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Menopause and alcohol addiction: what you need to know
The links between menopause and addiction, and where to get help
Many of us reach for a glass of wine in the evening after a busy day. But what should you do if you are starting to worry about your drinking?
Being addicted to or dependent on alcohol can have a major impact on your life, but the impact of the menopause on these behaviours remains poorly researched and understood.
However, healthcare professionals working with women who are perimenopausal and menopausal regularly see that managing addictive behaviour can become more challenging at this time.
‘We see a lot of women in our clinics struggling with issues around alcohol and other addictions,’ says Newson Health GP and Menopause Specialist Claire Phipps.
‘While there isn’t a lot of evidence – because the research simply hasn’t been done – we do know that alcohol consumption often goes up during significant life changes, such as the menopause. It’s an area where women can need help.’
When is alcohol a problem?
Alcohol misuse is when you drink in a way that’s harmful, or when you’re dependent on alcohol, according to the NHS.
There is no safe level, according to the NHS, but to keep health risks from alcohol at a low level, both men and women are advised not to regularly drink more than 14 units a week.
The number of units varies on the size and strength of a drink. A bottle of wine with a 13.5% alcohol by volume contains 10 units, a single shot of 40% spirit has one unit, a bottle of 5% beer or lager has 1.7 units.
Higher risk drinking for women is defined as drinking more than 35 units per week.
Does alcohol affect women differently?
Men and women’s bodies respond to alcohol differently. Although men are more likely to drink alcohol and consume larger amounts, biological differences mean women absorb more alcohol and take longer to break it down .
After drinking the same amount of alcohol, women tend to have higher levels of alcohol in their blood than men, and the immediate effects of alcohol usually occur more quickly and last longer in women.
These differences mean women are at higher risk of the long-term negative health effects of alcohol compared with men.
Health impact of alcohol
You are at higher risk of alcohol-related liver disease and cirrhosis than men, and alcohol-related cognitive decline and brain shrinkage occurs more quickly.
Women are at an increased risk for damage to the heart muscle at lower levels of drinking and over fewer years of drinking than men.
Drinking alcohol also increases your risk of several other types of cancer, including liver, bowel, mouth, oesophageal cancer (gullet) and laryngeal cancer (voice box), according to charity Drinkaware.
Alcohol is also associated with a higher risk of breast cancer. Oxford University’s Million Women Study of 1.3 million women estimated that each additional alcoholic drink regularly consumed per day was associated with 11 additional breast cancers per 1,000 women, in developed countries, up to age 75 .
Other risks associated with alcohol
Excessive alcohol use, particularly binge drinking, is a contributing factor to sexual violence . As well as increasing the risk of serious health problems, long-term alcohol misuse can lead to social problems for some people, such as unemployment, divorce, domestic abuse and homelessness, according to the NHS.
How does the perimenopause and menopause affect drinking habits?
Like much of women’s experience of the menopause, this remains a significantly under-researched area.
But Dr Phipps says that drinking can increase during life changes such as the perimenopause.
‘The perimenopause can have a massive impact on women – it can make you feel anxious, have that sense of overwhelm and maybe lead to you having an extra glass of wine as you feel you aren’t coping’ she says. ‘That can escalate into drinking more and more. It so common to hear women say I am drinking more than I used to, I’m becoming reliant on alcohol and I’m at a tough stage.’
The causes are of increased drinking are often multifactorial, Dr Phipps says. The perimenopause could provide the tipping point on top of other sources of stress from busy family and work life commitments.
She has seen women relapse with problems they have had in the past, such as drinking to excess or eating disorders.
‘During perimenopause, hormonal fluctuations mess with your brain, particularly with the neurotransmitters, which are the chemicals which carry messages between brain cells, and that can mean you are more at risk of looking for coping strategies,’ she says.
Figures show that women are most likely to exceed recommended drinking limits during the age of 45 to 64, with almost one in five (19%) women drinking more than 14 units of alcohol in a week in England .
A Yale University study of more than 3,000 women suggested that those who don’t drink much could change to excessive drinkers during the early perimenopause onwards, while women who were excessive drinkers before the menopause, appeared to moderate their drinking during that phase . Researchers from said it was clear that menopause marked a period of ‘instability’ in drinking habits.
Another review found that stress and depression related to menopause may trigger the onset of alcohol abuse or worsen established alcohol misuse .
Researchers pointed out that due to social stigmas, women tend to have more difficulty gaining access to treatment and recovering from alcohol dependence than do men.
Some women find that alcohol, particularly red wine, triggers hot flushes and night sweats, though the evidence is mixed in this regard [6,7].
What impact does alcohol have on mood?
You may find you turn to alcohol when feeling stressed or anxious, as when you have a drink your brain produces more of the happy hormone dopamine.
The charity Alcohol Change UK says that these changes in the brain initially make you feel good and also make want you to drink more.
It can lead to loss of inhibition and slows the parts of the brain that makes decisions.
Alcohol can also affect mood. In the short term a hangover, a combination of dehydration, low blood sugar and the by-products of alcohol can be a miserable experience.
And in the longer term, your body gets used to the dopamine boosts and starts to make less, which can lead to low mood and anxiety.
Alcohol can also impact your general mental health, with research showing links between excessive drinking is linked with depression, self-harm and suicide .
How does alcohol affect my hormones?
One study suggests that heavy drinking could lead to an earlier menopause .
There is some evidence that the perimenopause can reduce your body’s ability to metabolise alcohol, Dr Phipps says.
‘My menopause while in alcohol recovery’
Earlier this year, balance shared an anonymous account of a woman on the challenges of maintaining her sobriety during the perimenopause, and the strategies that helped her.
‘I chose to go on HRT at 48 years old,’ she wrote.
‘After some tweaking of the dosages and introducing some lifestyle changes including yoga, exercise, nutrition, therapy and plugging right back into my 12-step programme, my symptoms subsided and are now mostly in remission – those that remain are very mild. By not asking for help earlier, I created fertile soil for my illness to grow. Thankfully I didn’t pick up a drink.’
Read the full account here.
Where should I turn for help?
If you are concerned about your drinking, then make an appointment with your GP.
‘This is the best first step, but often women in this situation don’t want to talk about it. There is a big stigma or taboo against asking for help, which is the single most important thing we can do,’ Dr Phipps says. ‘But take heart that there is a lot of good support out there for women with addictions.’
Accessing therapy is often part of this, she says.
‘Really thinking about what your trigger may be and how you can address that. It is a very personal journey, working on that source and behaviour change.’
Looking after yourself, by eating well and taking regular exercise, can also be an important part of recovering.
‘For some women, taking HRT may be part of the solution that will help them look after their wellbeing and restore some balance,’ says Dr Phipps.
‘This can be part of a holistic approach to looking after your health, which should include making time for the things you enjoy.’
Tips for cutting down
- drink and think in units so that you can see how much of the recommended 14 units you are drinking a week
- keep a drinking diary
- try low alcohol and alcohol-free drinks
- remember it is fine to say no to alcohol
- have a few alcohol-free days every week
- eat before and while you drink to slow the rate the alcohol is absorbed into your bloodstream
- ask for help
If you are dependent on alcohol it is important not to stop drinking suddenly as it can be very dangerous or even kill you. Speak to a GP or support service who will be able to get help for you to reduce your drinking safely.
1. Centers for Disease Control and Prevention (2022), ‘Excessive alcohol use is a risk to women’s health’
2. Drinkaware ‘Alcohol and women’
3. House of Commons Library (2021), ‘Alcohol statistics: England’
4. Peltier, M.R., et. al (2020), ‘Changes in excessive alcohol use among older women across the menopausal transition: a longitudinal analysis of the Study of Women’s Health Across the Nation’, Biology of Sex Differences, 11(1), 37. doi.org/10.1186/s13293-020-00314-7
5. Milic J., Glisic M., Voortman T., et al. (2018), ‘Menopause, ageing, and alcohol use disorders in women’, Maturitas, 111:100-109. doi:10.1016/j.maturitas.2018.03.006
6. Sievert, L. L., Obermeyer, C. M., Price, K. (2006). ‘Determinants of hot flashes and night sweats’, Annals of Human Biology, 33(1), pp.4–16. doi.org/10.1080/03014460500421338
7. Schilling C., Gallicchio L., Miller S.R., Langenberg P., Zacur H., Flaws J.A. (2007), ‘Current alcohol use, hormone levels, and hot flashes in midlife women’, Fertility and Sterility, 87 (6), pp.1483-6. doi: 10.1016/j.fertnstert.2006.11.033
8. NHS.uk (2022), ‘The risks of drinking too much’
9. Gill J. (2022), ‘The effects of moderate alcohol consumption on female hormone levels and reproductive function’, Alcohol and Alcoholism, 35(5):417-23. doi:10.1093/alcalc/35.5.417