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 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.
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.
You can calculate your weekly intake using Alcohol Change UK’s online calculator.
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 [1].
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.
According to the NHS, there are many long-term health risks associated with alcohol misuse, including increasing the risk of several types of cancer, including liver cancer, mouth cancer, head and neck cancer, breast and bowel cancer.
Other risks associated with alcohol
Excessive alcohol use, particularly binge drinking, is a contributing factor to sexual violence [1].
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 perimenopause and menopause affect drinking habits?
Like much of women’s experience of menopause, this remains a significantly under-researched area.
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 [3].
A Yale University study of more than 3,000 women suggested that those who don’t drink much could change to excessive drinkers during early perimenopause onwards, while women who were excessive drinkers before menopause, appeared to moderate their drinking during that phase [4]. 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 [5].
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].
RELATED: Alcohol, addiction and hormones
Newson addictions survey
A 2023 survey of almost 1,200 women by Newson Clinic revealed that one in three (33%) respondents said they drink more since becoming perimenopausal or menopausal, while one in eight women regularly consume more alcohol than the recommended intake of 14 units a week to alleviate their menopause symptoms.
‘I speak to many of my women who are struggling with issues around alcohol and other addictions,’ says Dr Louise Newson.
‘The changes experienced in perimenopause and menopause can cause women a lot of discomfort and stress. As a result, they may turn to painkillers or alcohol to relieve these symptoms or, as our study shows, be more susceptible to substance abuse.
‘For people already addicted to substances, addictive behaviours can increase during perimenopause and menopause, likely because of the loss of sex hormones in the brain. The sad truth is that these women would find greater relief for menopause symptoms and less disruption to their lives were they to have access to appropriate education and treatment, including HRT.
'We must do more to make menopause treatment more broadly accessible and to stop women turning to unhelpful and harmful substances in desperation.’
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 [8]. One study suggests that heavy drinking could lead to an earlier menopause [9], and there is some evidence that the perimenopause can reduce your body’s ability to metabolise alcohol.
Where should I turn for help for alcohol addiction in menopause?
If you are concerned about your drinking, then make an appointment with your GP as a first step, and accessing therapy is often part of recovery.
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.
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.
