How Alcohol Impacts Menopause Symptoms, Plus Tips To Quit Drinking
For most of her adult life, Amy B. was that reliable drinking buddy who would head to a friend’s house or dinner out and say, “of course I’ll have a drink!”
It was an end-of-day ritual when her kids were little “to pour myself a glass of wine and start making dinner,” the New York City mom says, adding that she would often share a bottle over dinner with her husband. “It was part of our everyday life.”
Three years ago, though, during her annual girls trip—“we play tennis, work out, lay on the beach for a while, and at four o’clock, the wine bottle comes out,” she describes—she had an epiphany moment: “It was at the end of that week drinking five or six days straight [when] I thought, I really don’t feel well. That was the day that I woke up and I just went, you know what? I think I’m over this for a while.”
Amy went 68 days without a drop of alcohol. Today, she drinks only occasionally.
While it wasn’t because of menopause that she made this choice, Amy feels noticeably different after drinking alcohol than she did before the transition. “First of all, I’m completely dehydrated as soon as I have a glass of wine,” the 56-year-old says, noting that recovery the next day is also more difficult. “Also, your mortality comes in. It’s just not good for you.”
Indeed, alcohol is linked to increased risk for at least seven different types of cancer, including breast cancer, according to the U.S. Surgeon General Vivek Murthy, MD, who recently called for cancer warnings to be put on alcoholic beverage labels. And past research shows that booze can play a role in heart disease, dementia, and hundreds of other diseases as well as weight gain and sleep issues.
And as Amy experienced firsthand, perimenopause and menopause can amplify the negative impact of alcohol. “Declining estrogen at menopause can impact alcohol metabolism,” says Juliana (Jewel) Kling, MD, chair of Women’s Health Internal Medicine at Mayo Clinic Alix School of Medicine, Arizona Campus. “Alcohol can also increase the risk of osteoporosis, breast cancer, and heart disease, all diagnoses that women are at higher risk of post-menopause.” What’s more, drinking can worsen already-frustrating menopause symptoms, such as hot flashes, mood symptoms, and sleep disturbance, she adds.
Cutting back on alcohol during this time of your life—and leaning into other healthy habits like exercise and nutritious eating—can significantly lessen your risk of chronic disease and improve menopause symptoms, Dr. Kling says. Amy, for one, says she sleeps better and can put more into her workouts that include weight lifting and Pilates, and possibly training for a half marathon later this year.
Meet the experts: Deborah Gomez Kwolek, MD, is an assistant professor of medicine at Harvard Medical School and is the founding lead of the Mass General Women’s Health and Sex and Gender Medicine Program. She is a certified specialist through the Menopause Society and a practicing primary care physician. Juliana (Jewel) Kling, MD, is a chair of Women’s Health Internal Medicine at Mayo Clinic Alix School of Medicine, Arizona Campus.
And thanks to more sober curiosity (and a booming non-alcoholic beverage market) in general, paired with society finally being more open about menopause, women who want to cut back or quit altogether have more support and resources than ever before. Keep reading for more information on the alcohol-menopause connection, plus advice from doctors and real women for changing your relationship with booze in midlife.
Why Alcohol Is Especially Detrimental During Menopause
First, know this: “Women [of any age] are more susceptible than men to the adverse effects of alcohol because there [are fewer] enzymes in the stomach to neutralize it,” says Deborah Gomez Kwolek, MD, an assistant professor of medicine at Harvard Medical School and the founding lead of the Mass General Women’s Health and Sex and Gender Medicine Program. From the stomach, it floods the liver, putting the organ into overdrive to process it. But add menopausal changes on top of that, and the impact on your liver—and entire metabolic system—is even more detrimental.
Since estrogen, which declines during menopause, is metabolized in the liver, the organ is already “super stressed” during this time, says Dr. Kwolek, which could up your risk for fatty liver, diabetes, high cholesterol, and weight gain. But “alcohol sort of fuels that because it further stresses the liver,” she explains.
But it’s not just these hormonal changes that make alcohol even more health-harming for perimenopausal and menopausal women. Alcohol is considered empty calories, meaning it provides no nutrients and can contribute to weight gain especially in the abdomen (the so-called “meno belly”). Drinking also disrupts sleep, can worsen hot flashes, and even moderate drinking is considered a significant risk factor for breast cancer. “You have to realize that [drinking] really is not doing your body a favor,” Dr. Kwolek says.
Here’s the reassuring part: “If you cut back, you’re going to feel so much better,” Dr. Kwolek says. You’ll likely feel more energized since you’ll sleep better, she says. On the health front, by removing the toxin (yup, alcohol is a toxin!), you help your liver detoxify and reduce your risk of many of those aforementioned diseases. “Women may also find that cutting out alcohol helps them lose weight or achieve their weight goals more easily,” Dr. Kling adds.
6 Realistic Tips For Cutting Back On Alcohol
Adopt this sound advice from real women who have done it, as well as our experts, on how to reel in your alcohol habit before or during menopause (or, anytime in your life, really). Then, reap the health benefits that come along with the decision.
1. Open up to your friends and family about your decision.
Memories of peer pressure from young adulthood can be strong—and Amy felt almost as if she owed it to her friends to be “the fun one” always up for a drink. In actuality, she found that sharing her decision to cut back with her friend group invited mature conversations and empathy instead. “I realized that I had no responsibility to say yes to the glass of wine,” says Amy, adding that she realized that much of the pressure she felt to drink—to be the “party girl—was actually coming from herself. “Nobody really saw me that way.”
In fact, many of her friends are coming to the same conclusion that she has, and they often share health- and menopause-related articles, including about the recent call to add cancer warnings to alcoholic beverages, with one another. “This was something that we all knew, but now it’s really been studied and that article was shared between all of us,” she says. “That’s something that we do for each other.”
2. Consider a gradual cut-back.
As Natasha L. approached 50 and began experiencing menopause symptoms in an obvious way, she noticed a massive difference in how she felt after drinking compared to when she was younger. “Even a glass or two of wine derails me for at least two days,” says Natasha, who lives in New York City. “The next day, I’m hungover and didn’t sleep well, and I’m really hungry, so that affects my food choices. And then my energy levels are terrible, so I end up not going to the gym. The second day, I still feel a tiny bit hungover and not 100 percent. It’s like, is it worth it?”
For the last few years, she decided to only drink on the weekends. But then, she realized that her whole weekend revolved around drinking and then recovering from drinking. “What a waste of time,” she says. Now, she only drinks on special occasions. She had a glass of wine at a New Year’s Eve party this year, for example, and prior to that, she had a drink on Halloween. She credits this more gradual approach—versus attempting to go cold turkey—with her ultimate success.
Dr. Kling agrees that attempting to stay within the recommended amount of alcohol for women —one serving or less per day—is a good place to start for women who are currently drinking more than that. “The less you drink, the better,” Dr. Kwolek reiterates. “But if you cut back, that’s healthier than drinking more.”
3. Get (really) honest with yourself.
Natasha says changing her mindset around alcohol—and owning the fact that it wasn’t making her feel good anymore—was the biggest factor in successfully cutting back. “I just got really honest—and really tired of feeling like shit,” she says. “It took a long time for me to come to grips with that. I wanted to be the girl that could drink a margarita and go to the gym the next day. And I’m slowly realizing I’m just not that person.”
Dr. Kwolek also says that it’s important to take a “hard look” at your relationship with alcohol and whether or not you need or want to cut back. It may be helpful to go as far as doing a therapy appointment to work through some questions and answers about how you feel during and after drinking, or journaling about it. This way, you say or read your answers directly, which can help give them weight and help you make a different choice.
4. Take advantage of the many N/A and low-ABV beverages on the market.
The options these days for non-alcoholic and low-alcoholic beverages abound—and Dr. Kwolek says finding a substitute for your go-to cocktail or glass of wine can be helpful.
Natasha says mocktails are her go-to in social settings: “I need something to feel like I’m doing the thing,” she says. “At the very least, I need sparkling water in a wine glass.” For Amy and her friends, though, mocktails and alcohol substitutes aren’t a big thing: “I think there are just a lot more water bottles on the table now,” she says.
“Another tip is to make a wine cooler with seltzer water or Ginger Ale, and just pour a little bit of wine into it for the flavor,” Dr. Kwolek says, which she herself has done. If options like individually portioned glasses of wine and/or lower-alcohol wines help you to cut back, that can be helpful, too, says Dr. Kwolek. “Just remember it still is toxic, so it’s better to get rid of it.” (Dr. Kwolek also personally avoids liquor because it’s stronger and often mixed with something sweet, making it easier to consume more of it compared to wine.)
5. Look at your family history.
There are some genetic differences when it comes to how well people metabolize alcohol. Natasha points out that some of her friends of the same age still drink quite a bit and seem to “power through,” whereas she’s always been more sensitive (and even more-so since starting menopause).
“Some people just genetically get away with it,” Dr. Kwolek acknowledges. “They interview these 105-year-olds and they say, ‘yeah, I had vodka every night.’ But we do know that on the whole alcohol is not good for you, and the more you can cut back, the better, the healthier you’ll be.”
You could consider a DNA test which can let you know how well you metabolize alcohol, or look at whether you or someone in your family has fatty liver disease or diabetes, for example. “If you already have issues like that, then drinking’s going to be even doubly bad,” Dr. Kwolek says.
6. Focus on an overall healthy lifestyle, not just alcohol.
For Natasha, “getting off booze” was just part of the formula for feeling her best during menopause. She also credits hormone replacement therapy, exercise (she started weight lifting for the first time last year), and good nutrition (she says eating some of the same foods on rotation helps her eat healthy more consistently).
All of your health-conscious changes go hand-in-hand, Dr. Kwolek says. “I talk to my patients about lifestyle medicine: exercise, nutrition, sleep, stress reduction, and avoiding toxins (e.g., alcohol) are the five of the big pillars of that.”
Caitlin is a health and fitness journalist based in New York City. In addition to Women’s Health, she writes for publications including The Wall Street Journal and Runner’s World. She’s completed 12 marathons, including the six World Marathon Majors, is semi-fluent in French, and volunteers as a greeter on The High Line. Follow her on Instagram or LinkedIn.
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