Alcohol and Menopause - A Relationship on the Rocks?

After a long day, it seems natural to unwind with a glass or two of your favourite drink if you have been doing so for most of your life. But if menopause has come knocking, the tables might have already turned.

"How often can I drink during menopause?"
"Can I continue to have my regular drink every day?"
"Are my symptoms getting worse because of alcohol?"
"I want to stop drinking. But where do I start?"

I am faced with such questions every other day, so I will distil down some of the concepts related to alcohol and menopause for you as you read along.

Gender and Alcohol: It's Not All Cheers. 

Alcohol affects women differently than men. Women have lower levels of dehydrogenase enzymes, the enzyme that breaks down alcohol. 

The fat-to-water ratio also being higher in women means water content in their body is low and cannot dilute the alcohol. This causes alcohol levels to rise much faster when compared to men. 

With lower tolerance levels than men, hangovers can also worsen as you age.

Women are more vulnerable to alcohol's harmful effects and tend to develop alcohol-related diseases earlier in life than men. 

Alcohol's Effect on Menopause - The Hard-Hitting Truth

As women age and go through menopause, they experience changes in body composition. Stress and depression related to menopause may trigger the onset of alcohol abuse or worsen existing alcohol misuse. 

Alcohol abuse decreases the quality of life, and any potential positive effects of moderate alcohol intake are minuscule compared to its adverse effects.

When I mentioned this to one of my patients, Michelle (name changed), she remarked that many of her friends advocated drinking alcohol during menopause too.

 "A drink or two a day wouldn't hurt… would it?" 

She looked at me with eager eyes, waiting for me to say, No.

In recent times, many studies are both for and against drinking alcohol during menopause. 

A survey conducted in 2005 concluded that the risk of hot flashes is lowered with alcohol use, and on the contrary, another study stated that alcohol consumption was a significant predictor of vasomotor symptoms (hot flashes)

Alcohol, Menopause and Hot Flashes

According to Ayurveda, everyone has a specific body constitution. This constitution consists of three doshas - Vata, Pitta and Kapha. A person's physiological and mental health depends on the composition of these doshas.

Alcohol can act as a trigger for hot flashes and night sweats because it raises internal body temperature. Pitta dosha gets aggravated by fermented drinks, beer, wine, and other kinds of alcohol, as the fermentation increases heat - something that a Pitta dosha person already has in abundance. For the same reason, this constitution should also decrease the consumption of any beverages that are acidic in nature.

Despite some evidence that shows drinking might be beneficial in managing hot flashes, it can still set off hot flashes in women. If you already take certain medications, alcohol can make hot flashes worse.

Alcohol, Menopause and Weight Gain

Weight gain is a demon most women face during menopause because of hormone-level fluctuations. Couple this with drinking; reaching and sustaining a healthy weight can become difficult.

Let me ask you a question. Do you know how many calories your glass of wine has?

I'll answer that. Your glass of wine (5-0z) contains 125 calories. If you consume a glass of wine every day, that will be 45,625 calories gained a year!

Now you can imagine how much exercise you would need to burn those.

Remember that wine is one of the alcoholic beverages with relatively fewer calories. It's easier to gain more weight and harder to lose when you drink regularly. 

Alcohol also influences hormones related to satiety and appetite. It can also impact neurons in your brain, giving you a feeling of intense hunger. Not only do you eat more than you otherwise might, but your choices could tend to be unhealthy, most likely to harm your health and weight. 

Alcohol, Menopause and Brain Fog

A common symptom of menopause is brain fog. In a study, 60 per cent of midlife women reported an undesirable change in their memory. Women complain of feeling forgetful and an inability to concentrate. 

According to Ayurveda, brain fog is caused due to Kapha imbalance. Alcohol affects the doshas; hence, a pre-existing condition can worsen. Alcohol is known to impact cognitive functions - both short and long-term. 

Alcohol affects the area of the brain responsible for memory and thinking. This can also explain blackouts or memory gaps when a person might find it challenging to remember episodes from when they were intoxicated.

If the brain fog is caused by a hangover, it will go away within 8 to 24 hours. However, this may not be the case for menopausal women who already suffer from brain fog due to hormonal imbalances. Menopause brain fog usually reduces with time as the fluctuating hormone levels settle down. 

Alcohol, Menopause and Mood

According to Ayurveda, alcohol opposes the vital energy, Ojas and causes Vata and Pitta imbalance in the body. Vata and Pitta are the main doshas aggravated during menopause. All the disturbances observed in this phase are directly proportional to the vitiation of vata dosha. 

Vata is responsible for the higher mental functions, cognitive functions and the correct functioning of the sense organs. When Vata dosha is affected or imbalanced, psychological disturbances like anxiety, depression, and mood swings happen. 

Alcohol, Menopause and Insomnia

Read this if you have been filling your glass to help you sleep. 

Behavioural studies suggest that up to 2 to 3 standard drinks before bedtime initially promote sleep, but these effects diminish in as few as three days of continued use. 

The decline in oestrogen levels during menopause also contributes to disturbed sleep through physiological symptoms like hot flashes, night sweats, joint pains and bladder issues, and mood disorders like depression and anxiety. 

People dealing with insomnia are at an increased risk of accidents - at home, at the workplace, or even while driving. Add alcohol to this mix, and you can see how dangerous a cocktail this can turn out to be!

Alcohol and Menopause - An Ayurveda Perspective

Alcohol, or 'Madya' in Ayurveda, has many facets. Being hot and light in nature, it rapidly penetrates and spreads inside the body. Its hot nature aggravates Pitta. At the same time, Kapha and Vata are alleviated. 

Ayurveda states that alcohol is a toxin. However, if taken at all, it should be in the appropriate manner, time and place.  If judiciously consumed, alcohol can be a good friend; if overdone, it can cause intoxication and addiction. 

Body constitution, health conditions and digestive capacity should be considered when consuming alcohol. It's essential to maintain a balanced diet too. 

Alcohol and Doshas

Vata can get aggravated by chilled fizzy beer as it contains gas and is cold too. 

Strong liquors create a burning sensation and increase Pitta. Red wine is considered hot and helps with digestion, especially when dense foods are taken along with it. It enhances Pitta.

White wine does not influence doshas as much as other drinks. It is less hot than red wine. Fruit-based beverages are cool in nature and can increase Kapha dosha.

Let's see how alcohol agrees with the three Prakriti (body constitution) types.

Vata - Vata predominant people, should be careful when having fizzy beers and other carbonated beverages. If you are a Vata Prakriti and dehydration and dryness have been bothering you, try limiting your intake of carbonated beers. White wine or fruit beers can be your go-to drink. 

Pitta - Be wary of drinking red wine if you are a Pitta-predominated person. Avoid wine entirely if you are dealing with any inflammation or acidity. Other liquors can also aggravate Pitta. You can opt for chilled beer instead. 

Kapha - Kapha-predominated people can say cheers to small quantities of wine and beer and should consume it wisely. Do monitor the amount of consumption. When consumed excessively, wine can create more appetite and increase food consumption. Too much beer can cause fluid loss too. 

Excessive Alcohol Consumption 

Too much alcohol can adversely affect your doshas and throw them off balance. 

• Alcohol affects vata dosha and leads to hiccups, breathing difficulties, headache, tremors, bloating, abdominal pain, lack of sleep and irrelevant talk.
• Alcohol affects pitta dosha and leads to excessive thirst, hunger, delusion, sweating, diarrhoea, and liver disorders.
• Alcohol affects kapha dosha and leads to vomiting, lack of interest in food, nausea, sleepiness and tiredness. 

How Much can you Drink during Menopause?

After a lengthy discussion with Michelle, we returned to a crucial question she had already posed.

"How would you know if you are drinking in moderation or too much?"

According to Ayurveda, Manas Bhavas (emotions), like grief, fear, envy, anger, grief, and other emotions, play a crucial role in causing diseases. Control of the Manas Bhavas is suggested to prevent Manasika Rogas (psychological conditions) and psychosomatic illnesses. 

The period of menopause is a time of tremendous lifestyle changes. Hormonal imbalances often lead to various bodily and psychological disturbances. Women also deal with emotional and spiritual challenges during menopause which may not be related to hormonal changes. Alcohol intake may temporarily relieve these problems but does not address them as a permanent solution. 

According to NHS, the current guidelines advise men and women not to drink more than 14 units a week. And if they do drink all 14 units, they should spread it across three or more days.

*14 units is equivalent to 6 pints of average-strength beer or ten small glasses of lower-strength wine. 

Many women worry that limiting or cutting alcohol could bring down the shutters on a big part of their social life. 

1. If you find quitting very difficult, drink in moderation. 2 servings max per session. 

2. Designate certain days of the week as no alcohol days if you plan to regulate intake. 

3. Remember to keep yourself extra hydrated when you have alcohol. For every glass of alcohol that you drink, do drink a glass of water along with it. 

4. Avoid drinking on an empty stomach. 

5. Take Rasayana (rejuvenating herbs) before and after drinking alcohol. Some herbs like Amalaki (Indian gooseberry), Shatavari (Asparagus racemosus), and Turmeric help enhance liver function and clean and purify your blood. 

6. Drink only if you are in good health. If you feel weak or sick, drinking alcohol will make you feel weaker as it is a toxic substance.

7. Drink only if you are feeling happy and in good spirits. Your happiness is directly connected with the level of Ojas you have. Alcohol can only provide a temporary influx of happy chemicals and will be short-lived. 

Risks of Heavy Drinking 

Excessive alcohol consumption is detrimental to all, not just women. The effects of alcohol can accelerate the progression of certain conditions in menopausal women, such as

• Osteoporosis
• Heart disease
• Cancer
• Liver disease
• Depression
• Alcoholism

Studies have shown that heavy drinking is associated with an increased risk of certain cancers like head and neck cancer, oesophagal cancer, liver cancer, breast cancer and colorectal cancer.

Some studies conclude that women have a higher risk of heart disease and obesity.

Menopause can speed up bone loss, causing an increased risk of osteoporosis. Alcohol which also acts similarly, can make the process of bone loss faster in menopausal women who drink.

Giving up Alcohol during Menopause

I tell all my patients that abstinence could be a tough but good call. 

Contrasting results from various studies point to both positive and negative side effects of alcohol during menopause. However, menopausal or not, man or woman, too much alcohol has its downside.

If you are thinking of quitting alcohol altogether, here are some steps you can follow. 

1. Grind coriander, capsicum and rock sugar. Soak 1 tsp of it in water and leave overnight. The following day, filter it and have it on an empty stomach.

2. Mix a spoonful of lemon juice with a bit of salt and have this on an empty stomach every morning to detoxify your body.

3. Include curd in your diet occasionally. It helps in detoxification.

4. Include fruits like pomegranates, apples and grapes in your diet. Their juices can be considered too. Have this at least three days a week.

5. Use ghee for cooking food instead of cooking oil. You can also mix 10 gm of ghee with rock sugar and eat it. That acts as both an antioxidant and a detoxifier.

6. One spoonful of onion juice daily helps reduce withdrawal symptoms and alcohol addiction. 

Here are some simple lifestyle tweaks that can help you.

• Focus on nutrition.
• Stay hydrated.
• Exercise regularly. 
• Practice good sleep hygiene. 
• Join a yoga class.
• Practice meditation and mindfulness.
• Hang out with sober friends.
• Stay occupied - try out creative activities like painting, drawing etc.
• Indulge in Ayurvedic oil massages.

Here's a tip, if you are serious, start a journal. Journalling will help you identify your emotions and their various associated triggers. A weekly review of your journal can help you plan a course correction to help you realise your health goals.

Conclusion

To drink or not to drink is a choice you need to make. In Ayurveda, there is nothing that is beneficial to all or harmful to all. Ayurveda is a highly personalised medicine. What works for one may not work for another. 

Not all women are the same, and the same rules cannot apply to all. You know your body the best. You know what would work best for you. If you feel that your menopause symptoms are messing with your daily life, try cutting down or quitting alcohol for a few days or weeks. If you feel better, you know what to do.