed afterwards. Think of a glass filled with citrus slices and tonic with just a half ounce of gin–or soda water with a splash of sweet vermouth, or newcomer Haus topped with mineral water.

As for wine, anecdotally, the dryer the red the worse the hot flashes. Is it the tannins? We don’t know yet. And, of course, it varies from one woman to the next. Natural wines, which contain fewer sulfides, sweeteners, colorings, and other additives, may agree with you better. But again, there’s no data to back that up, yet. Regardless of what’s in your glass, let moderation be your guide.

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