A — 

AN I

WOMEN’S H

ISSUE 

A U.S. Department of Health

& Human Services 

National Institutes of Health 

National Institute on Alcohol Abuse 

and Alcoholism 

Number 62 July 2004 

LCOHOL

MPORTANT 

EALTH 

LERT 

While it’s true that men are more likely to drink alcohol and more likely to drink greater amounts, women 

have a higher risk of developing problems from alcohol 

consumption. When a woman drinks, the alcohol in 

her bloodstream typically reaches a higher level than a 

man’s even if both are drinking the same amount. This 

is because women’s bodies generally have less water than 

men’s bodies. Because alcohol mixes with body water, a 

given amount of alcohol is less diluted in a woman’s body 

than in a man’s. Women become more impaired by alcohol’s 

effects and are more susceptible to alcohol-related organ 

damage. That is, women develop damage at lower levels 

of consumption over a shorter period of time. 

Considering that about one-third of American women 

report regular alcohol consumption (1) and 2.3 percent, 

or 2.5 million women, meet the criteria for alcohol 

dependence (2), it is clear that research to better understand the effects of alcohol in women is critical. This 

issue of Alcohol Alert summarizes some of the most 

practical implications for women across the lifespan to 

come from that research. 

Adolescence— 

Setting the Stage 

Results from national surveys show that alcohol use is 

prevalent among both adolescents and young adults. 

And while heavy drinking remains more common 

among young men, the number of young women who 

drink heavily is alarmingly high (3). 

Adolescence is a critical stage of development. Rapidly 

changing body systems may be especially vulnerable to 

alcohol’s effects. Drinking during this time of accelerated 

brain and hormonal maturation may have long-term 

consequences (4). 

During adolescence, striking physical changes occur 

“

The younger a woman is when she begins
 in the brain. The prefrontal 

cortex, the brain region drinking, the more likely she is to develop 	 thought to be involved 

in various goal-directed 

behaviors, undergoes sub­ a problem with alcohol later in life.” stantial changes (5). The
amygdala, the brain structure believed to be involved 

in a person’s emotional reactions and coordinating the 

body’s response to stress, also undergoes developmental 

changes (6). Changes in these systems have a powerful 

effect on adolescent psychological functioning and 

behavior. As a result, some adolescents may be more 

likely to engage in risk-taking behaviors, such as experimenting with alcohol and other drugs. 

In adolescents with significant alcohol use problems, 

the volume of the hippocampus, a brain region important for learning and memory, has been found to be significantly smaller than in control subjects (7). Limited 

research suggests that women may be more susceptible 

than men to shrinkage of brain regions (8). Whether 

this is true in adolescent girls is not yet known. 

Adolescence is a time of dramatic changes in hormone 

levels and patterns. Gender differences in the body’s 

hormonal response to stress also begin to emerge. Some 

girls may be at particular risk for emotional difficulties, 

depression, and problems with self-image as well as an 

increase in risk-taking behaviors. In addition, during 

early adolescence, girls may be especially vulnerable to 

stress (9–11). Levels of perceived stress have been found 

to be the most powerful predictor of alcohol and other 

drug use, after peer substance use (12). 

Finally, evidence from animal studies suggests that 

alcohol may affect adolescents differently than adults. 

Adolescents do not become as uncoordinated or sleepy 

when drinking alcohol as adults do (13). Adolescents 

do, however, appear to be more sensitive to alcoholinduced disruptions in certain types of memory (14). 

Clearly, more research 

The Reproductive Years 

Alcohol use may have effects on female reproductive 

function at several stages of life. Some research suggests 

that the growth spurt and normal timing or progression of puberty may be at risk in human adolescents 

who consume even moderate amounts of alcohol on 

a regular basis (16). Heavy drinking has been shown 

to disrupt normal menstrual cycling and reproductive 

function. The reproductive consequences associated 

with alcohol abuse and alcoholism range from infertility and increased risk for spontaneous abortion, to 

impaired fetal growth and development (17). 

What Is a Drink? 

▲ 

▲ ▲ 

One 12-ounce bottle of 

beer or wine cooler 

One 5-ounce glass of wine 

1.5 ounces of 80-proof 

distilled spirits. 

Fetal Alcohol Syndrome 

Maternal alcohol use during pregnancy contributes to 

a wide range of effects on exposed offspring, including 

hyperactivity and attention problems, learning and 

memory deficits, and problems with social and emotional development. The most serious consequence of 

maternal drinking during pregnancy is fetal alcohol 

syndrome (FAS). Children with FAS have a distinctive 

set of facial anomalies, growth retardation, and significant learning and/or behavioral problems. Even children prenatally exposed to lower levels of alcohol may 

is needed to explain 

how gender differences 

may influence the 

way alcohol affects 

the developing adolesexhibit learning and behavioral problems. Thus far, a 

threshold below which no fetal damage will occur has 

not been established. In the absence of such informa­ cent brain and other 

body systems. What 

is known, however, is 

tion, following the Surgeon General’s recommendation 

that women abstain from drinking alcohol during 

pregnancy remains the safest course (18). that the younger a 

person begins drinking, the more likely Breast Cancer


he or she is to develop One of every eight American women will develop breast 

a problem with alcohol cancer in her lifetime (19). Some evidence suggests that 

later in life (15). alcohol consumption may increase the risk of breast 

cancer. Although the risk is 

relatively small, the benefits 

of moderate alcohol use 

“Research suggests that moderate alcohol
 should be weighed against 

the risk of developing cancer, use may be linked to breast cancer.” especially in women with a 

2 
family history of breast 

cancer, who appear to be 

at particular risk, even at 

low levels of drinking (20). 

Likewise, postmenopausal 

women who drink moderate amounts of alcohol 

have a higher risk of breast 

cancer if they use hormone 

“Light-to-moderate drinking may be 

associated with increased bone mineral 

density and decreased risk of fracture in 

postmenopausal women.” 

replacement therapy (HRT),


a known risk factor for 


breast cancer (21).


ALCOHOL AND OLDER WOMEN 

The cessation of ovarian function at menopause and 

the accompanying decline in the production of the sex 

steroid hormones secreted by the ovaries are marked 

not only by characteristic signs and symptoms but also 

by a loss of estrogen’s protective effects against osteoporosis and coronary heart disease. Alcohol use affects 

the health of postmenopausal women in two ways— 

directly, through its impact on organ systems such as 

the liver, brain, and gastrointestinal tract, and indirectly, by altering the blood levels of sex steroids that affect 

the risk for disease (22). Both the pattern and amount 

of alcohol that a woman drinks influence whether alcohol has a beneficial or harmful effect on her body. 

What Is a Safe Level of Drinking? 

The Dietary Guidelines for Americans 

recommend no more than one 

drink per day for women, and no 

more than two drinks per day 

for men. Drinking at these levels 

usually is not associated with 

▲ 

health risks and may prevent 

certain forms of heart disease. 

risk of CHD increases, approaching that 

of men. A large body 

of epidemiological 

evidence strongly 

suggests that lightto-moderate alcohol 

consumption significantly reduces the 

risk of CHD in both 

genders. Although 

the exact mechanisms remain 

unclear, alcohol has 

been found to improve the risk factors and conditions 

associated with CHD, such as reducing the LDL, or 

“bad” cholesterol, and increasing the HDL, or “good” 

cholesterol; and reducing blood clotting and the “stickiness” of platelets, small cells that play an important role 

in clot formation. It is clear, on the other hand, that 

heavy drinking can damage the heart. 

Bone Disease 

Osteoporosis is a skeletal disease characterized by low 

bone mass, increased bone fragility, and susceptibility 

to fracture. Nearly half of all women over age 50 will 

have an osteoporosis-related fracture in their lifetime 

(25). At about age 35, people reach their “peak bone 

mass”—the point at which their bones are as strong as 

they will become (26). After age 35, women lose 0.5 

to 1 percent of their bone mass each year. At menopause, 

when the ovaries stop producing estrogen, the rate of 

bone loss increases to about 3 to 7 percent per year (27). 

Heart Disease 

Coronary heart disease (CHD) is the number one 

killer of American women. One in every three American 

women dies of CHD (23). Several studies suggest that 

in pre- and postmenopausal women, light-to-moderate 

alcohol consumption may increase blood concentrations 

of estrogen and its metabolic byproducts—which may 

serve to protect against CHD (24). In fact, the incidence of CHD remains low until after menopause, 

apparently because abundant estrogen protects women 

against CHD. After menopause, however, women’s 

Some epidemiological studies suggest that light-tomoderate alcohol consumption may be associated with 

increased bone mineral density and decreased fracture 

risk in postmenopausal women (28,29). This effect has 

not been found in animal studies in which the amount 

of alcohol consumed as well as other lifestyle factors 

could be controlled (30). On the other hand, heavy alcohol 

use clearly has been shown to compromise bone health 

and to increase the risk of osteoporosis by decreasing 

bone density and weakening the bone’s mechanical properties. These effects are especially striking in young 

3

women, whose bones are still developing, but chronic 

alcohol use in adulthood also can harm bone health (31). 

In addition, animal studies suggest that bones do not 

overcome the damaging effects of early chronic alcohol 

exposure even when alcohol use is discontinued (32). 

Other lifestyle factors, such as tobacco use, also may 

increase the risk of osteoporosis and fractures. People 

who drink are 75 percent more likely to smoke, and 

smokers are 86 percent more likely to drink (33). This 

combination of habits significantly compounds osteoporosis risk (34). 

Alcohol’s Effect on Bone


Normal bone (top) and bone after 

heavy alcohol consumption (bottom). 

Note that lighter-colored areas of bone 

are missing in the bottom image. 

The greatest risk factor for the development of osteoporosis in women is menopause. Previous research 

found that postmenopausal HRT protected against the 

loss of bone density and greatly reduced the risk of 

osteoporosis-related fractures. However, findings from 

the Women’s Health Initiative—a large study on the 

risks and benefits of strategies that may reduce the incidence of heart disease, breast 

have a high risk of fracture (35). Other factors, such as 

weight-bearing exercise and increased body mass, do 

have beneficial effects on bone health (31,35). 

Memory and Brain Function 

Alzheimer’s disease (AD) is the most common form of 

dementia among older people. It is characterized by 

progressive changes in cognitive ability, memory, and 

mood. Women appear to be at greater risk than men 

for AD, although women’s longer life spans may contribute 

to this higher risk (36). Heavy alcohol consumption 

is known to result in memory deficits. Heavy alcohol 

consumption also may increase the risk for AD in both 

genders and in women in particular, as they appear to 

be more vulnerable than men to alcohol-induced brain 

damage (36). At present there is no evidence to suggest 

that brain function is negatively affected by moderate 

alcohol consumption. In fact, some researchers believe 

that moderate drinking may even protect the blood 

vessels in the brain, in a way that is similar to how it 

protects the vessels in the heart against CHD. 

Mixing Alcohol With Medications 

More than 150 prescription and over-the-counter 

(OTC) medications interact negatively with alcohol 

(37). Older women may be more sensitive to the 

effects of OTC and prescription medications (38,39). 

Although people over 65 make up 12 percent of the 

population, they consume 25 to 30 percent of all prescription medications (40). Careful attention to the 

occurrence of alcohol/medication interactions is especially important in this population. 

Putting Research 

Into Practice 

Research is providing information on many aspects 

of women’s use of alcohol, including ethnic patterns 

of drinking, differences between the sexes in how 

genes affect the risk of alcohol-related problems, and 

the greater vulnerability of women to the health effects 

of heavy drinking. 

The bottom line is that health care professionals, especially those involved in prevention and treatment of 

alcohol use disorders, but also those providing general 

and colon cancer, and fractures 

in postmenopausal women— 

“More than 150 prescription and over-
 found that when weighed 

against the risk of other types the-counter medications interact of disease, such as cancer, there 

was no net benefit for using negatively with alcohol.” HRT, even in women who 

4 
health care, need to be aware of how alcohol use may 

affect women’s health. The ability to effectively deliver 

care to women may be significantly influenced by patients’ 

use of alcohol or their knowledge of the impact that 

alcohol may have on their well-being. Helping each 

woman to balance the risks and benefits of alcohol use, 

and to understand the tradeoffs involved with drinking, is critical. 

References 

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in Alcohol Research & Health, 

The 

is a patient education 

▲ ▲ ▲ 

R e s o u r c e s 

Source material for this Alcohol Alert originally appeared 

Volume 26, Number 4, 2002. 

See NIAAA’s Web site for subscription information. 

Dietary Guidelines for Americans are issued jointly 

by the U.S. Department of Agriculture and the U.S. 

Department of Health and Human Services.The 

Guidelines can be viewed online at the Web site 

www.nutrition.gov. 

Alcohol: A Women’s Health Issue 

booklet describing the health effects of both moderate 

and heavy drinking on women. It is available in English and 

Spanish, and health care providers may order multiple copies to share 

with patients. An educational video also is available. For more information, 

and for additional resources, visit NIAAA’s Web site, www.niaaa.nih.gov. 

Full text of this publication is available on NIAAA’s World Wide Web site at http://www.niaaa.nih.gov. 

All material contained in the Alcohol Alert is in the public domain and may be used or reproduced 

without permission from NIAAA. Citation of the source is appreciated.


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