If you've reached midlife and noticed that your favourite glass of wine now leaves you feeling anxious or nursing a worse hangover, you are far from alone. A significant shift in how the body processes alcohol during perimenopause and menopause is extremely common, yet it remains a topic many women are hesitant to discuss openly.
The Physical Reasons Behind Changing Tolerance
According to medical experts, several key physiological changes converge during this life stage, altering your reaction to alcohol. Dr Alisha Esmail, a GP and BMS-accredited menopause specialist at London Gynaecology, states that a slowing metabolism is a universal factor. "As we get older, especially once you start hitting your 40s, pretty much everybody's metabolism slows," she explains. This means the body breaks down alcohol more slowly, allowing it to linger in the system longer and intensifying both its immediate effects and next-day repercussions.
Body composition changes also play a critical role. Dr Esmail notes that the natural decline in muscle mass and increase in fat stores during menopause impacts alcohol absorption. "Fat doesn't absorb alcohol or store alcohol as well as muscle," she says, meaning alcohol remains at a higher concentration in the bloodstream. Furthermore, the liver's efficiency in processing toxins, including alcohol, diminishes with age.
The hormonal rollercoaster of menopause adds another layer of complexity. "Oestrogen pretty much affects every part of your body, including how your body processes alcohol," Dr Esmail adds. As oestrogen levels fluctuate, the body's ability to metabolise alcohol becomes less consistent and efficient.
Amplified Symptoms and Disrupted Sleep
This altered processing can exacerbate many common menopausal symptoms. Dr Naomi Potter, menopause specialist and founder of Menopause Care, describes alcohol and perimenopause as "two evil twin sisters working together in harmony to make things worse."
One of the most notable effects is on sleep. Alcohol is known to disrupt REM sleep and increase nighttime waking. "If you have that on top of your perimenopausal sleep symptoms, it can compound that effect," warns Dr Potter. This broken sleep can then intensify next-day anxiety and low mood.
Hot flushes and night sweats may also become more severe. Dr Potter explains that alcohol is a vasodilator, causing blood vessels to open wide—the same mechanism behind a hot flush. Consequently, drinking can trigger more frequent and intense episodes.
Practical Strategies for Navigating the Change
Experts emphasise that acceptance and honest self-assessment are the first steps. "We all naturally want to see the best in ourselves, so we are not always honest... about how regularly and how much we're drinking," advises Dr Esmail.
They recommend several practical adjustments:
- Take planned breaks: Incorporate regular 'dry spells' to allow your body to reset and gauge how you feel without alcohol.
- Stay rigorously hydrated: Alcohol is a diuretic. Drink water between alcoholic beverages and consider electrolytes the next day to combat dehydration.
- Never drink on an empty stomach: Always have a nutrient-rich meal before consuming alcohol to slow its absorption.
- Explore alcohol-free alternatives: The market now boasts sophisticated non-alcoholic options that can provide the ritual of a celebratory drink without the side effects.
Ultimately, fighting the change is counterproductive. "It's important to have that acceptance that you probably aren't going to be able to drink like you could in your 20s," concludes Dr Potter. By making conscious lifestyle adjustments, women can navigate social situations more comfortably and support their overall wellbeing during the menopause transition.
