Alcohol and Menopause: What women really need to know

Menopause is a time of significant change for women, both physically and emotionally. During this transition, women may experience symptoms such as hot flashes, mood swings, and changes in their sex drive. While having a glass of wine or two may seem like a reasonable way to cope, adding alcohol into the mix can further complicate matters. Let's take a closer look at the effects of alcohol on women's bodies during this transition, and tips for managing alcohol consumption during menopause.

How does alcohol affect the body during menopause?

Women at any age tend to exhibit lower alcohol tolerance than men. Because of their biological makeup, women typically absorb more alcohol and metabolize it more slowly than men. As a result, consuming the same amount of alcohol can result in higher blood alcohol levels for women, causing them to feel the effect of alcohol more quickly and for a longer period of time compared to men.

As women enter menopause, their bodies undergo significant changes in hormone levels that can affect how they process alcohol. The liver is responsible for breaking down alcohol in the body, but during menopause, the liver's ability to process alcohol can decrease due to decreasing estrogen levels. This can lead to a worsening of menopausal symptoms and related health conditions.

Does alcohol make menopause worse?

When it comes to women's alcohol consumption in midlife, the medical literature doesn't really offer much guidance. It's tough to determine whether drinking is the actual cause of health changes, and if so, how big of an impact it has. Plus, most of the info out there on alcohol and menopause only focuses on post-menopausal women, and it doesn't really distinguish between menopause and other aging effects.

Here’s the risk factors we know about so far:

Hot flushes: Alcohol is a vasodilator, which means it widens blood vessels and increases blood flow. Some menopausal women find that alcohol triggers their symptoms, while others find that it helps relieve their symptoms.

Disrupted sleep patterns: From midlife on, women are increasingly likely to have sleep disturbances, and night sweats can greatly aggravate this. Many women report that alcohol worsen their night sweats.

While alcohol can make us sleepy and help us get to sleep faster, overall it’s more likely to cause sleep disruptions and decrease in sleep quality.

Low Mood: Women going through the menopausal transition have a higher risk of developing depression, especially if they have previously experienced it. This is because a decrease in estrogen levels can lead to a reduction in serotonin, affecting the brain's pleasure receptors. It's important to note that alcohol is also a depressant for the central nervous system, which can exacerbate feelings of low mood already caused by hormonal changes.

Breast Cancer: in postmenopausal women, an alcohol dose-related increase breast cancer risk is well documented. The Nurse’s Health Study found that even low alcohol consumption (equivalent to 3-6 glasses of wine/week) was modestly associated with breast cancer(PMID: 27028261).

Bone Health: Research about alcohol and bone health is ongoing. According to the NIH, “human and animal studies clearly demonstrate that chronic, heavy alcohol consumption compromises bone health and increases the risk of osteoporosis(internal link). However light to moderate drinking after menopause is consistently associated with improved bone density (PMID:22456655). However it should be noted that excessive alcohol consumption does increase the risk of falls.

Heart Health: The relationship between cardiovascular disease and alcohol intake is complex. Recent studies have shown that women who drink moderately have reduced risk of heart disease. (PMID: 27028261). However, it is difficult to tease out the impact of alcohol intake alone verses other lifestyle factors. There is strong evidence for positive benefits on heart health for those who follow the Mediterranean style of eating(which includes a glass or two of red wine).

Diabetes: It appears that light to moderate alcohol intake can lower the risk of type 2 diabetes. Moderate alcohol consumption increases insulin sensitivity and reduces fasting insulin levels in the blood. But again this is often in combination of healthy diet, regular exercise, smoking abstinence or cessation (PMID:36812419). There is some evidence that these benefits go away with excessive drinking.

Dementia: Struggling with brain fog during menopause can often make us worry about the onset of dementia. The good news is that current research show with protective effects with low-to-moderate alcohol consumption for dementia and cognitive function. The effects of chronic, heavy alcohol use are clear, with excessive consumption causing alcohol-related brain damage.

Deciding if you should drink or not during menopause can be confusing as alcohol intake has both risks and potential benefits. As a registered dietitian I usually advise my clients to consider their family and personal health history. For example those with a strong family history of breast cancer may want to consider abstaining. Those with extensive family history of heart disease may want to consider some consumption. But generally I recommend women to avoid heavy drinking and certainly not to start drinking if they currently don’t.

How much can you drink during menopause?

Alcohol consumption guidelines vary from country to country, but here are some of the alcohol limit recommendations from health organizations around the world:

1. World Health Organization (WHO): The WHO recommends that adults should not consume more than 2 standard drinks per day and should have at least 2 alcohol-free days per week. Their latest statement includes “that when it comes to alcohol consumption, there is no safe amount that does not affect health”.
2. American Heart Association (AHA): The AHA recommends that adults should limit their alcohol consumption to no more than 1-2 drinks per day for men and 1 alcoholic drink per day for women.
3. National Health Service (NHS) in the UK: The NHS recommends that both men and women should not regularly drink more than 14 units of alcohol per week.
4. Australian Government Department of Health: The Australian guidelines recommend that adults should consume no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol.
5. Canada’s Guidance on Alcohol and Health states that there is a continuum of risk associated with weekly alcohol use where 2 standard drinks or less per week, you are likely to avoid alcohol-related consequences for yourself or others.

Tips for managing alcohol consumption during menopause:

1. Limit your intake: If you choose to drink alcohol, it's essential to be honest about your intake. All the health benefits associated with alcohol are at the light to moderate intake level.
2. Stay hydrated: Drinking plenty of water can help mitigate some of the immediate effects of alcohol and keep you hydrated.
3. Experiment with low or no alcohol mocktails, wines or spirits.
4. Be aware of medication interactions: Alcohol can have harmful interactions with many medications, even ones you may not think about. Check commonly used medications that interact with alcohol here. 
5. Talk to your doctor: If you're struggling with alcohol use during menopause, talk to your health care provider. They can help you come up with a plan to manage your alcohol consumption and address any underlying issues.

Ways to cope without alcohol.

While alcohol may seem like a quick fix for coping with symptoms, there are healthier ways to manage these changes. Here are some effective strategies for coping with menopause without turning to alcohol:

1. Exercise: Exercise is known to reduce hot flashes, boost mood, and improve sleep. Even gentle activities like walking or yoga can be beneficial.
2. Mindfulness: Mindfulness practices such as meditation, deep breathing, and visualization can help manage stress and improve sleep.
3. Social support: Connect with friends and family or join a menopause support group. Talking with others who are going through the same experience can be reassuring and helpful.
4. Healthy eating: Eating a Mediterranean style diet with plenty of fruits, vegetables, and whole grains can boost our energy and help us cope with menopause symptoms.
5. Sleep hygiene: Good sleep habits, such as avoiding screens before bed and establishing a regular sleep routine, can improve sleep quality.
6. Self-care: Taking time for yourself, whether it's a relaxing bath, reading a book, or pursuing a hobby, can help manage stress and improve overall wellbeing.
7. Hormone therapy: For some women, hormone therapy may be an effective option for managing menopause symptoms. Talk to your healthcare provider to see if it's right for you.

Non-alcoholic alternatives

While alcohol can be a part of many people's social lives, it's important to remember that it's not the only option. For women going through menopause, there are plenty of non-alcoholic alternatives to enjoy. Mocktails made with fresh fruit, soda water, and other mixers can be a refreshing and healthy alternative to alcohol. Additionally, herbal teas and sparkling water with a splash of citrus can provide a similar experience to a cocktail without the alcohol.

Here are some fun mocktail recipes to try:

Virgin Margarita

Ingredients:

• 2 cups of ice
• 1 cup of freshly squeezed lime juice
• 1/2 cup of orange juice
• 1/4 cup of honey
• Salt for the rim of the glass

Instructions:

1. Rim a glass with salt by rubbing a lime around the rim and dipping it in salt.
2. In a blender, add ice, lime juice, orange juice, and honey.
3. Blend until smooth.
4. Pour the mixture into the salt-rimmed glass and garnish with a lime slice.

Strawberry Basil Lemonade

Ingredients:

• 1 cup of fresh strawberries
• 1/4 cup of fresh basil leaves
• 1/2 cup of freshly squeezed lemon juice
• 1/4 cup of honey
• 3 cups of water
• Ice cubes

Instructions:

1. In a blender, add fresh strawberries, basil leaves, lemon juice, honey, and 1 cup of water.
2. Blend until smooth.
3. Pour the mixture into a pitcher and add the remaining 2 cups of water.
4. Stir to combine.
5. Chill in the refrigerator for at least an hour.
6. Serve in a glass with ice cubes.

Sparkling Peach Punch

Ingredients:

• 2 cups of peach nectar
• 1 cup of sparkling water
• 1/2 cup of orange juice
• 1/4 cup of lemon juice
• 2 peaches, sliced
• Mint leaves for garnish

Instructions:

1. In a large pitcher, combine peach nectar, sparkling water, orange juice, and lemon juice.
2. Stir to combine.
3. Add sliced peaches and stir again.
4. Chill in the refrigerator for at least an hour.
5. Serve in a glass with ice and garnish with mint leaves.

No/Low alcohol wines and spirits

Demand for low or no alcohol wines and spirits are on the rise and are a great option for those who want to enjoy the taste of their favorite drinks without the negative effects of alcohol. These drinks typically have less than 0.5% alcohol by volume (ABV), which means they are considered non-alcoholic. They are made by removing the alcohol from the wine or spirit, either through distillation or reverse osmosis.

 Here are some top recommended no alcohol wines and spirits:

• Seedlip: Seedlip is a non-alcoholic spirit made with botanicals such as peas, rosemary, and spearmint. It comes in three different flavors: Spice 94, Garden 108, and Grove 42.
• Fre Wines: Fre Wines offers a range of alcohol-free wines, including Chardonnay, Merlot, and Rosé. They are made using traditional winemaking techniques and have a similar taste profile to their alcoholic counterparts.
• Ariel Wines: Ariel Wines offers a variety of non-alcoholic wines, including Cabernet Sauvignon, Chardonnay, and White Zinfandel. They are made using a process that removes the alcohol while retaining the wine's flavor and aroma.
• Lyre's: Lyre's is a range of non-alcoholic spirits that includes gin, rum, and whisky. They are made using natural flavors and botanicals and have a similar taste profile to their alcoholic counterparts.
• Belvoir Fruit Farms: Belvoir Fruit Farms offers a range of non-alcoholic drinks, including elderflower pressé, ginger beer, and raspberry lemonade. They are made using natural ingredients and have a refreshing taste.
• Nosecco: Nosecco is a non-alcoholic sparkling wine that is made using traditional methods. It has a crisp, dry taste and is a great alternative to champagne.
• Ceder's: Ceder's is a non-alcoholic gin that is made using botanicals such as juniper berries, coriander, and rose petals. It has a similar taste profile to gin and tonic and can be used in cocktails.

Menopause is a significant life transition that can be challenging to navigate. Adding alcohol into the mix can be both potentially harmful or potentially helpful depending on your symptoms, personal health and family history. Overall if you do choose to drink, less is better. And remember that there are many healthy and effective ways to manage symptoms without resorting to alcohol.

Need help with menopause nutrition? Book a connection call to see how I can help.