Menopause and Alcohol Intolerance: Stopping Wine Hot Flashes

There may have been a time in your life when you could knock one back with the best of them. A 10 p.m. martini on a Wednesday? You’d be in the office the next day like nothing happened. Sharing a bottle of wine on a date? Eh, you’d drink an extra glass of water in the morning.

As you enter midlife, things are different. It feels like menopause alcohol intolerance has hit you hard. Pinot noir practically guarantees a hot flash. If you even think about pouring yourself a second glass of wine on a Friday evening, your body rebels with a weekend-long hangover.

Many women lean on alcohol to unwind or cope with menopause symptoms, but it’s a strategy that can backfire. Midlife hormonal shifts and other age-related changes alter your body’s ability to metabolize alcohol effectively, which can amplify its side effects and trigger more intense menopause symptoms.

About the Experts
Lauren Streicher, M.D., clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine.

MacKenzie Peltier, Ph.D., assistant professor of psychiatry at Yale University.

Does Menopause Cause Alcohol Intolerance?

Midlife changes—including hormonal ones—can make you more sensitive to alcohol and its effects, meaning you feel tipsy quicker. ¹ This is different from alcohol intolerance, which is a genetic condition that causes negative reactions like flushing and nausea because your body has difficulty metabolizing alcohol. ²

For some women, declining estrogen during menopause alters how their body processes alcohol. ³ “There’s some evidence—mostly in animal models—that low estrogen has an impact on alcohol metabolism,” says gynecologist Lauren Streicher, M.D. “It’s not well-studied, but certainly alcohol and estrogen are tied together,” she adds.

Menopause and wine flush

If you find yourself flushing after a glass of wine, the reaction could be due to:

• Alcohol flush reaction: A genetic intolerance to alcohol that causes redness, hives, nausea, low blood pressure, and migraines ⁴.
• Wine flush: A menopause-related response where alcohol triggers hot flashes.

“We’ve known that alcohol, particularly red wine, is a trigger for hot flashes for some women,” says Streicher. If you notice that a glass of Merlot reliably sets off a hot flash, consider switching drinks to see whether others affect you differently.

Beer may have a slight advantage: A study of 37 women found that women who drank a moderate amount of beer daily—alcoholic or non-alcoholic—reported fewer hot flashes
⁵. Researchers suspect that phytoestrogens in beer may be responsible for the benefits.

Dehydration

Alcohol intolerance is made worse in menopause because as you age, the amount of water in the body decreases. This allows alcohol to enter your bloodstream more quickly and linger longer. ⁶ Estrogen and progesterone, which are also responsible for maintaining the body’s balance of fluids, also decline. ⁷ The result? Alcohol hits harder and stays in your system for longer.

Liver health

A lifetime of removing toxins from the body affects liver function, and alcohol intolerance as a result. “As someone gets older, their liver becomes less effective at metabolizing alcohol, so alcohol levels stay higher in the body for longer,” says Streicher. “They’ll be more aware of symptoms and feel worse after drinking, though we don’t know exactly what age that starts happening since everyone’s liver is different,” she explains.

How Alcohol Worsens Menopause Symptoms

Alcohol disrupts hormone balance, which can exacerbate many common menopause symptoms, including hot flashes, sleep disturbances, and mood swings.

Some research has found that women who consume about one drink per day have higher levels of estrogen compared to non-drinkers. ⁸ This may be one reason alcohol intake is associated with higher breast cancer risk.

Another study found that low and moderate intake (up to three drinks per week) is associated with later menopause, though researchers aren’t sure if this is because people who drink less may have healthier diet and exercise habits that affect menopause timing. ⁹

Alcohol may also have pro-estrogenic effects, meaning it can influence estrogen and other hormones that affect ovarian function. ¹⁰ Some alcoholic drinks themselves may contain phytoestrogens, compounds that mimic estrogen. ¹¹ A stronger body of research is needed to confirm these findings.

1. Hot flashes and night sweats

Four out of five women have hot flashes during menopause, but they may not be caused by menopause. ¹² “Alcohol can make you have hot flashes that have nothing to do with a change in estrogen,” says Streicher. Researchers believe alcohol impacts body temperature regulation and neurotransmitters involved in thermoregulation. ¹³

That said, hormones do play a role. Data on premenopausal women found that the more alcohol women drank, the greater their risk of having early-onset hot flashes and night sweats—and more bothersome ones on top of it. Although the mechanism isn’t clear, the researchers suggest that alcohol may alter several hormones (including follicular stimulating hormone and androgens) that trigger hot flashes.

2. Sleep disruptions

Half of postmenopausal women report having a sleep disorder. ¹⁴ Commonly, that’s due to underlying conditions such as insomnia, obstructive sleep apnea, or restless legs syndrome, all of which become more prevalent during menopause. Night sweats also wake you up at night.

Alcohol compounds the issue. While initially sedating, alcohol disrupts your sleep cycle. It’s also been shown to cause fragmented sleep (making it easier to wake up) and less “restorative” REM sleep. ¹⁵

3. Mood swings and anxiety

Estrogen affects neurotransmitters that stabilize your mood, which may explain why a review of 22 studies concluded that women are more at risk for depression and anxiety during menopause. ¹⁶

While alcohol may initially make you feel relaxed due to a rise in neurotransmitters like gamma-aminobutyric acid (GABA)the effect is short-lived. As the alcohol wears off, the brain compensates by bringing down levels of these chemicals, creating increased anxiety—or “hangxiety.” ¹⁷

How to Get Rid of Hot Flashes After Drinking Alcohol

You can ease alcohol-related hot flashes by drinking ice water, taking off a layer of clothing, turning up the fan, or calming down your nervous system with deep breathing. ¹⁸

Beyond that, if you’re having hot flashes, adjust what you’re drinking, how much you’re drinking, or even whether you’re drinking at all. “The bottom-line message is to listen to your body. Whether it’s aging or symptoms of perimenopause, if alcohol is making you feel bad, either cut down or eliminate it altogether,” Streicher says.

Can You Drink Alcohol on HRT?

Yes, it’s safe to drink alcohol on hormone therapies, says Streicher. “HT is no different than having your own estrogen,” she says. HT, or hormone therapy—also referred to as HRT, or hormone replacement therapy—provides your body with small amounts of estrogen and/or progesterone through pills, patches, a vaginal ring, and other delivery mechanisms. It’s considered a gold-standard treatment for hot flashes in menopause. ¹⁹

Can Alcohol Cause Early Menopause?

Some studies suggest that drinking lowers the risk of early menopause, but others suggest drinking raises it.

One 2021 study found women who drink low to moderate amounts of wine or liquor (but not beer) had a lower risk of early menopause. ²⁰ Researchers suspect that alcohol may increase estrogen and reduce oxidative stress—damage caused by harmful molecules—in ovarian tissue, allowing them to produce eggs longer.

Heavy drinking may have the opposite effect. A study of 1,332 women between the ages of 40 and 60 years found that higher alcohol intake was associated with an increased risk of early menopause. ²¹

Although early menopause—when a woman’s periods stop before the age of 45—is linked to a higher risk of health conditions like heart disease, autoimmune disorders, and osteoporosis, the connection between alcohol and menopause remains complex.

Strategies for Cutting Back on Alcohol and Minimizing Side Effects

If perimenopause or menopause has you thinking about giving up alcohol entirely or just cutting back, know this: It might be hard, but it’s not impossible. If you realize that the amount you’re drinking is doing you more harm than good, here’s where to start with managing menopause alcohol intolerance.

Reevaluate when and why you drink

Research shows that alcohol use changes as women go through menopause. Some women cut back, while others increase their intake, sometimes to excess. ²² “Notably, there has been a significant increase in alcohol use, particularly binge drinking among older women,” says MacKenzie Peltier, Ph.D., assistant professor of psychiatry and co-author of the aforementioned research.

For some, drinking more may be a strategy for coping with common menopause symptoms. “One important factor is that women are more likely to drink to regulate stress or negative mood. The menopausal transition is a time of significant fluctuation across many different facets of a woman’s life, and that may be one of several reasons that our research showed that women who were not previously drinking ‘excessively’ increased their alcohol use during various stages of the menopausal transition,” she explains.

If you recognize this change in your relationship to alcohol, it’s helpful to dig in and examine why you’re drinking and how you might cope with stress and menopause symptoms without alcohol. “The first step is to understand how much you are drinking. I encourage my patients to begin to track their alcohol use based upon standard drinks,” says Peltier. (This is a helpful guide.)

Seek support

If you want to make a change in your drinking habits, tell others about it. “You can never have enough support,” says Peltier. “Discuss the changes you want to make with family and friends. It can be helpful to have supportive allies, especially if you’re looking to start incorporating social events that do not involve alcohol into your calendar,” she says.

Change your signature drink

If you suspect that wine is a hot flash trigger for you but you’d like to continue to drink alcohol, it’s time to experiment. You might switch to a low-sulfite or no-sulfite-added wine or a spirit-based cocktail. It can also help to eliminate alcohol entirely and then slowly reintroduce different kinds to see whether there’s one that works best with your physiology.

Explore alcohol-free alternatives

One of the great things about the sober-ish or sober-curious trend is that there are so many delicious drinks out there. Try non-alcoholic drink options such as NA beers or spirits or alcohol-removed wine, or go for a mocktail or flavored sparkling water. “Socially, there’s more of an acceptance of not drinking. We are evolving to appreciate that alcohol does not have to be how we socialize anymore,” says Streicher.

Stay hydrated and eat well

Alcohol is a diuretic, meaning you urinate more fluid than you take in. ²³ That can make you dehydrated, which is one of the main causes of hangovers. Stay hydrated while you drink—have a glass of water in between each glass of wine or beer or cocktail. What’s more, pair your drink with food: Drinking alcohol along with a balanced meal slows the absorption of alcohol and reduces its effects. ²⁴

Exercise regularly

There’s some evidence that exercise can help reduce alcohol consumption, according to a randomized clinical trial on adults with alcohol-use disorder. Reasons for the reduction include the fact that physical activity boosts mood, improves stress regulation, stimulates the brain’s dopaminergic system (a reward pathway), and reduces alcohol cravings. ²⁵

If you’re in menopause and have been turning to alcohol to help you deal with your symptoms, it’s important to keep in mind that lifestyle and medical treatments are available. “We have a number of hormonal and nonhormonal solutions for menopause. Talk to a menopause expert to find out what your options are,” says Streicher. “Menopause is forever—this is the time to get real solutions.”