The relationship between menopause, perimenopause and alcohol use: A narrative review

Background: The relationship between menopausal transition, alcohol use, and women's health outcomes remains poorly understood despite its clinical relevance in psychiatry, women's health, and addiction medicine. Alcohol and menopausal symptoms share overlapping features, which may lead to symptom misattribution and barriers to appropriate care. Objectives: To map the existing literature on the relationship between menopause, perimenopause, and alcohol use, synthesise current evidence, and identify knowledge gaps across three domains: alcohol and menopausal physiology and symptoms; menopause as a potential risk factor for alcohol use and misuse; and psychosocial context and mental health outcomes. Methods: A narrative review was conducted using the MEDLINE, Embase, and PsycINFO databases, with literature from 1995 onwards included. Studies were included if they involved perimenopausal, menopausal, or postmenopausal women and addressed alcohol use, misuse, dependence, or alcohol use disorder. Data were synthesised thematically across the three predefined domains. Results: Fifty-three studies were included, predominantly cross-sectional (n=37) and prospective cohort (n=12) designs. Most focused on postmenopausal populations, with perimenopausal women under-represented. Moderate alcohol consumption was associated with higher estradiol and lower FSH levels, though effects on menopausal timing were inconsistent. Findings on vasomotor symptoms, sleep disturbance, and sexual function varied considerably across populations. No consistent evidence demonstrated that menopausal transition independently increases alcohol consumption. Mental health outcomes were reported in fewer than one-quarter of studies, with moderate drinking showing neutral effects while heavy consumption correlated with worse mood and cognitive complaints. Conclusions: The literature provides only a partial understanding of the menopause-alcohol relationship, with conflicting results across vasomotor symptoms, sleep, sexual function, and psychological outcomes. A dose-response pattern indicates moderate drinking showed neutral or minimal risks, while heavy consumption correlated with worse mood and subjective cognitive complaints.