Alcohol and Menopause: A Dangerous Cocktail
My menopause is complicated.
That’s what an Arkansas doctor told me. He was a giant man, maybe six-five, who perched on a tiny stool and crouched so he was able to look me in the eye.
“Women who go through war during menopause, women who are raped,” he said gently. “Women who lose children. It’s so traumatic, it panics the hormone receptors and makes them go wild.”
I’d turned 50 in 2016, barely aware of perimenopause. Then my 28-year-old son, Andrew, died and six months later I was not only dumb with grief, but a mass of crawling symptoms. Sleeplessness, joint aches, skin eruptions, heavy bleeding every 18 days. Worst were the mood swings. Sadness was a constant, but along with that was a cycle of dim, hazy days I could tolerate then a plunge into blackness so profound and evil I spent my time on the Internet, looking for ways to die.
My husband worked from home most days so he could watch over me. When he had to leave — for a meeting or a class — he enlisted friends to come over with a bottle of wine and pace me through the afternoon. Once home, he’d open another bottle and we’d spend a couple hours in the warmth of love. I’d go to bed feeling like life was possible. Then I would awaken at 2 a.m. — skin burning, stranded in the nausea of disturbing dreams — and twitch until morning when I would drag myself out of bed, sleepless, hopeless, and plotting suicide.
That doctor in Arkansas gave me prescriptions for hormone replacement therapy (HRT) — both estrogen and progesterone. He put an enormous hand on my shoulder and said, “You do whatever it takes to get through this. In five to eight years, I promise, this will be over. I’m so sorry about your son.”
The hormones helped a little. Back in Minneapolis, my regular gynecologist had me try different combinations. An estrogen patch and 100 mg of progesterone. Half a patch. 200 mg. Some symptoms dissipated while others worsened. I felt puffy and spent. Then the headaches started. I took pain relievers that gave me constant heartburn. Afternoons were long and bleak, filled with bile and bad memories.
At night I lay awake cataloging the things that might have saved Andrew, which was an endless exercise: coroners had found no cause of death, so the list included basically everything we hadn’t done. During the day I was ghostly, grim and frail.
Take magnesium, one friend told me. Others chimed in. Black Cohosh. Soy. Aromatherapy. Acupuncture. Melatonin. Valerian. Fresh oregano. Beer high in hops.
I was seeing a therapist who was nearly as frustrated and grim as I. Nothing she did seemed to help. EMDR that worked on post-traumatic soldiers…visualization exercises…anti-depressants. Finally, she employed the only lifesaving measure she could.
“You have a husband and two living children,” she told me. “If you kill yourself, you will ruin their lives.” It was the thing that kept me on earth in 2017.
We were completely out of options by the time I went in for my check-up in 2018. I was about to turn 52 and my periods were still on an erratic 12–20 day cycle, with no highs and bottomless lows. My gynecologist stared at my chart with a defeated look. “I have nothing left for you,” she said.
“I know,” I said, gathering up my clothes.
“Wait.” She couldn’t let me leave this way. “What about an anti-inflammatory diet?”
I sighed. “I’ve been doing that for years. No sugar or gluten. Lots of vegetables and alkaline foods. Golden milk.”
“Alcohol?” she asked. It was the first time in two years that anyone had.
“Of course,” I said. “In moderation. Two drinks a day.” Or three, I thought to myself.
“Try cutting out the alcohol,” she said.
I stared at her. Several times a month, someone sent me a new study saying alcohol (in moderation, always those two words were attached) was good for you. Drinking was an essential part of my business [I work in advertising]. My husband and I marked every sundown with the gentle pop of a cork. One of our only comforts the summer after Andrew’s death was taking our dog to a local brewpub and sitting silently under the stars.
Cutting out alcohol would eliminate — I did a quick calculation — maybe 70% of my social life. How was that going to help with being suicidally depressed?
I’m sure my skepticism was clear. “Ethanol,” she said curtly. “That’s what alcohol becomes in your system. Pure ethanol.”
I thought of gas pumps and truck fumes and the heady smell my husband sometimes gave off after a particularly late night.
“Just give it a try?” She said as she opened the door to leave.
“OK,” I said. “For a week.”
Here’s what I didn’t say: This is going to rock my marriage.
John is a large, taciturn Southern man who’d been drinking whisky since the age of 16. He stopped for a couple years in his late 30s, he told me once, because he was drinking too much.
“You mean, more than this?” I’d asked, over our nightly bottle-plus.
“A lot more,” he’d said.
“What does that mean?” asked my therapist when I told her. “What’s his current intake?”
“Three to five drinks a night,” I said. “But he’s…steady. It’s hard to explain. He doesn’t change at all. I’ve seen him have eight in a night and he can still have a conversation about abstract math theorems. I’ve never seen him drunk.”
“Maybe you have…?”
“Apparently his father was this way,” I went on. “He drank a pint of whisky every single day. I never met him; he was dead by the time I met John.”
“What did he die of?” she asked.
“Shot himself in the head.” I realized even as I was speaking how crazy this sounded. “Um, during an argument with his fifth wife.”
By this time, I’d been off alcohol for three days. I couldn’t be sure, but it seemed like things were getting better. The headaches and heartburn were almost gone. My mouth and eyes weren’t so dry. I’d awakened to fierce itching only once. But it was hard to tell.
What I knew for sure was that our evenings — John’s and mine — were awkward. I had more energy after dinner. He’d continued our habit of drinking quietly while reading on the couch. I knew it was unfair, but I resented his numbed-out remoteness. Two nights in a row I went out by myself, once to see a movie and the other to take a long walk. Things were tense when I got home.
“What if we drank together, but only half the nights?” he asked. “I’d be happy to quit three days a week.”
It had been 10 days of no alcohol for me and I could tell — with a growing sense of dread — that I definitely felt better. I’d slept straight through the previous night, eight hours, which had not happened in years. I no longer needed pain relievers or heartburn pills. It even seemed like my skin was getting softer; my face sucked in less moisturizer before bed.
“I’m sorry,” I said. “I want to spend time with you. But my body is happier without alcohol. I’m happier.”
He said little, which is his way. But when I got home from a business dinner the following night he was sitting at the table, working and drinking a bottle of Perrier. He shot me a look that said, Not now.
John came in the door the next day at 5:30, just as I was pouring myself a grapefruit-juice-and-club-soda. (I was better enough at this point that he felt safe leaving and going in to work.)
“Hey, could you make me one of those?” he asked. And that’s all that was said for a couple weeks, until the night he took my hands and told me he was sorry. He regretted ever asking me to drink. He was grateful I’d stuck to my no-alcohol policy because it was clear how much better it made me feel.
And it was. I’d passed through an entire hormone cycle without the usual descent into blackness. I felt more stable and surefooted than I had since the time before our son’s death. My sadness had actually increased, because I wasn’t blacking it out. But it was huge and real, not furtive and nightmarish. I began to adjust to what was.
Physically, the change was profound. After six weeks without alcohol, I was sleeping regularly in a deep, satisfying way that felt like slaking longtime thirst. Gone were the restless legs, touchy stomach and bloated feeling. I was able to wake on a schedule, without those queasy first moments of day. I was less muddled and made fewer mistakes at work.
During the second month, a slightly younger colleague sidled up to ask where I’d gotten my eyes “done” (as in lifted) because she was thinking of doing it herself. When I told her the truth — no procedure; it was only the effect of quitting alcohol — she laughed drily and said she’d rather have the surgery, but thanks.
I’m still impressed by my husband, who broke a 40-year habit purely out of solidarity. It was something I’d never considered he would do.
I watched him closely that first week, wondering if his body would rebel. He lost 18 pounds in the first month of not drinking alcohol, which was alarming. But otherwise, he said he felt surprisingly great.
And for me, the advantages just multiplied. John no longer snored, so my sleep was near perfect. Bed became a sanctuary, which it had never — in all my insomniac years — been. (About other things bedroom-related, let me just say: If middle-aged people the world over abstained from alcohol, it might kill the markets for Cialis and Astroglide.)
We cut about $250 a month from our budget, in whisky, wine and craft beer. So we decided to apply that money to other activities. Plays, art galleries, gong meditations. Life became more interesting, which made it more interesting to live.
On our anniversary, we went to a jazz club and each drank one $24 glass of Oregon Pinot Noir. It was excellent — and enough. Daily drinking had meant we consumed muddy, sour $10-a-bottle wine. One glass per quarter of exquisite wine was different, like eating a piece of perfect dark chocolate versus a whole fudgy Costco cake.
So the downsides? (Yes, there are downsides.)
The first, and minor, is that food doesn’t taste quite as good. There’s a reason doctors have long recommended a little sherry for elderly people who struggle to eat. Alcohol’s reputation as a superior digestif, all true.
The second, and major, is that abstaining from alcohol has weakened relationships with people we genuinely love. We hung out with a seriously hard-drinking crowd and had always been the tamest among them. These were the people who’d gathered around us when our son died. They stopped by repeatedly in that first awful year: arms full of casserole dishes and roasted chickens, but also enough bottles and growlers to stock a liquor store.
A few were gracious when we quit. My dear wine-drinking friend of 25 years hugged me and said, “I am so relieved that you feel better!” then shrugged off any concern that it would affect us. “I can drink without you,” she assured me. And she has — in a healthy, cheerful way — without umbrage or complaint.
But most people found our not drinking obtrusive, and I kind of saw their point. We started lugging club soda to every event. We were less motivated to join them for happy hour. My newfound love of sleep meant we were leaving earlier in the evening, when they were just gearing up for dessert, after-dinner drinks and Cards Against Humanity.
This wasn’t without its dark side. One of my wine o’clock women friends had started to yellow around the eyes and lips. A friend’s husband was admitted to the ICU with pancreatitis and sepsis. Word leaked out that a local writer in her 50s, who’d died under mysterious circumstances, had actually succumbed to alcohol.
The art of drinking moderately is especially fraught for women in the eight to 10 years of perimenopause. It’s a time when many of us feel more need the blunting effect of a couple cocktails. We’re worrying about aging parents and near-adult children. We’re at the busy peak of our careers. We finally have the freedom men have always had to check out at night. But the interplay between women’s health and alcohol is confusing — even to researchers.
“Moderate drinking — meaning one drink — appears good for your heart and has been associated with better bone density,” says Dr. JoAnn Pinkerton, Executive Director, The North American Menopause Society (NAMS) and Professor of Obstetrics and Gynecology at the University of Virginia Health system. “That said, alcohol does increase the risk for breast cancer.”
This is a dichotomy we women have been facing for years and it was easy (for me) to weight the heart-healthy reputation of booze over the cancer-causing one. But the relationship between alcohol and menopausal symptoms is a bit more clear.
“In terms of hot flashes, some studies find alcohol increases them, whereas others find the opposite,” says Pinkerton. “But even moderate drinking can trigger mood swings, making depression or anxiety worse. Alcohol is a depressant that has been shown to disrupt sleep and worsen insomnia. And it’s terribly dehydrating. Drinking if you have night sweats will only make the problem worse.”
I do believe there’s a healthy level of alcohol for me: probably one or two drinks a week. But right now, the depressive, disruptive and dehydrating qualities make it mostly not worth the risk.
Which is unfortunate. Because some people in my circle desperately want clarity. It confuses them that I quit drinking though I wasn’t technically an alcoholic. The fact that John decided to join me has provoked a few conversations about “codependency in reverse.” They get especially jumpy if I accept a glass of champagne at a celebration then refuse a drink the next time they see me, as if I’m wantonly changing the rules.
“Are you still doing that non-drinking thing?” friends ask when I arrive at their house, and I understand that mostly their question is logistic. They need to know how many glasses to pour. But it’s also curiosity, irritation and impatience. Are you still? Is this a lifelong decision? If you plan to start again some day, exactly when?
“Maybe never,” I tell the ones who ask straight out. “But I’m open to it. Maybe in five to eight years. Who knows how I’ll feel if this menopause ever ends.”
Ann Bauer is author of the novels “The Forever Marriage” and “Forgiveness 4 You.”
Alcohol and Menopause: A Dangerous Cocktail
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