Alcohol, HRT & Menopause

glass of wine
All of a sudden, one glass of wine can feel like a whole bottle. No, you’re not a cheap date, but your body’s tolerance can change when menopause hits. Nutritionist and author Alli Godbold explains what’s going on and how you can still enjoy wine o’clock.

If you’re a menopausal woman who now feels the effects of just one glass of wine, when in your youth you loved to enjoy more than that, then you are not alone. The reality is that menopause, HRT and alcohol don’t seem to be a good mix. If you’re one of the many women wondering, “can you drink alcohol while taking HRT,” this article is here to help.

In this article we will answer many frequently asked questions including:

From battling summer hot flushes (the worst), to weight gain, there are many reasons we reconsider our relationship with alcohol. Recently, team Hylda went on a road trip with four midlife women, all of whom turned down the offer of a glass of white wine after a long workshop session. Twenty years ago, it would have been quite a different story!

Our changing relationship with alcohol during menopause is good news for our health (especially those of us who have always suspected we drank a little too much), but bad news for our love of wine. For many of us, it’s the first time in our lives when we’ve been able to look a doctor in the eye and answer “social drinking only” when asked about our weekly units.

Can menopause make you intolerant to alcohol?

The good news is that if you want to have an alcoholic drink, you can still have one. “The most important thing is how much you drink,” is how the North American Menopause Society (NAMS) puts it. “The benefits come with moderate—big emphasis on moderate—drinking.”

Can you drink alcohol when taking HRT?

What is the relationship between HRT and alcohol in menopause? Moderation is a message reinforced by advice from the American Addiction Centers, especially when it comes to the relationship between HRT and alcohol in menopause.

“Studies have estimated that women who are taking HRT and have one to two drinks daily are three times more likely to develop breast cancer,” they say. “While women who have more than two drinks a day and are taking HRT are at five times greater risk of developing breast cancer.

In other words, the more you drink, the more your risk increases. It’s not the HRT and alcohol, but the alcohol and more alcohol.

This sense of risk when it comes to considering HRT and alcohol is put into perspective brilliantly by menopause expert Dr Clare Spencer, co founder of My Menopause Centre, Hylda’s women’s health partner.

READ MORE Book your private menopause appointment.

“Life is full of risks – we take a risk when we get into a car and drive,” says Dr Clare. “There is a small risk of breast cancer related to the type of HRT and how long HRT is taken. Drinking alcohol also increases the risk of breast cancer – and the Women’s Health Initiative study showed that the risk from drinking two units of alcohol a day, on average, is greater than taking HRT.”

READ MORE Is HRT safe? Everything you need to know.

Should you avoid alcohol during menopause?

The menopause seems to coincide with a decrease in tolerance to alcohol. Women may have lower levels of the enzymes that we need to break down alcohol, compared with men. In the menopause we may have a higher fat/water ratio meaning there is less water in the body to dilute alcohol, ensuring a higher blood alcohol content.

Plus, we may be more inclined to drink more in the menopause transition. “Many women say they drink because ‘it takes the edge off anxiety’ or gets them off to sleep,” explains Dr Clare. “But the reality is that sleep is lighter and you may be more likely to wake at night, and alcohol can worsen mood and anxiety.”

Why is alcohol bad in menopause?

Yes, hangovers get worse with age… for everyone. Enzymes in the liver responsible for breaking down alcohol can also diminish as we age, which is why hangovers seem to get worse and worse as we get older. So it appears that the decrease in tolerance to alcohol is caused by the ageing process rather than the hormonal changes of menopause.

Does alcohol speed up menopause?

A study published in the US Journal of Epidemiology suggests that drinking white wine may delay the onset of early menopause in some women – though we aren’t suggesting that you should drink for this reason. However, for many women, it can certainly speed up symptoms: Alcohol can trigger hot flushes, affect sleep and cause low mood and anxiety. If you’ve ever woken up at 3am with hot legs and anxiety after a boozy evening, then you’ll know what we’re taking about. (And yes, hot legs is most definitely a thing!)

READ MORE What are the 34 menopause symptoms?

Is it possible to be a healthy menopausal drinker?

According to the British Heart Foundation, moderate drinking can benefit post-menopausal women with a small reduction in risk of heart attacks – but this is not true for other types of heart disease, strokes and dementia. However, risk is also affected by the way we handle alcohol, which differs from one person to the next. This is due to many factors including our different genes, our microbes (bacteria in the gut), what the rest of our diet is like and whether we drink moderately or binge-style.

READ MORE What causes brain fog during menopause?

That’s why it is hard to say exactly how much alcohol or wine represents a safe, moderate limit. Instead, as you know yourself better than anyone, you should be making your own guidelines. If you know you can’t stop at one glass it might be better for you to opt for at least three nights off a week or restrict alcohol to weekends only.

READ MORE The lowdown on menopause and anxiety.

What are the guidelines on how many drinks are healthy?

The number is less than you think! Many of us drink way more than the recommended maximum of 14 units a week – which is only about eight standard glasses of wine.

The problem is that, for many, drinking is a slippery slope and although you might start off with good intentions of sticking to one small glass, that small glass soon becomes a second glass and before you know, it half a bottle.

What’s the best drink for menopause?

It is widely believed that red wine is the healthiest choice – drinking a little red wine is thought to prevent heart disease.  The protective effects of red wine are thought to be due to its high content of polyphenols, which include flavonoids and the compound resveratrol.  These polyphenols are thought to improve blood flow, increase the beneficial HDL cholesterol and reduce clotting. They have also been shown to reduce age related memory loss and improve production of insulin.

READ MORE What is the difference between perimenopause and menopause?

There is also some evidence that the polyphenols have a positive effect on the diversity of our gut microbes. Professor Tim Spector is a scientist who studies these microbes – he’s one of the founders of the Zoe gut health app. In his book, The Diet Myth, he reviews recent data from a study of 8000 subjects taking part in the American and British Gut Projects which shows a big increase in microbial diversity in regular alcohol drinkers. Professor Spector proposes that this association is caused by the chemicals in the grape.

Greater microbial diversity is linked to better general health and we should be doing everything in our power to encourage this.

What is the healthiest red wine to drink?

There are some red wines that are better than others in terms of their polyphenol content, the darker red wines, such as Cabernet Sauvignon, having the highest antioxidant content.  Professor Andrew Waterhouse from the University of California particularly recommends Merlot, Zinfandel, Syrah and Petit Syrah.

However, a number of critics have stated that you would have to drink the equivalent of six bottles of wine to get the desired health benefits!  

Resveratrol is found in the skin of grapes, dark berries and peanuts so you can get the same benefits by eating some berries at breakfast and a handful of peanuts as a snack rather than drinking red wine.

Can I drink beer during menopause?

Good news for beer lovers, there is some research that suggests that beer can help with symptoms. Yes, we were surprised too. However, according to a research paper from science publisher Hindawi, there is some evidence that “regular and moderate intake of the polyphenols commonly found in hop and beer may help to relieve many common symptoms presented by women undergoing menopause.” Who’d have thought.

What are some great non alcoholic drinks?

If the menopause has affected your alcohol tolerance then don’t fight it, adjust your habits instead. Switch to non-alcohol alternatives – Seedlip is a favourite of Team Hylda, as is Gordons alcohol-free gin – keep hydrated and listen to your body and Punchy’s Blood Orange Bitters & Cardamom.

The upshot of all of this? Menopause is an opportunity to look at your health and lifestyle habits and make some improvements. Drink a little less, eat more healthily and move more.

Cheers to all of that.

READ MORE Dr Clare Spencer is the co founder and Clinical Director of My Menopause Centre. You can find out more about the clinic and book an appointment here

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