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Women and Alcohol:
Facts for the Provider

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Prevalence

  • About one third or 3.95 million of the alcohol abusing population in the U.S. are women.

  • Women comprise the fastest growing segment of the alcohol abusing population.

  • Alcohol abuse is estimated to cost billions of dollars annually in the U.S. when considering:
    • Medical expenses
    • Legal problems
    • Lost job productivity

Which women have the highest risk of alcohol abuse and alcoholism?

  • Women who have family histories of alcoholism.
  • Women who are victims of violence as children or adults.
  • Women whose partners are alcoholic.
  • Women with binge/purge eating disorders.
  • Women with dual diagnosis-especially depression.
  • Women who are single or co-habitating.
  • Middle-aged women in transition (divorce, retirement, children leaving home).
  • Older women with grief and loss issues.

Pharmacologic Effects

  • CNS depressant10 absorbed through the GI tract via simple diffusion. Effects may vary depending on the rate of ingestion, duration of exposure to a given concentration, and the duration of chronic exposure.

  • Rate of absorption depends on the concentration of ethanol ingested, the amount of food in the stomach, gender, and use of medications that affect gastric motility.

  • Initial breakdown (first pass metabolism) occurs in the stomach and small intestine and is mediated by alcohol dehydrogenase. In women, first pass metabolism is less efficient than in men and higher blood alcohol concentrations may result. Ultimately, this leads to increased uptake of endotoxins and free radicals into the blood and lymph system.

  • Following absorption, ethanol is transported to the portal system for breakdown. The higher the concentration, the more toxic it is to the liver.

  • Ethanol is thought to be more toxic to women than men because women have proportionately less body water and diminished activity of alcohol dehydrogenase in the stomach.

  • Women may eliminate (or metabolize) ethanol up to 33% faster than men do. This could result in higher, though transient, acetaldehyde concentrations in the liver over a lifetime of drinking.

Medical Complications of Alcohol in Women

Cardiovascular:
  • Hypertension
    • Risk increases 41% with 2 to 3 drinks per day
    • Risk increases 90% with 3.5 or more drinks per day

  • Cardiomyopathy
    • Risk for women who abuse alcohol for 10 to 20 years or more. The at-risk dose for a 55 kg woman is nine ounces of spirits or one liter of wine per day for 20 years
    • Disease occurs at lifetime alcohol doses that are 60% lower those of men who develop this condition.
Neurologic:

Women are subject to similar neuroanatomical deficits as men after shorter and less severe drinking histories than men. Problems include:

  • Decrease in size of the cerebral cortex
  • Sleep disturbances
  • Korsakoff syndrome

Endocrine:

There is a dose-response relationship to alcohol consumption and menstrual problems. Three or more drinks per day have been associated with infertility through suppression of ovulation and increased risk for spontaneous abortion by interfering with the pregnancy maintaining function of the corpus luteum.

Regular alcohol consumption in early adolescence may delay the onset of puberty by altering the function of IGF-1 in the liver.

Breast cancer is positively correlated with alcohol consumption, which is not affected by menopausal status.

Bone:

Alcohol consumption can disrupt the balance between erosion and remodeling of bone because alcohol inhibits osteoblasts and calcitropic hormones including vitamin D and parathyroid hormone.24 This is of particular concern to women in light of bone demineralization that occurs in conjunction with decreased estrogen levels at menopause.

Post-menopausal women who are heavy drinkers may experience modest increases in bone density compared with occasional and non-drinkers. The rationale for this is not completely understood but may be related to adrenal stimulation, which has a positive impact on bone mineral density.

How much drinking is safe for women?

The U.S. Department of Health & Human Services advises:

  • No more than one drink per day for daily drinkers.
  • No more than two drinks per day for occasional drinkers.

One drink is equal to: 12 oz. beer, 5 oz. wine, 1.5 oz. hard liquor.

What constitutes alcohol abuse?

  • Heavy drinking for women is three or more drinks per day.
  • A binge drinker drinks excessively or out-of-control with periods of abstinence between. A binge, for women, consists of three or more drinks on one occasion.
  • An alcohol dependent drinker has psychological or physiologic dependence on alcohol. Dependence is characterized by preoccupation with drinking, craving for alcohol, tolerance to the effects of alcohol, and/or withdrawal symptoms.

University of Washington Medical Center
Women's Health Care Center

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