Alcohol is a major part of the social grid. The alcohol industry, which supports $220 billion in sales annually, makes sure of it. This has led to a quandary as a physician: There are well-known and proven risks of drinking not only too much alcohol, but more recently consuming even moderate alcohol. In fact, the latest data show there is no safe amount of alcohol.

In medical school, I never learned about the specific harms of alcohol to women. Some of them we didn’t yet know, like the greater risk of breast cancer even at 3 servings per week. Some of them took years and better technology to identify, like the role of alcohol as a gut and brain toxin. Some of them we still don’t know because research on women and alcohol is sadly lacking.

Of course, alcohol isn’t just a problem for women. Heavy alcohol use among Americans has been rising dramatically in recent years. The Centers for Disease Control just released a report documenting in a survey of 400,000 Americans that 37 million of us binge drink, which is nearly 20%of the adult population. Every year, 88,000 people die from alcohol-related problems, half from binge drinking. You don’t have to be dependent on alcohol to binge drink; it’s defined as a blood alcohol concentration (BAC) to 0.08 grams percent or above, typically from a man consuming five drinks or more in two hours, or a woman consuming 4 drinks or more.

Drinking alcohol—even at “normal” levels—can be risky for women, much riskier than for men. There are many scientific reasons. First, women metabolize alcohol less effectively than men—we have slower rates of eliminating alcohol from the body and lower volumes of total body water. So, for the same amount of intake, women have higher blood alcohol levels compared with men.

Second, among people who develop alcohol use disorders, women progress more quickly from initial use to abuse than men, a phenomenon called “telescoping.” Women with a history of childhood maltreatment are at particular risk for telescoping, far higher than seen in men. On the other hand, lack of data on women result in mixed data. Third, women make estrogens, a master switch in the female body. Estrogen creates breasts and hips but it’s also a growth factor that can turn on inflammation and abnormal growth, causing breast cancer, endometrial cancer, diabetes, fibroids, and endometriosis. Beer, wine, and bourbon are all phytoestrogens that can raise a woman’s estrogen load regardless of age, putting her at risk of estrogen-sensitive conditions like those mentioned. Third, as you get older, metabolism slows down further. What you could tolerate in your twenties you may no longer tolerate without health consequences in your thirties or older.

For decades, public health officials have said a one or two drinks per day are good for you, but the narrative on the health risks of moderate drinking have shifted dramatically in the past year based on new data. This article is about the top 10 ways alcohol harms women that you need to know before you take your next drink.

1. Shorter Lifespan

Modest levels of alcohol that were previously thought to be harmless are now linked to an earlier death in a rigorous new meta-analysis of 600,000 people—in fact, after age 40, every extra drink can rob you of 30 minutes of lifespan.

Over time, that adds up.

2. Infertility

About 20 percent of American women have difficulty becoming pregnant, and alcohol increases the risk of “ovulatory factor,” in which the root cause is related to the release of an unfertilized egg by the ovary each cycle. There’s a 30%increased risk of ovulatory factor in moderate drinkers, and a 60% increased risk in heavier drinkers, compared with non-drinkers.

Yet little attention has been paid to the role of alcohol in reproductive health. Animal studies show smaller ovaries and loss of period in rats or monkeys administered alcohol. Women with alcohol use disorder have higher rates of menstrual irregularity, miscarriage, and gynecologic surgery compared with controls.

Even one glass of wine a day increases breast cancer risk by 11 percent.

3. Leaky Gut

Known in medical lingo as “increased intestinal permeability,” leaky junctions between cells of the gut lining are associated with several problems, including an increase in foreign compounds entering the bloodstream and overly sensitive immune system. Alcohol pokes holes in the gut wall in a dose- and time-dependent manner.

4. Endometriosis

In a review of 15 studies, the risk of endometriosis—a painful condition affecting 6%of women—was increased 24% in drinkers versus non-drinkers.

The good news is that current drinkers had a 42%increased risk of endometriosis, compared with no increased risk in former drinkers. This has been known for 25 years—one of the early reports was published in 1994 showing a 50% to 60% increased risk of endometriosis among drinkers compared to controls.

5. Fibroids

Researchers in the majority of studies show that alcohol increases the risk of uterine fibroids, probably because alcohol raises the body’s level of two estrogens, estrone and estradiol. This is particularly pertinent to Black women who are already 3 times more likely than white women to develop fibroids, and typically at a younger age. 

6. Liver Damage

We all know that alcohol can disrupt the function of the liver. Over time, excess alcohol causes cirrhosis and life-threatening liver failure that may require a transplant.

Women with alcohol use disorder have higher rates of menstrual irregularity, miscarriage, and gynecologic surgery compared with controls.

7. Breast Cancer

Even one glass of wine a day increases breast cancer risk by 11 percent. Yikes!

In a landmark study published in the Journal of the American Medical Association, researchers found that drinking more than three alcoholic servings per week increases risk of breast cancer. Newer data show that younger women with a family history of breast cancer are at significantly higher risk. Alcohol increases the risk of other cancers: mouth, throat, esophageal, liver, and colorectal. That makes alcohol a known carcinogen, even though it’s the thing we reach for in order to chill out. The dangers of alcohol deserve your fresh-eyed attention. Know what’s better? Broccoli. Components in broccoli like sulphorophanes change the expression of your genes to help balance your sex hormones, reducing breast and other cancers.

8. Brain Atrophy and Dementia

In chronic alcohol use, the brain shrinks faster in women compared with men. The parts of the brain that shrink the most are the cingulate gyrus (part of the limbic system—involved in emotion formation, processing, and motivation) and insula (involved in homeostasis or balance, and also emotion, including compassion, empathy, perception, self-awareness, some cognition and motor control, and interpersonal experience).

Fortunately, sobriety helps you regain lost brain volume. Unfortunately, temporary sobriety and relapse yields no benefit. Overall, researchers have found that people who don’t drink at all and people who drink more than two servings per day have an increased risk of developing dementia.

Addiction isn’t just in the head—it’s in the head and gut, which means healing the brain/body connection is essential to healing addiction.

9. Stroke

Alcohol increases the risk of stroke, according to a meta-analysis of 27 prospective studies.

10. Microbiome

About 40%of people with alcohol use disorder have leaky gut (increased intestinal permeability), imbalanced gut microbes (dysbiosis), or altered metabolomics (changes in microbial metabolism). Dysbiosis (imbalanced gut microbiota) correlates with the craving, depression, and anxiety associated with alcohol use disorder, though it’s not yet clear if the disordered gut ecology is a cause or effect of drinking.

Taken further, the gut ecosystem is involved in not just the genesis of addiction, but downstream issues like altered physiology, thought, and social functioning. So, addiction isn’t just in the head—it’s in the head and gut, which means healing the brain/body connection is essential to healing addiction. Accordingly, we need to target the population, diversity, and function of your microbiota as part of treating the whole person with addiction.

Where to Go from Here

There are many harms associated with alcohol consumption that I haven’t listed—the lapses in judgment, the increased risk of injury, the downstream risks of anxiety, depression, and addiction. Of course, alcohol can cause health problems not only for the person who consumes, but also their family, friends, coworkers, and employers. Current scientific evidence is leading to revisions of the guidelines that previously encouraged moderate consumption, now known to be associated with greater risks for breast cancer and shorter life.

The questions I was taught to ask in medical school include the following:

  • Have you ever felt you needed to cut down on your drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt guilty about drinking?
  • Have you ever felt you needed to drink first thing in the morning to steady your nerves or get rid of a hangover?
  • Or this one, more from a research perspective: How much alcohol consumption is too much for you?

I no longer like or use these questions in my medical practice. Instead, I prefer Holly Glenn Whitaker’s question: Is alcohol getting in the way of my life—my best life—and how much longer am I willing to put up with that?