Drinking through the menopause: the effects of alcohol

Women tend to drink less alcohol than men overall, but the amount they consume still has a major influence on their health. There are both protective and detrimental effects. Drinking habits vary throughout life. More women drink around the time of the menopause than do young women; older women are more likely to drink regularly than drink excessively. But as women get older, alcohol consumption has more effect on their health. Compared with men, they are less able to metabolize alcohol and with increasing age these liver enzymes become less effective. This makes women more vulnerable to the health effects of alcohol as they get older. The acute effects of alcohol intoxication are obvious and well documented. They include all sorts of falls, accidents, violence and self-inflicted injuries. Chronic heavy drinking carries a large health risk at any age. Deaths from alcoholic liver disease in women are increasing, although still not as common as in men. Overall, modest alcohol consumption seems to be protective to women – those who consume up to 2 units of alcohol per day have a lower mortality rate than tee-total women. Once consumption exceeds 2 units per day, the age-related risk is increased. The major contributors to this mortality risk are the effects of alcohol on the risk of cardiovascular disease (protective) and on breast cancer (increased risk). Even modest levels of alcohol consumption are associated with an increased risk of breast cancer and the risk escalates with increasing levels of consumption. For many other cancers (mouth, pharynx, larynx, oesophagus and liver) there is an association between moderate alcohol consumption and an increased risk of developing that particular cancer. It is uncertain how the extra risk of breast cancer is caused by alcohol, but it is likely to be through changes in estrogen levels. Drinking alcohol leads to increased levels of circulating estrogens, and many alcoholic beverages contain significant quantities of phytoestrogens. The main benefit of alcohol consumption is the reduction in mortality from cardiovascular disease. Estrogen may again be the causative factor. It is likely that this protection is mediated through alterations in lipids and lipoproteins, as well as reductions in clot formation and platelet aggregation. Cardiovascular disease is uncommon in women before the menopause and therefore the majority of this benefit occurs in postmenopausal women.