Alcohol and menopause: what are the risks?

Contemporary OB/GYN:

Hi, I'm Celeste Krewson with Contemporary OB/GYN, and I’m here with Dr. Prairie to discuss the effects of alcohol on menopause. Do you want to introduce yourself?

Beth A. Prairie, MD, MPH, FACOG, FACPM:

Thank you so much. I'm Beth Prairie. I am a gynecologist specializing in menopause at the Allegheny Health Network, West Penn Hospital here in Pittsburgh, Pennsylvania. Thank you so much for the opportunity to talk about this topic today.

Contemporary OB/GYN:

Thank you for joining me. So, how does alcohol consumption impacts menopause in midlife woman?

Prairie:

It's a great question, and I know it's something that has been on people's minds, especially after the lay press coverage related to increased alcohol consumption in women during the pandemic. And so, I think it's always worth talking about first alcohol consumption in general. We know that alcohol consumption is a risk factor for about 11 different kinds of cancers. We know that it can contribute to diabetes and cardiovascular disease, particularly in women. And of course, we know that we need to worry about alcohol use disorder and dependence on alcohol. So, anytime I'm talking about alcohol and women's health, I always want to make sure that we start with that level setting about alcohol. At the same time, alcohol use is a part of our culture, it's often how we celebrate. And public health experts have recommended that we counsel our patients on healthier use of alcohol, as opposed to counseling teetotaling or no alcohol use for everyone. Women who are going through their menopausal transition, often complain of hot flashes, and or night sweats, which are also sometimes called vasomotor symptoms. I know from many years of clinical practice that my patients tell me that alcohol consumption can make their hot flashes worse, so, I counsel my patients that way. However, the data that we have has been really inconsistent in supporting that in laboratory situations, as well as in large cohort studies. And then the last, I believe in listening to women, and they listen to my patients, and that is often their experience. The other thing we know about alcohol consumption, particularly in the evenings around dinnertime or afterwards, is that it can be a significant disruptor of sleep. We know that sleep is disrupted during the menopausal transition, and we also know that the structure of our sleep, the quality of our sleep, changes with aging. Those are all good reasons to be mindful of alcohol use if you are having sleep issues during your menopausal transition. One of the things that we would always recommend for a woman who was struggling with sleep during the menopausal transition, or during perimenopause would be to cut back on alcohol at night and in the evenings to see if that's at all helpful. Finally, although alcohol can produce as everyone knows, well, an intoxication effect or even a mild euphoria, it is actually acting as a depressant in our brains and can leave someone more vulnerable to depression and anxiety. We know that the time of the menopausal transition is a time of increased risk for depression and anxiety. And that's another good reason for women to think carefully about their alcohol consumption going through the menopausal transition.

Contemporary OB/GYN:

And is there any other advice that you have for midlife women who wants to consume alcohol?

Prairie:

So, we would always advise a safer alcohol consumption level. There's been a little bit of debate about exactly what that looks like, because of some new evidence that's come out over the last 5 to 10 years. But in general rule of thumb is that for most women, no more than 2 drinks in any given day, and fewer than 13 drinks in a week. There's some evidence to suggest that 13 drinks a week is perhaps overly generous, and we should actually be talking about something closer to not more than 7 total drinks a week. But in general, moderate drinking with not more than 2 drinks in a given day is considered to be a safer level of alcohol exposure. I would add that I think many women had heard that women should drink less than men because we are, on average, physically smaller. It is true on average, women are physically smaller, and that does play a role in how we metabolize alcohol. But what we've known for years now is actually that the enzymes that our bodies produce to process alcohol when we ingest it are different in women than they are in men. That difference in enzymes makes alcohol relatively more toxic in female bodies, and that is an important thing to keep in mind when we think about safer levels of alcohol use in women.

Contemporary OB/GYN:

Those are really good points. We're just about ready to wrap up, but is there anything you want to add first?

Prairie:

I would say that for all women going through the menopausal transition, the first thing is to know that we really are here for you to listen to you and to help you. I always say I have a tool belt full of tools and I am happy to share them with you. There are lots of options for us to help you feel better if you are struggling with your menopausal transition. For everyone, protecting your sleep, exercising, moving your body every single day. Spending time with people who love you, bring you joy, and support you are things that make all of us feel better. And it's especially important that women take care of themselves after for many of us, having taken care of others for most of our lives. It's an important period of time for you to think about yourself, your own health and make your own health a priority.