Why has my alcohol tolerance suddenly become lower during menopause?

If you have started to notice that your tolerance for alcohol has changed during menopause, you’re not alone.

Dr Naomi Potter, menopause specialist and founder of Menopause Care, says that although this is extremely common, it’s something that people are often reluctant to speak about openly.

“It’s something that women are a little bit sheepish to admit to, but it’s still very common,” says Potter. “It can present itself in a number of different ways, but most women report that their tolerance goes down.

“A lot of women say that they used to be able to drink half a bottle of wine and be able to function well and hold a proper conversation and not feel drunk, whereas now they tolerate it a lot less in terms of how drunk they get and tend to also get much worse hangovers.

“It can also make them feel very anxious so they don’t actually enjoy the feeling of having a drink.”

But what are the main reasons behind this shift – and what can we do to manage it over the party season?

What biological changes during menopause might impact our tolerance to alcohol?

“As we get older, especially once you start hitting your 40s, pretty much everybody’s metabolism slows,” says Dr Alisha Esmail, GP and BMS-accredited menopause specialist at London Gynaecology. “So, the way your body processes any kind of input into the body changes, especially alcohol.

“Our body tends to break down the alcohol more slowly, it stays in the body for longer, therefore lots of people experience side effects such as feeling it more and experience lingering side effects of it for longer the next day.”

Other age-related changes, such as a natural change in body composition, can also have an effect.

“Because our metabolism slows, our body composition can change later in life and during menopause,” explains Esmail. “Your body naturally stores more fat than muscle as you get older, and fat doesn’t absorb alcohol or store alcohol as well as muscle.

“In addition, the liver, which is the main organ that breaks down alcohol, gets a bit less efficient as we get older.”

Hormone fluctuations during menopause then adds another layer onto this.

“Oestrogen pretty much affects every part of your body, including how your body processes alcohol and just toxins in general,” says Esmail. “So, as your levels of oestrogen go up and down during menopause, the way you process alcohol is not going to be as efficient as it used to be.”

How can drinking alcohol impact common menopausal symptoms?

“Drinking alcohol can have an exaggerated compounding effect on your pre-existing perimenopausal symptoms,” says Potter. “They are like two evil twin sisters working together in harmony to make things worse.”

She explains that some women find that consuming alcohol can make sleeping issues, which are often associated with menopause, even worse.

“Drinking alcohol can disrupt REM sleep, as you are much more likely to have increased night-time awakening, but if you have that on top of your perimenopausal sleep symptoms, it can compound that effect,” says Potter.

Drinking can also heighten anxiety.

“A lack of sleep will make you feel rubbish in itself, but especially if you’ve already got all the mood changes and anxiety that may come with menopause anyway, as it will make that a bit worse,” says Esmail.

In addition, consuming alcohol can exacerbate hot flushes and night sweats.

“Alcohol is what we call a vasodilator, so it makes your blood vessels open and that’s what happens when you have a hot flush,” explains Potter. “So, again it has that kind of compounded effect. You’re much more likely to have frequent hot flushes and worse hot flushes if you’ve been drinking.”

Here are some tips on how to take back control and manage these effects during the party season and beyond…

Be honest

“I think it’s just a case of being sensible and being honest with yourself about how much you are drinking,” says Esmail. “We all naturally want to see the best in ourselves, so we are not always honest with ourselves in terms of how regularly and how much we’re drinking.”

Taking breaks

“Consider taking breaks and having dry spells to see how you feel, as it can help give your body a bit of a break,” recommends Esmail.

Accept it

“Fighting against it doesn’t really work, so it’s important to have that acceptance that you probably aren’t going to be able to drink like you could in your 20s,” says Potter. “Making some lifestyle adjustments and working out what your social life is going to look like can make this much easier.”

Stay hydrated

“Stay hydrated because alcohol is a diuretic, and one of the reasons you feel so rubbish the day after drinking is because you’re so dehydrated,” says Esmail. “Maybe think about having some electrolytes too.”

Try the zebra striping method

“If you’re going to drink, try to have a big glass of water after every alcoholic drink or try alternating alcoholic drinks with non-alcoholic drinks,” suggests Potter.

Don’t drink on an empty stomach

“Make sure that you don’t drink on an empty stomach and that you have a proper nutrient-rich meal before you start drinking,” recommends Potter.

Try non-alcoholic options 

“There’s some amazing non-alcoholic drinks on the market now that make you feel like you’re having a celebratory drink,” says Potter.