Alcohol and Menopause: What every woman needs to know
Let’s talk about something that’s often brushed aside but affects nearly every woman in midlife: alcohol. You may have noticed that what used to be an easy glass of wine now leaves you flushed, restless or anxious. It’s not just in your head: hormonal changes significantly alter how your body processes alcohol. Understanding why can help you make choices that protect your hormones, your heart, and your energy.
How Alcohol Affects a Changing Body
Falling oestrogen levels slow the liver’s ability to metabolise alcohol. This means alcohol stays in your system longer, intensifying its effects and increasing inflammation. As blood sugar control becomes less stable during menopause, alcohol adds extra strain which can cause sharp glucose fluctuations that contribute to hot flushes, fatigue, and mood swings.
Because alcohol dilates blood vessels, even small amounts can cause rapid warmth and sweating, particularly in the face and chest. Add to this the impact on hydration (alcohol is a diuretic, drawing water out of your system) and the link between alcohol and flushes becomes clear.
The Science of Alcohol Metabolism
Your liver uses enzymes (ADH and ALDH) to convert alcohol into less harmful substances . SO, what changes in menopause??
Reduced ADH activity: Oestrogen supports ADH production in the stomach and liver. As oestrogen declines, less alcohol is metabolised before entering the bloodstream which leads to higher blood alcohol levels.
Slower clearance: Lower oestrogen reduces liver blood flow which means a slowing down in detoxification. This means that alcohol can remain in your system for several hours longer than it once did - hence feeling worse for longer.
Increased sensitivity to acetaldehyde: This compound contributes to flushing, headaches, and sleep disruption. You are probably suffering from these already and now alcohol makes it worse.
Higher fat-to-muscle ratio: Alcohol is water-soluble. With less lean tissue and more fat mass (common menopause symptoms due to decline in muscle mass), the same drink produces a stronger effect.
In short, what used to be one glass might now feel like two and your body will take longer to recover.
The Hidden Health Risks of Over-Drinking
Alcohol doesn’t just worsen menopause symptoms: it amplifies longer-term risks that already rise after midlife.
Heart health: Lower oestrogen reduces protective HDL cholesterol. Regular drinking increases blood pressure, triglycerides, and arterial stiffness, making cardiovascular disease more likely.
Weight gain: Alcohol provides 7 kcal per gram and is metabolised before fat or carbohydrates, meaning fat burning effectively pauses while your liver clears it. Combined with slower metabolism, this can lead to increased abdominal fat. Unfortunately alcohol is literally empty calories.
Breast cancer risk: Even light-to-moderate intake (a few drinks per week) can increase circulating oestrogen and oxidative stress, raising risk over time.
Bone health: Alcohol disrupts calcium absorption and bone formation, contributing to bone loss and osteoporosis.
Sleep and mood: Alcohol’s short-term sedative effect is followed by a rebound that fragments sleep and raises cortisol levels, fuelling anxiety and fatigue.
Are Some Drinks Better Than Others?
While no type of alcohol is “safe” in menopause, some are less problematic. I am not endorsing and encouraging drinking but I am being a realistic coach who knows that most of us like a glass of wine or 2 when we are socialising or unwinding. So, let’s see how you can do it with as much safe enjoyment as possible whilst navigating menopause:
Spirits (vodka, gin, whisky): Low in sugar if mixed with soda water, but high in alcohol concentration. Keep measures small and sip slowly.
Cava or prosecco: The bubbles accelerate absorption and can trigger flushes; choose brut (dry) styles if you drink them.
White wine: Typically higher in sugar, which can spike insulin and increase warmth and inflammation.
Red wine: Contains antioxidants like resveratrol, but even small amounts may still provoke night sweats or poor sleep.
If you choose to drink, one small glass of red wine with food or a single clear spirit with soda is the least disruptive option.
The New Rules for Drinking in Menopause
Know your personal threshold. What once felt fine may now feel too much. Know when you're done. We're not wingmen or teenagers anymore. Look after yourself rather than trying to keep up with your friend.
Avoid drinking close to bedtime. Give your liver time to process it before sleep and use this gap to drink more water to avoid that middle of the night dry mouthed feeling.
Eat with your drink. Protein and fibre help steady blood sugar and reduce flushes. It helps to absorb the alcohol and you'll definitely notice a difference the next day between drinking on an empty stomach and drinking with food.
Hydrate. Match every alcoholic drink with a glass of water.
Keep it occasional. Swap automatic weekday drinks for herbal teas or non-alcoholic alternatives. I personally really enjoy Fredam the alcohol free beer and I've recently started drinking fizzy water with lemon and ice. It's obviously not a replacement for wine but it's refreshing, healthy and actually really filling.
Choose quality over quantity. A single drink enjoyed slowly is always better than several by habit. If you spend money on a good wine, you'll savour it more to make it (and your money) last longer. Taste it, enjoy it, don't knock it back.
Three Alcohol-Free Cocktails to Try
1. Citrus & Ginger Sparkle
Ingredients:
150 ml sparkling water, 50 ml grapefruit juice, 1 tsp grated ginger, juice of ½ lime, mint leaves, ice.
Why it helps: Ginger supports circulation and reduces bloating; citrus provides vitamin C for adrenal and skin health.
2. Herbal Tonic Cooler
Ingredients:
150 ml unsweetened tonic water, juice of ½ lemon, ½ tsp apple cider vinegar, a sprig of rosemary, ice.
Why it helps: Apple cider vinegar aids digestion and blood sugar control; rosemary supports liver detoxification.
3. Berry & Basil Fizz
Ingredients:
Crushed raspberries or blueberries, 150 ml sparkling water, 1 tsp honey, basil leaves, ice.
Why it helps: Packed with antioxidants to reduce inflammation and support vascular health.
Try This Week
Take five alcohol-free nights in a row and observe your sleep, mood, and hot flush patterns. Most women notice better rest, clearer skin, and fewer night sweats within days.
Final Thoughts
Menopause doesn’t mean you can never enjoy a drink, it’s about knowing your body’s new boundaries. Alcohol affects hormones, heart health, and metabolism more powerfully in midlife, but small, conscious adjustments can have big payoffs. By choosing mindfully and embracing nourishing alternatives, you’ll wake up feeling energised, balanced, and more in tune with your changing body.
Call to Action
If you found this useful, subscribe to the Menopause Thrive Hub Newsletter for bi-weekly insights on nutrition, hormones, and lifestyle strategies that help you feel strong, calm, and confident through every stage of menopause. If you need help with any of the above or feel that you are drinking too much, please reach out to me.