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The effects of alcohol on women

The adverse effects of alcohol are common to both sexes. However, evidence suggests that many of these effects pose a greater risk to women's physical health at lower consumption levels than men.[1] The Royal Medical Colleges reported that studies conducted into alcohol-related harm in women were consistent in suggesting that the consumption level at which relative risk of mortality starts to rise is around 16 grammes of alcohol per day, or approximately 2 units. A woman will attain consistently higher blood ethanol concentrations than men following a standard oral dose of ethanol, regardless of body weight. This occurs primarily because their body water, and hence the compartment in which the ethanol distributes, is significantly smaller than in men.[2]

Research has suggested rates of alcohol-related deaths may vary independently for men and women: researchers found greater increases in alcohol-related mortality amongst women born between 1970 and 1979 in Glasgow, Manchester and Liverpool from 1980 to 2011.[3] It has also been found that women who drink excessively develop more medical problems than men.[4]

Some alcohol-related physical harms impact exclusively or nearly exclusively on women. Notable examples include disorders directly caused by the disruption of the reproductive system by alcohol, and breast cancer (for more information on the physical impacts of alcohol on women, please read our Health impacts factsheet).

Dependence

Higher blood ethanol concentrations can affect the risk of dependence at an earlier stage for women. Dependence jumps dramatically for men who exceed 7/8 drinks per occasion, but it can affect women sooner, i.e. those who drink 5/6 drinks per occasion (binge drinking levels).[5] Heavy steady chronic drinking at sufficiently high levels can also lead to the physiological changes that result in alcohol dependence – including liver disease such as cirrhosis and hepatitis – after a comparatively shorter period of heavy consumption than men.

Mental health

Associations have been noted between heavy drinking in women and psychiatric disorders such as depression, posttraumatic stress disorder, suicidality and eating disorders.[6]

Reproductive problems

In the first instance, heavy drinking is already known to be a possible cause of infertility, but a Danish study found that even small amounts of alcohol can affect a woman's fertility.[7] Furthermore, some women find that they are more affected by alcohol while ovulating or when they are premenstrual. This is because it takes alcohol longer to be metabolised, leading to a higher blood alcohol concentration. Alcohol has been found to affect menstrual cycles, which may lead to amenorrhea (absence of a menstrual period) and anovulation (a menstrual cycle without ovulation).[8] There is also evidence to suggest that women using oral contraceptives absorb and metabolise alcohol more slowly and evenly than those who do not use them.[9] Fertility treatments may also be affected; it was found that women who reduce their drinking or do not drink at all during fertility treatments were twice as likely to conceive as those who did not alter their drinking patterns before treatment.[10]

Women, pregnancy and postnatal care

The UK Department of Health advises against pregnant women or women trying to conceive drinking alcohol, and warn that “drinking during pregnancy can lead to long-term harm to the baby, with the more you drink, the greater the risk.”[11] The Scottish Chief Medical Officer also advises against pregnant women drinking alcohol during pregnancy, as “there is no 'safe' time for drinking alcohol during pregnancy and there is no 'safe' amount”. In 2009, Australian child health researchers came out in support of new official national guidelines advising against alcohol in pregnancy and urged community support to help women avoid alcohol when in pregnancy.[12]

In 2012, UK media outlets wrongly reported that it was safe to binge drink during pregnancy with no harm to the unborn child's development, on the basis of a study of 1,268 women recruited from the Danish National Birth cohort between 1997 and 2003.[13] The researchers found no significant association between low-to-moderate average weekly alcohol consumption and any binge drinking during early-to-mid pregnancy and the neurodevelopment of children at 5 years old. However, they did not say that alcohol consumption or binge drinking in pregnancy were “safe” for women or their unborn children.[14] For heavy and dependent female drinkers, the health risks of alcohol consumption to foetal development are well documented and recognised by the World Health Organisation (WHO), the global body on health issues.

While evidence on the effect of alcohol consumption while breastfeeding on infants is mixed and limited,[15],[16],[17],[18] NHS guidance on alcohol consumption during breastfeeding recommends that breastfeeding mothers have no more than one or two units or alcohol once or twice a week. They also highlight that parents should not share a bed or sofa with their babies if they have drunk any alcohol, as this has a strong association with sudden infant death syndrome (SIDS).[19]

Foetal Alcohol Syndrome

Heavy drinking during pregnancy can lead to spontaneous abortion or a range of disabilities known as foetal alcohol spectrum disorders, of which Foetal Alcohol Syndrome (FAS) is the most severe.[20]

By crossing the placental barrier, alcohol can affect a foetus by stunting its growth or weight, creating distinctive facial stigmata, and damaging the structure of the central nervous system in development. This can result in physical symptoms such as an abnormally small head, defective development of mid facial tissues, minor outer ear abnormalities, abnormally small eyes, and heart and genital defects. Those with Foetal Alcohol Spectrum Disorders have also been found to experience high rates of mental health problems, schooling disruption and trouble with the law[21] and are at high risk for sleep problems.[22]

Research conducted by the Canadian Centre on Substance Abuse has found that while it is clear that children who meet the criteria for FAS are only born to those mothers who consume alcohol during pregnancy, it is also evident that these mothers are subject to other adverse conditions which are major factors in many cases, including poverty, poor nutrition, illicit drug use, smoking, violence and a history of obstetric problems.[23]

Alcohol use in later life

Later life poses unique issues surrounding alcohol for women. Older women have less lean muscle mass and continue to lose this with age, which makes them more susceptible to effects of alcohol. Similarly, the liver enzymes which process alcohol and medication lose effectiveness with age, and the central nervous system becomes more sensitive; this poses a greater problem for older women who drink, as older women tend to take more medication. It has also been found that older women are less likely than older men to seek specialised addiction treatment.[24] One such article also reviewed research indicating potential beneficial effects of moderate alcohol use on conditions such as coronary heart disease. However, concerns have been raised with the design of such studies used to investigate this, including misclassification of drinking level of participants, sampling errors, and influence of confounding factors acting on participants such as access to health care services, education level and income. A recent meta-analysis exploring these concerns found no evidence of alcohol’s protective effects against death or morbidity from coronary heart disease.[25]

This is in line with the new guidelines from the UK Chief Medical Officers’, which highlight that recent evidence suggests “net benefits from small amounts of alcohol are less than previously thought and are significant in only a limited part of the population”. They note this benefit only applies to women over 55 years, “for whom the maximum benefit is gained when drinking around 5 units a week, with some beneficial effect up to around 14 units a week”.[26]

Breast Cancer

Studies began to indicate a correlation between alcohol use and breast cancer in the mid 1990s. An article in the New England Journal of Medicine suggested that the balance of risks and benefits for women was complicated by a light-to-moderate alcohol intake.[27]

Many studies have since identified beyond doubt that alcohol is a major risk factor for breast cancer. In 2004, the WHO published a comprehensive review of the evidence-based literature which stated that:

… not only hazardous or harmful drinking but also even moderate alcohol consumption can cause female breast cancer (Single et al. 1999a). A meta-analysis by Smith-Warner et al. (1998) found a clear linear relationship over the whole continuum of consumption... Recent studies have focused on plausible biological mechanisms, including alcohol’s effect on hormones and tissue, its contribution to the initiation, progression and promotion of breast cancer, and its interaction with nutritional factors (for an overview see Singletary and Gapstur 2001; Soler et al. 1998; U.S. Department of Health and Human Services 2000).[28]

Although the causality of the relationship is open to debate – there are several theories that attempt to explain how alcohol causes cancer – there is some knowledge of the ways in which alcohol triggers changes in women's bodies that could potentially lead to cancer. Alcohol is converted in the body to acetaldehyde, a toxic chemical which can cause cancer by damaging DNA and preventing repairs to this damage. Alcohol can also affect levels of oestrogen, and unusually high levels of this hormone increase the risk of breast cancer. Alcohol may also cause cancers by causing damage to DNA in our cells through the production of Reactive Oxygen Species here.[29] Therefore, standard medical advice commonly dictates that in order to limit the likelihood of getting breast cancer, women ought to avoid or limit the consumption of alcohol.[30]

 


 

In recent years, researchers have identified a relationship between moderate alcohol intake and cancer incidence in women.

A 2009 evaluation of data produced by the Million Women Study between 1996 and 2001 estimated that:***

… the excess cancer incidence up to age 75 for women in developed countries for every additional 10 g of alcohol (i.e. for every additional drink) regularly consumed per day was typically of the order of 11 per 1,000 for breast cancer...[31]

This means that the risk of breast cancer rises by 11 cases per 1,000 for every alcoholic drink consumed daily. This finding was consistent even at low consumption levels; for instance, a group of 1,000 women who have just 1 drink a day will have 11 more cases of breast cancer compared to non-drinkers. It was also estimated that about 11% of all breast cancer in women in the United Kingdom, that is, 5,000 (cases) annually, is attributable to alcohol.[32] Along with this, a 2012 meta-analysis found a significant increase in the risk of breast cancer of around 4% for intakes of up to one alcoholic drink per day, while heavy consumption (three or more drinks per day) was associated with an increased risk of 40-50%.[33]

In 2016, the UK Chief Medical Officers (CMO) published updated Low Risk Drinking Guidelines, based on an analysis from an expert group of the available evidence on alcohol’s health effects. The CMO note that evidence produced since the previous drinking guidelines were published in 1995 suggests that drinking alcohol increases women’s breast cancer risk, that this risk starts from any level of alcohol consumption, and that this risk rises with alcohol consumption. The official guidelines now state: “The risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases the more you drink on a regular basis.”[34]

Domestic violence

The World Health Organisation (WHO) states that alcohol consumption, especially at harmful and hazardous levels is a major contributor to the occurrence of intimate partner violence and links between the two are manifold.[35] In the UK, it has been estimated that 89% of victims of ongoing domestic or sexual abuse are female.[36]

The 2015 Crime Survey for England and Wales reported that 27.1% of women had experienced domestic abuse since the age of 16.[37] 18% of female victims of partner abuse stated that they believed the offender was under the influence of alcohol at the time of the most recent incident.[38] Victims may use alcohol as a coping mechanism and, in some cases, this may be used by violent partners as an excuse for continued abuse.[39] (For more information on domestic violence and alcohol, please read our Crime and Social Impacts factsheet).

Sexual assault

Alcohol is a major factor in sexual assaults. The 2013/14 Violent Crime and Sexual Offences statistics for England & Wales found that 35% of female victims surveyed believed their assailant to be under the influence of alcohol during a serious sexual assault, and a third of the victims themselves had also been under the influence of alcohol (29%).[40]

In a report on alcohol and sexual health, the Royal College Physicians said:

Use of alcohol by both victim and perpetrator is commonly implicated in sexual assault, although the state of intoxication of the victim is more significant. The proportion of reported rapes in which alcohol use is reported or can be detected biochemically in the alleged victim varies from 35 to 46%... Intake of alcohol by an individual increases the risk of both stranger rape and date rape occurring... Alcohol consumption alters risk perceptions as well as lowering inhibitions. At the same time, perpetrators may actually seek out intoxicated women.[41]

(For more information on sexual assault and alcohol, please read our Crime and social impacts factsheet).

 

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*** The Million Women Study was a national study of women’s health, involving more than one million UK women aged 50 and over, who were invited to participate between 1996 and 2001. It was the largest study of its kind in the world. For more information, visit <www.millionwomenstudy.org>.

[1] Edwards G et al (1994)., ‘Alcohol Policy and the Public Good’, Oxford University Press: USA

[2] Morgan MY, Ritson EB (2010)., ‘Alcohol and health: A guide for health-care professionals (5th edition)’, London: Medical Council on Alcohol, pp. 12–13

[3] Shipton D, Whyte B, and Walsh D (2013)., ‘Alcohol-related mortality in deprived UK cities: worrying trends in young women challenge recent national downward trends’, Journal of epidemiology and community health, jech-2013

[4] Erol A, and Karpyak VM, (2015)., ‘Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations’, Drug and alcohol dependence, 156, pp. 1–13

[5] National Institute on Alcohol Abuse and Alcoholism (June 2002), ‘Alcohol consumption and problems in the general population: Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey’

[6] Wilsnack SC, Wilsnack RW, and Kantor LW (2014)., ‘Focus on: women and the costs of alcohol use’, Alcohol research: current reviews, 35(2), p. 219

[7] Jensen TK et al (August 1998)., ‘Does moderate alcohol consumption affect fertility?’, BMJ, vol 317, pp. 505–510

[8] Aluko EO, Olubobokun TH, Adekunbi DA, and Udo NV (2014)., ‘Sexual Functions, Sexual Organs and Sex Hormone Level in Chronic Alcohol Intake’, British Journal of Medicine and Medical Research, 4(6), pp. 1279–1292

[9] Plant M, Cameron D (November 2000)., ‘The Alcohol Report’, citing Plant M, ‘Women and Alcohol: Contemporary and Historical Perspectives’, London: Free Association Books

[10] Gormack AA, Peek JC, Derraik JG, Gluckman PD, Young NL, and Cutfield WS (2015)., ‘Many women undergoing fertility treatment make poor lifestyle choices that may affect treatment outcome’, Human reproduction, 30(7), pp. 1617–1624

[11] Department of Health, (2016), ‘UK Chief Medical Officers’ Alcohol Guidelines Review: Summary of the proposed new guidelines’ <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf>

[12] Global Alcohol Policy Alliance (GAPA) (2009), ‘No alcohol in pregnancy safest choice’, The Globe, Issue 2, Blueprint Cambridge Ltd <http://www.ias.org.uk/resources/publications/theglobe/globe200902/gl200902_p17a.html>

[13] Daily Telegraph (June 2012), 'Small alcoholic drink a day during pregnancy “has no effect on baby”'; BBC News, (June 2012), 'Moderate drinking in early pregnancy branded “safe”'; Daily Express (June 2012), '“12 drinks safe” while pregnant'; Hope, Jenny (June 2012), 'A drink a day for pregnant women “will NOT harm unborn baby's development”', Daily Mail; Metro (June 2012), 'Pregnant women can binge drink safely, says research'

[14] NHS Choices, 'Daily drinking in pregnancy “not safe”'

<http://www.nhs.uk/news/2012/06june/Pages/daily-drinking-pregnancy-risk-not-safe.aspx>

[15] Little RE, Anderson KW, Ervin CH, Worthington-Roberts B, and Clarren SK (1989)., ‘Maternal alcohol use during breast-feeding and infant mental and motor development at one year’, New England Journal of Medicine, 321(7), pp. 425–430

[16] Little RE, Northstone K, and Golding J (2002)., ‘Alcohol, breastfeeding, and development at 18 months.’, Pediatrics, 109(5), e72–e72

[17] Mennella JA, and Beauchamp GK (1991)., ‘The transfer of alcohol to human milk: effects on flavor and the infant's behavior’, New England Journal of Medicine, 325(14), pp. 981–985

[18] Haastrup MB, Pottegård A, and Damkier P (2014)., ‘Alcohol and breastfeeding.’, Basic & clinical pharmacology & toxicology, 114(2), pp. 168–173

[19] NHS Choices (January 2016), ‘Breastfeeding and drinking alcohol’,

<http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-alcohol.aspx>

[20] World Health Organisation (WHO) (2011), ‘Fetal alcohol syndrome: dashed hopes, damaged lives’, Bulletin of the World Health Organization 2011, 89, pp. 398–399 <http://www.who.int/bulletin/volumes/89/6/11-020611/en/index.html>

[21] Petrenko CL, Tahir N, Mahoney EC, and Chin NP (2014)., ‘Prevention of secondary conditions in fetal alcohol spectrum disorders: Identification of systems-level barriers’, Maternal and child health journal, 18(6), pp. 1496–1505

[22] Ipsiroglu OS, McKellin WH, Carey N, and Loock C (2013)., ‘“They silently live in terror…” why sleep problems and night-time related quality-of-life are missed in children with a fetal alcohol spectrum disorder.’, Social science & medicine, 79, pp. 76–83

[23] Poole NA (2008)., 'Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives', <http://bit.ly/2lT8Kri>

[24] Blow FC, and Barry KL (2002)., ‘Use and misuse of alcohol among older women’, Alcohol Research and Health, 26(4), pp. 308–315

[25] Chikritzhs T, Fillmore K, and Stockwell T (2009)., ‘A healthy dose of scepticism: four good reasons to think again about protective effects of alcohol on coronary heart disease’ Drug and alcohol review, 28(4), p. 441–444

[26] Department of Health (August 2016), ‘UK Chief Medical Officers’ Low Risk Drinking Guidelines’, <http://bit.ly/2mt5SVx>

[27] Fuchs CS et al (May 1995)., ‘Alcohol Consumption and Mortality among Women’, New England Journal of Medicine, 332: 19, pp. 1245–1250 <http://www.nejm.org/doi/full/10.1056/NEJM199505113321901

[28] Rehm J, Room R et al (2004)., ‘Alcohol use’, in ‘Comparative quantification of health risks: Global and regional burden of disease due to selected major risk factors’, volume 1, WHO, pp. 1,009–10 <http://www.who.int/healthinfo/global_burden_disease/cra/en/>

[29] Cancer Research UK, 'How does alcohol cause cancer?'

<http://www.cancerresearchuk.org/cancer-info/healthyliving/alcohol/howdoesalcoholcausecancer/>

[30] American Cancer Society (August 2012), 'Breast Cancer', p. 22

[31] Allen et al (February 2009)., 'Moderate Alcohol Intake and Cancer Incidence in Women', Journal of the National Cancer Institute, 101: 5, pp. 296–305, pp. 301–303 <http://jnci.oxfordjournals.org/content/101/5/296.full.pdf&embedded=true>

[32] Allen et al., Journal of the National Cancer Institute, pp. 301–303

[33] Seitz HK, Pelucchi C, Bagnardi V, and La Vecchia C (2012)., ‘Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012’, Alcohol and Alcoholism, 47(3), pp. 204–212

[34] Department of Health, (August 2016), ‘UK Chief Medical Officers’ Low Risk Drinking Guidelines’, <http://bit.ly/2mt5SVx>

[35] WHO, 'Intimate Partner Violence and Alcohol Fact Sheet', p. 1 <http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/>

[36] Walby S, and Allen J (March 2004)., 'Domestic violence, sexual assault and stalking: Findings from the British Crime Survey', Home Office Research Study 276, Home Office Research, Development and Statistics Directorate, p. vii

[37] Office for National Statistics (ONS) (February 2016), ‘Intimate personal violence and partner abuse’, in Focus on Violent Crime and Sexual Offences: Year ending March 2015

[38] ONS (February 2016), ‘Intimate personal violence and partner abuse’, in Focus on Violent Crime and Sexual Offences: Year ending March 2015

[39] Royal Colleges of Physicians (May 2005), 'Alcohol and Violence: Briefing Statement', p. 2

[40] ONS (February 2015), Appendix Tables, in 'Crime Statistics, Focus on: Violent Crime and Sexual Offences, 2013/14', Table 4.16 <http://bit.ly/2lKhx37>

[41] Royal College of Physicians (December 2011), 'Alcohol and sex: a cocktail for poor sexual health. Report of the Alcohol and Sexual Health Working Party', London: RCP p. 6

<http://www.rcplondon.ac.uk/press-releases/nhs-missing-key-opportunities-tackle-alcohol-abuse>