How does alcohol affect menopause and perimenopause?

Published June 2023 | 6 min read
Expert contributors Jayashri Kulkarni, professor of psychiatry, women’s hormone specialist and director of HER Centre Australia at Monash University; Dr Fatima Khan, perimenopause and menopause expert at Epworth Hospital
Words by Stephanie Osfield

Rethinking the way you drink alcohol during this time can bring relief from some of the symptoms and help you enjoy better physical and mental health. Here’s why.

Do you feel the effects of a couple of glasses of wine much more in your 40s than you did in your 20s and 30s? If so, your hormones could be to blame. During their 40s, many women experience perimenopause, the natural process when your ovulation and periods may become irregular or stop. This period of time leads into menopause, when your menstrual cycle has officially stopped for a year. Anecdotally, many women say that drinking alcohol during menopause and perimenopause makes mood swings, insomnia and hot flushes even worse.

"Though the shifts in oestrogen and progesterone [during perimenopause] can cause issues like hot flushes and dry or itchy skin, believe it or not, there can also be an upside for a woman’s health," says Jayashri Kulkarni, a professor of psychiatry, women’s hormone specialist and director of HER Centre Australia at Monash University. "Adopting healthier lifestyle habits to address menopausal symptoms can help boost your mood and energy, and protect you from disease."

Changing your drinking habits is a good place to start.

Alcohol, menopause weight gain and other health risks

The significant hormone changes experienced during menopause can increase a woman’s risk of developing health issues including heart problems (and palpitations) and osteoporosis as well as weight gain. Alcohol can add to these risks because it raises blood pressure and cholesterol, contains kilojoules that can contribute to weight gain and can increase the risk of breast cancer.

How you can feel better: Think about how much you drink and whether you would feel better lowering your intake and trying lower-alcohol or alcohol-free drinks. For a health-boosting drink, enjoy freshly brewed tea, which has been linked to lower rates of dementia and heart disease as well as a longer life. Mix up different types of tea like white, black and green to enjoy a range of different health benefits. Keep water handy to sip on during the day as staying hydrated can help lessen anxiety and depression. For a flavour burst, try kombucha or sparkling water with an added twist of lime, lemon or mint.

Menopause can lower your alcohol tolerance

"Compared to men, women are more likely to get tipsy after drinking less alcohol because their bodies have a higher ratio of body fat, a lower ratio of water and they often have a smaller liver," says Dr Fatima Khan, a perimenopause and menopause expert at Epworth Hospital in Victoria.

During perimenopause, the function of the liver, which breaks down alcohol and produces and metabolises a woman’s hormones, may be less efficient due to age. "The liver may eliminate alcohol more slowly," explains Dr Khan. "This delays it from breaking down the hormones that are fluctuating at midlife. The knock-on effect can lead to more intense menopausal symptoms such as hot flushes, night sweats, headaches, sleep disturbances and mood changes."

Women’s bodies also have a smaller amount of an important enzyme in the liver that breaks down alcohol. "By menopause, levels of that enzyme can dip even more due to age," says Dr Khan. This is why perimenopausal women often notice they have a lower tolerance for alcohol, and may feel tipsy or hungover after only a couple of drinks.

How you can feel better: Make sure you’re familiar with the national drinking guidelines. "They suggest women have several alcohol-free days," says Dr Khan. "But many women I see find that having three, four or even five alcohol-free days helps reduce menopausal symptoms like hot flushes, hormonal headaches and sleep issues more effectively. Cutting back on alcohol can also help reduce bladder problems, as menopausal hormone changes can make bladder tissue less elastic. Alcohol doesn’t help because it acts as an irritant to the bladder."

Alcohol and menopause symptoms

"Wine can be particularly problematic for hot flushes, as it contains a range of different chemicals such as sulphites, histamine and tyramine, which some women become more sensitive to during menopause," says Dr Khan.

"Thankfully, women often report that when they cut back on alcohol, menopausal symptoms, such as hot flushes, hormonal headaches and brain fog, all improve."

How you can feel better: To help reduce the hot flushes many women experience after drinking alcohol, try reducing the amount of alcohol you drink by having spritzers (e.g. wine mixed with mineral water or soda water) and by making sure each glass you order or pour is no bigger than a standard serve (which is any drink containing 10 grams of alcohol, regardless of container size or alcohol type (e.g beer, wine, spirit).

"Some women also find that they handle spirits better than wine at this stage of life," says Dr Khan. If this applies to you, remember that the alcohol content in spirits is higher – so go for half a shot or only have one drink. Make sure you also watch your choice of mixers; some tonic water contains as much sugar as a soft drink, which makes it higher in kilojoules, so it can contribute to weight gain.

Alcohol and menopause mood swings

Many women find the mental toll of perimenopause and menopause, coupled with the mental load of midlife, can make for a challenging time. "Around perimenopause and menopause, women may drink in part to self-medicate because they’re under enormous stress, juggling work and family commitments such as looking after their children or supporting ageing parents," says Prof Kulkarni.

"Unfortunately, though alcohol may help you unwind at the end of a busy day, the morning after it can cause a drop in your mood or make you feel more tired. This may not be good for your mental health, as growing research shows that the hormonal changes of menopause alone can lead women to experience higher levels of depression and anxiety."

How you can feel better: Talk to your GP about whether menopausal hormone treatment (MHT) or hormone replacement therapy (HRT) is right for you. "I constantly see women with depression or anxiety triggered by menopause and they’ve been prescribed antidepressants, which are not working because their hormones are the main cause," says Prof Kulkarni. "When they start taking MHT (menopausal hormone treatment, also known as HRT), within weeks, they often report that they no longer feel teary or anxious all the time and they get their energy back and feel more like their old selves."

To support members with faster, easier access to qualified mental health professionals, we’re offering a free HCF HealthyMinds Check-in with a PSYCH2U psychologist for eligible members^*.

Alcohol and menopause sleep quality

"Though alcohol can feel sedating, it can also interfere with your sleep cycle and dream (REM) sleep so that you wake feeling less rested," says Prof Kulkarni. "It can also make you wake overnight to go to the toilet or drink water, because the alcohol has left you dehydrated."

How you can feel better: Instead of using alcohol to unwind, set better sleep habits. Practise good sleep hygiene, like keeping lights low in the evening and avoiding screen time in the hour before bed. Include some down time to unwind before you head to bed and, instead of drinking, switch to sleep-friendly rituals like a 15-minute evening meditation, reading a book in the bath or journalling for 10 minutes about your day while you enjoy a chamomile tea.

Thanks to our partnership with Sleepfit Solutions, eligible HCF members^{^} can get a free 12-month subscription to the Sleepfit app designed to improve sleep and overall wellbeing.

Menopause Matters podcast

The journey through perimenopause and menopause can be a challenging but also a liberating time – physically, mentally and emotionally.

In our Menopause Matters podcast, join host Alison Brahe-Daddo as she unpacks the experience of this life-changing yet entirely normal part of life. Speaking with leading menopause experts, Alison sheds light on issues faced by many women, including some of the best ways to manage your symptoms, how to navigate your career, mental health and relationships during this time, and shares the joys of life post-menopause. 

How to change your relationship with alcohol

If you’re keen to rethink the way you drink during perimenopause or menopause, Hello Sunday Morning has a mission to change the world’s relationship with alcohol. Its flagship program, Daybreak, is a digital service that people can access through an app or the web. It gives you an anonymous and supportive environment to set alcohol behaviour-change goals. No matter how busy you are or where you live, Daybreak is accessible at any time on a smartphone with no waiting lists, so you can access Daybreak when you need it.