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Alcohol and Menopause: What Science Already Knows About This Relationship

Menopause is the stage in a woman's life marked by the natural end of menstruation and fertility, due to declining hormone levels, particularly estrogen. Recent scientific evidence suggests that alcohol consumption during this phase can interfere with symptoms such as hot flashes, mood, and mental health, as well as accelerate bone loss and increase cardiovascular risks like hypertension and arrhythmias. Alcohol may also affect the outcomes of hormone therapy, increasing the risk of complications such as breast cancer. Learn how alcohol can impact women’s health during menopause.

 

Effects of Alcohol on Menopausal Symptoms

Hot flashes (vasomotor symptoms):
Observational studies have shown mixed results—some associate alcohol consumption with more hot flashes, others find no clear relationship or even suggest fewer hot flashes with light to moderate consumption (1).
In a cohort study of over 4,000 premenopausal Korean women, those who consumed ≥20 g of alcohol per day (approximately 2 or more standard drinks) had a 1.7 to 2.2 times higher risk of developing moderate to severe hot flashes and night sweats compared to abstainers. The authors concluded that avoiding alcohol may help prevent vasomotor symptoms in women approaching the menopausal transition (1).

Mood and mental health:
Menopause is a period of increased vulnerability to mood changes and depression, and heavy alcohol consumption tends to worsen these symptoms. Excessive drinking is associated with worsening depression and anxiety, and menopausal women who drink heavily are 2 to 7 times more likely to develop depression compared to men with alcohol use disorder (2).
Turning to alcohol as a way to cope with stress or negative moods may increase during the menopausal transition, due to psychological symptoms and social stressors, reinforcing the need for caution and support for women who start drinking more to relieve emotional discomfort (3).

Sleep:
Alcohol consumption, especially in the evening, can impair sleep quality—a common issue during menopause. Studies show that alcohol reduces REM sleep and increases nighttime awakenings, exacerbating daytime fatigue and emotional distress (4).

 

Relationship Between Alcohol, Bone, and Cardiovascular Health During Menopause

Bone health:
Light to moderate alcohol consumption appears to have a neutral or even slightly beneficial effect on bone mineral density (BMD) in postmenopausal women. A 2022 meta-analysis (11 studies, ~47,000 participants) found that women who drank up to 1–2 alcoholic drinks per day had higher hip and spine BMD compared to abstainers (5).
However, excessive drinking has a clearly harmful effect: the same 2022 study found that with nearly 3 drinks per day, the risk of osteoporotic fractures increased sharply. Women consuming 3 drinks/day had about a 33% higher risk of hip fracture (and almost 59% higher with 4 drinks/day) compared to non-drinkers.
Still, these findings should be interpreted cautiously due to limitations like potential reverse causality, heterogeneity between studies (in terms of BMD measurement and alcohol consumption classification), and unmeasured confounders such as diet, physical activity, hormone therapy use, and smoking (5).

Cardiovascular health:
After menopause, women's cardiovascular risk increases due to the loss of estrogen’s protective effects. The role of alcohol in this context has been widely studied.
The current consensus from organizations like the American Heart Association (6) is that small amounts of alcohol do not pose cardiovascular risk, but higher doses quickly eliminate any benefit and increase the risk of hypertension, arrhythmias, stroke, and cardiomyopathy.

 

Impact of Alcohol on Hormone Therapy and Menopause Treatments

Hormonal metabolism and alcohol interact significantly after menopause. Alcohol is known to raise circulating levels of endogenous estrogens. Studies have shown that postmenopausal women who drink alcohol have higher estradiol levels due to increased peripheral aromatization and reduced estrogen breakdown in the liver (7).
This effect can amplify the action of hormone therapies used during menopause. In fact, a review found that alcohol consumption may increase estradiol concentrations in women undergoing estrogen replacement therapy.
This alcohol-induced hormonal increase raises concern, as it may reduce the effectiveness of anti-hormonal treatments (e.g., in breast cancer survivors taking aromatase inhibitors) and may heighten the risks associated with hormone therapy, such as breast câncer (8).
Even in women not on hormone therapy, regular alcohol consumption has been linked to increased breast cancer risk—possibly due to elevated estrogen levels and the production of carcinogenic metabolites (9).

 

Are There Guidelines for Alcohol Use Among Menopausal Women?

One recent and interesting finding: moderate alcohol consumption was associated with a slight delay in natural menopause. A 2021 prospective analysis found a weak but significant link between moderate alcohol intake (10–14.9 g/day), especially white wine, and a lower risk of early menopause (before age 45) (10).
Women in this category had about a 19% lower risk of early menopause compared to non-drinkers, though higher alcohol intake did not offer the same benefit.
The authors noted that similar results have been seen in other studies on menopausal age and alcohol, suggesting that low doses may influence hormones in a way that slightly delays ovarian depletion. While biologically intriguing, this is not a recommendation to drink—just another epidemiological data point in the complex relationship between alcohol and menopause.

Despite the potential health implications of alcohol during menopause, the topic is often overlooked in consultations with mature women—either due to assumptions of abstinence or lack of routine screening.
However, healthcare providers are advised not to assume abstinence in this population and to use screening tools, such as the AUDIT questionnaire, to identify risky drinking patterns.
Promoting open conversations about alcohol use, clearly informing what is considered moderate and safe consumption (maximum of 1 drink or 10 g of alcohol per day for women), and clarifying the thresholds for excessive use can support better health decisions and quality of life during menopause.

 

References:

  1. Kwon, R., Chang, Y., Kim, Y., Cho, Y., Choi, H. R., Lim, G.-Y., Kang, J., Kim, K.-H., Kim, H., Hong, Y. S., Park, J., Zhao, D., Rampal, S., Cho, J., Guallar, E., Park, H.-Y., & Ryu, S. (2022). Alcohol Consumption Patterns and Risk of Early-Onset Vasomotor Symptoms in Premenopausal Women.Nutrients14(11), 2276. https://doi.org/10.3390/nu14112276
  2. Peltier, M. R., Verplaetse, T. L., Roberts, W., Moore, K., Burke, C., Marotta, P. L., Phillips, S., Smith, P. H., & McKee, S. A. (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. https://doi.org/10.1186/s13293-020-00314-7
  3. Peltier, M. R., Verplaetse, T. L., Mineur, Y. S., Petrakis, I. L., Cosgrove, K. P., Picciotto, M. R., & McKee, S. A. (2019). Sex differences in stress-related alcohol use. Neurobiology of stress, 10, 100149. https://doi.org/10.1016/j.ynstr.2019.100149
  4. Roehrs, T., & Roth, T. (2001). Sleep, sleepiness, sleep disorders and alcohol use and abuse.Sleep medicine reviews, 5(4), 287–297. https://doi.org/10.1053/smrv.2001.0162
  5. Godos, J., Giampieri, F., Chisari, E., Micek, A., Paladino, N., Forbes-Hernández, T. Y., Quiles, J. L., Battino, M., La Vignera, S., Musumeci, G., & Grosso, G. (2022). Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose-Response Meta-Analysis. International journal of environmental research and public health19(3), 1515. https://doi.org/10.3390/ijerph19031515
  6. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Review of Evidence on Alcohol and Health; Stone KB, Calonge BN, editors. Review of Evidence on Alcohol and Health. Washington (DC): National Academies Press (US); 2025 Apr 23. 6, Cardiovascular Disease.Available from: https://www.ncbi.nlm.nih.gov/books/NBK614695/#
  7. Erol, A., Ho, A. M., Winham, S. J., & Karpyak, V. M. (2019). Sex hormones in alcohol consumption: a systematic review of evidence. Addiction biology24(2), 157–169. https://doi.org/10.1111/adb.12589
  8. Mostofsky, E., Buring, J. E., Come, S. E., Tung, N. M., Zhang, C., & Mukamal, K. J. (2025). Effect of daily alcohol intake on sex hormone levels among postmenopausal breast cancer survivors on aromatase inhibitor therapy: a randomized controlled crossover pilot study. Breast cancer research : BCR, 27(1), 5. https://doi.org/10.1186/s13058-024-01940-4
  9. Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V., Scotti, L., Jenab, M., Turati, F., Pasquali, E., Pelucchi, C., Galeone, C., Bellocco, R., Negri, E., Corrao, G., Boffetta, P., & La Vecchia, C. (2015). Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. British journal of cancer, 112(3), 580–593. https://doi.org/10.1038/bjc.2014.579
  10. Freeman, J. R., Whitcomb, B. W., Purdue-Smithe, A. C., Manson, J. E., Langton, C. R., Hankinson, S. E., Rosner, B. A., & Bertone-Johnson, E. R. (2021). Is Alcohol Consumption Associated With Risk of Early Menopause?. American journal of epidemiology190(12), 2612–2617. https://doi.org/10.1093/aje/kwab182

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