Alcohol and Women's Health

Because of their size, body type, and the way their bodies process alcohol, women are:

• more quickly effected by alcohol than men are, and
• more vulnerable to both the acute and chronic effects of alcohol misuse.

Research shows that for women:

• Drinking up to an average of 2 standards drinks per day holds little risk of premature death.
• Drinking 4-5 standard drinks per day increases the risk of death by up to 40% higher than that of non-drinkers.
• The greater the amount of alcohol consumed, the higher the risk.
• Extreme dieting and thinness increase the risk of effects from alcohol.
• Maximum health benefits for the heart can be gained from less than 1 standard drink a day, for women aged 45-50 years of age and older.
• Approximately 2% of female deaths are alcohol-related, with the main cause of such deaths being stroke, followed by alcoholic liver cirrhosis, road injury, breast cancer and alcohol dependence.
• Other health concerns include those related to alcohol and violence, and to alcohol and pregnancy (in terms of possible effects on the unborn child).

Women are more vulnerable to the effects of alcohol than men are because:

• Alcohol, when it is absorbed, is distributed throughout the body's total water content, and since women, on average, have smaller bodies than men, a given amount of alcohol is distributed over a smaller body volume.
• Women have a higher proportion of body fat, and alcohol is not taken up by fatty tissues.
• The ability to break down alcohol is limited by the size of the liver, and women on average have smaller livers than men.
• The culture of "thinness" and dieting that particularly affects young women, also places them at increased risk of the effects of alcohol. Dieting leads to an excessive loss of body fluid, so that a given quantity of alcohol in a person who is dieting leads to an even higher concentration of alcohol within the body than for the average-sized person.

The risks to women's health therefore start at lower amounts of alcohol:

• The amount of alcohol consumption linked with premature deaths is lower for women than for men. For women the risk of death starts to increase at above 2 drinks a day, while for men it starts at above 4 drinks a day. The top 2 causes of alcohol-related deaths for women are stroke and fall injuries.
• Women's smaller liver size means that at lower levels of drinking, they are vulnerable to liver damage and cirrhosis, as well as to the risk of death from alcoholic liver cirrhosis.
• For a given amount of alcohol, there is a higher concentration of alcohol in a woman's body, leading to a greater degree of intoxication, and this has serious implications in terms of safety.

Other alcohol-related health issues of concern to women:

• Alcohol increases women's risk of breast cancer, and the risk rises with the level of alcohol consumed. While more research is needed to explain the links, it has been found that compared with women who drink little or no alcohol, the risk of breast cancer is 35% higher in women who drink 3-4 standard drinks per day, and 67% with more than 4 standard drinks per day.
• The alcohol in the blood stream of a pregnant woman enters that of her unborn child, and, in sufficient quantities, this can cause problems for the unborn child. The first few weeks after conception are the most vulnerable period.

Alcohol is involved, in varying ways, in about 50% of cases of domestic physical and sexual violence.

To minimise risks in the short and longer term, and gain any longer-term benefits, the alcohol drinking guidelines for women have been set by the NHMRC at:

• an average of no more than 2 standard drinks a day, and no more than 14 standard drinks over a week;
• not more than 4 standard drinks in any one day;
• one or two alcohol-free days per week.

Women should note, too, that:

These drinks should be spread over several hours, and consumed at a moderate rate of no more than 1 drink per hour, to minimise intoxication.
The levels set in these guidelines may be too high for women of below-average body size; and those who may be on medication, pregnant, or driving.
Alcohol can help to prevent heart disease from about 45-50 years of age for females, but the maximum benefit can be gained by a low level of drinking, of less than one standard drink per day for women. However, alcohol is not necessary to achieve this health benefit, as it can be obtained by using other strategies, preferably in combination, such as stopping smoking, increasing exercise, improving diet, and taking small quantities of aspirin.

Adapted from:
Australian Department of Health and Ageing, Australian Alcohol Guidelines Fact Sheets www.alcoholguidelines.gov.au

Principal source:
National Health and Medical Research Council (NHMRC) (2001). Australian Alcohol Guidelines: Health Risks and Benefits. NHMRC, Canberra.

Additional sources:
Alcohol in Australia: Issues and Strategies. (2001) Commonwealth Department of Health and Aged Care, Canberra.

Chikritzhs T, Jonas H, Heale P, Dietze P, Hanlin K and Stockwell T (1999). Alcohol-caused deaths and hospitalisations in Australia, 1990-1997. National Alcohol Indicators Bulletin No. 1, December.

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