Menopause and ETOH: Beware the Tipping Point

Women experiencing menopause who drink alcohol should limit consumption to moderate drinking, according to experts. However, binge drinking in this population has been on the rise, for which clinicians can help by referring these patients to appropriate treatment.

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“One misconception is that older women do not drink alcohol,” said MacKenzie Peltier, PhD, an assistant professor of psychiatry at Yale School of Medicine in New Haven, Connecticut. “But we know that over the past several decades, there have been significant increases in the prevalence of alcohol use among older women. Notably, there has been an increase in the rate of binge drinking within this population.” The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a blood alcohol level reaching 0.08 g/dL (approximately 4 drinks) within approximately 2 hours.¹

“One misconception is that older women do not drink alcohol. But we know that over the past several decades, there have been significant increases in the prevalence of alcohol use among older women. Notably, there has been an increase in the rate of binge drinking within this population.”

Peltier was lead author of a longitudinal analysis of the Study of Women’s Health Across the Nation that assessed changes in excessive alcohol use among older women across the menopausal transition, which was published in Biology of Sex Differences in 2020^.2 “Our research demonstrated that the menopausal transition was a time for change in alcohol use among older women,” Peltier told Patient Care^® partner website Contemporary OB/GYN.^® “Those who excessively consumed alcohol were more likely to transition to nonexcessive drinking across the menopausal transition.”

Conversely, women who were not excessive drinkers were more likely to transition to excessive drinking in the early peri- and postmenopausal stages. “There are unique factors related to menopause that may be associated with alcohol use among those who previously did not drink excessively, including negative affect/depression, changes in cognitive functioning, and vasomotor symptoms,” Peltier said. “These factors warrant additional research.”

Because alcohol causes dilation of blood vessels, hot flashes might be triggered, as well. “Starting with the Framingham Heart Study, big epidemiologic studies have shown that [although] moderate drinking has some benefits, drinking much more than that can be detrimental,” according to the North American Menopause Society website.³ “More than 2 drinks per day and the negative effects begin to pile up, with increases in the rates of cancer, stroke, and more.”

“Starting with the Framingham Heart Study, big epidemiologic studies have shown that [although] moderate drinking has some benefits, drinking much more than that can be detrimental. More than 2 drinks per day and the negative effects begin to pile up, with increases in the rates of cancer, stroke, and more.”

The website notes that hormone therapy does not negate the heart benefits from moderate drinking, which the NIAAA defines as no more than 7 drinks per week and no more than 3 drinks on any single day.² Women who drink moderately have a lower risk of type 2 diabetes and a lower risk of dementia than those who don’t drink at all. Furthermore, women between the ages of 50 and 62 years who drink moderately have stronger bones than nondrinkers, whereas midlife and older women who drink moderately are less likely to become obese than nondrinkers.²

Menopausal women are particularly vulnerable to depression, which heavy drinking can exacerbate. “Heavy drinking itself can lead to depression, and women who show signs of alcoholism are 2 to 7 times more at risk of developing depression than men,” the website states.² In summary, “if you drink alcohol, enjoy yourself, but make sure your drinking is moderate,” the website advocates.

A large prospective study revealed a weak link between moderate alcohol intake and lower risk of natural early menopause. However, the study, which was published in the American Journal of Epidemiology in 2021,³ found that moderate white wine consumption was significantly connected to a lower risk of early natural menopause in models that controlled for confounding and other beverage subtypes.

On the other hand, moderate red wine and liquor intake were marginally associated with lower risk of early natural menopause, whereas moderate and light beer consumption were not connected to risk of early natural menopause. Moreover, high alcohol intake of any type were not linked to lower risk of early natural menopause. “Our findings are consistent with literature considering alcohol intake and age at menopause,” the authors wrote.

“It is important for clinicians to feel comfortable screening for problematic alcohol use among their patients,” Peltier said. “Clinicians should also never assume someone does or does not drink alcohol based on their demographic information.”

“It is important for clinicians to feel comfortable screening for problematic alcohol use among their patients. Clinicians should also never assume someone does or does not drink alcohol based on their demographic information.”

Providing patients with the criteria for what is considered a standard drink, as well as levels of hazardous drinking per NIAAA guidelines, can also be helpful. “There are many resources available on the NIAAA website about screening and referral to treatment,” Peltier said. “Research has shown that no amount of alcohol consumption is safe⁵ so access to appropriate treatment is important. This is especially true for older women, who are more vulnerable to health consequences related to alcohol use.”

However, because of social stigma, women face more barriers to treatment and recovering from alcohol dependence than men. Additional research exploring alcohol use among older women is needed to address the increases in drinking in this population, according to Peltier. “New research needs to include studying the effectiveness of the current treatments for alcohol use disorder among older women, a population that has historically not been adequately represented in previous studies,” she said.

References

1. Understanding binge drinking. National Institute on Alcohol Abuse and Alcoholism (Niaaa). March 2023. Accessed June 8, 2023. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/binge-drinking

2. Peltier MR, Verplaetse TL, Roberts W, et al. 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. Biol Sex Differ. 2020;11(1):37. doi:10.1186/s13293-020-00314-7

3. Alcohol & menopause, menopause information & articles. The North American Menopause Society. Accessed June 8, 2023. https://www.menopause.org/for-women/menopauseflashes/exercise-and-diet/drink-to-your-health-at-menopause-or-not

4. Freeman JR, Whitcomb BW, Purdue-Smithe AC, et al. Is alcohol consumption associated with risk of early menopause? Am J Epidemiol. 2021;190(12):2612-2617. doi:10.1093/aje/kwab182

5. Griswold MG, Fullman N, Hawley C, et al; GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2