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The Menopause Exchange Blog

SMOKING AND ALCOHOL AT THE MENOPAUSE

One of the most important things you can do at this time of life is to make sure you’re as healthy as you can be. Women, on average, live a third of their life in the post-menopausal phase, so this is a good time to re-evaluate your health and try to improve it.

This article was included in issue 79 (winter 2018/2019) of The Menopause Exchange newsletter.

Women are subjected to many health messages, especially through the media. They may not realise that two of the most published ones (stopping smoking and reducing their alcohol intake) will, and can, have an impact on their general health and experience of the menopause. This, in turn, can affect their physical health, mood and cognitive function (such as memory, decision making, language, problem solving and concentration).

Smoking risks
Women who smoke can have an earlier menopause than women who don’t smoke, often by around two years. It’s been shown that menopausal women who smoke have worse hot flushes and night sweats than non-smokers, and smoking has also been linked to an increase in premenstrual syndrome (PMS) symptoms.

Smoking is identified as one of nine cardiovascular disease risk factors that you can change. By stopping smoking, you can decrease your risk of cardiovascular disease by 90%. The other risk factors are high blood pressure, an increase in blood lipids (cholesterol), diabetes, weight gain, decreased exercise, increase in alcohol intake, decreased fruit and vegetable intake and stress/social factors. Weight gain, decreased exercise and increased alcohol intake also have a part to play in the onset and severity of menopausal symptoms, so this may be an incentive to try to do something about them.

Smoking is linked to many other health risks. It increases the risk of heart disease, heart attacks, strokes and lung cancer and all forms of lung disease, especially chronic obstructive pulmonary disease (COPD). Smoking has been linked with other cancers, e.g. those of the mouth and throat, oesophagus, bladder, bowel, cervix and stomach.

Reduced oestrogen at the menopause increases the risk of low bone density and osteoporosis (thinning bones). This risk can be increased by smoking, alcohol, less exercise and poor diet. Stopping smoking and cutting back on alcohol may preserve your bone strength.

Research shows that smoking is ‘anti oestrogen’, which is why it’s linked with osteoporosis. For this reason, smoking can have far-reaching, long-term effects, with research suggesting that a person’s bone formation may be affected if their mother smoked.

Smokers are also at risk of developing a cough or chest diseases. This can affect pelvic floor muscles (which may already have been weakened by ageing and the menopause), leading to a risk of stress incontinence (bladder weakness).

Quitting smoking
If you want to stop smoking, speak to a healthcare professional. They can put you in touch with your local stop smoking service. You’ll be able to try smoking cessation medicines (available on prescription and over the counter from pharmacies), as well as get some expert lifestyle advice and tips.

Some self-help tips include:

  • write down a list of reasons to quit
  •  set a date and stick to it
  •  identify anything that makes you crave a cigarette (such as a party or stress)
  •  keep your hands and mouth busy.

Using NHS local stop smoking clinics can mean you’re four times more likely to stop smoking and stay off the cigarettes for good. The free NHS Smokefree national helpline number is 0300 123 1044 (Monday to Friday 9am to 8pm and Saturday and Sunday 11am to 4pm).

Alcohol risks
Alcohol can affect your menopausal symptoms in the same way that smoking can, increasing your hot flushes. Some women find that not all alcohol affects them in this way, but the effects may be more pronounced with red wine. Women who drink alcohol may have an earlier menopause than non-drinkers.

Drinking habits can change when women reach the menopause. Some women drink more alcohol, or drink more regularly, which can lead to disturbed sleep, empty calories (calories that don’t contain nutrients) and a lower metabolism of alcohol. This can mean weight gain at a time when women find it more difficult to lose weight. Two small glasses of wine are equal to one burger or over 300 calories. In addition, if you’re drinking alcohol, you may be unsteady and more prone to falls, which isn’t good for your bones.

Women who are prone to migraines may find that these increase in the perimenopausal period, and alcohol can have an impact on them as well. Some studies suggest that drinking alcohol in moderation can protect the heart, but this needs to be balanced with the increased risk in breast cancer (and an increase in cancers of the mouth, oesophagus and liver as well). Alcohol may increase circulating oestrogen, which may explain why it increases breast cancer risk.

Drinking alcohol can cause interstitial cystitis at a time when women may already have bladder issues and, as with smoking, may increase PMS-like symptoms. It can also make anxiety worse, especially if women aren’t sleeping well. Some women may drink alcohol to combat anxiety, yet this can make anxiety worse. Alcohol (especially heavy drinking) has been linked to other health issues such as pancreatitis, bowel, breast, liver, pancreas, larynx, mouth and oseophageal cancers. liver disease, diabetes and heart disease.

Lowering your alcohol intake
Women (and men) should drink no more than 14 units of alcohol a week. These should be spread out to make sure you have several alcohol-free days. A single pub measure of spirits contains one unit, as does one 50ml glass of sherry. A standard 175ml glass of wine contains 2.3 units. A half-pint of normal strength lager, cider or beer contains 1.1 units, but some beers and ciders are stronger than this. Drinkaware (www.drinkaware.co.uk) has a drinking tracker and other tools to see if you’re drinking too much, as well as facts, advice and tips on reducing your alcohol intake and making better choices about drinking.

About the author
Debby Holloway is a nurse consultant specialising in gynaecology at the Guys and St Thomas NHS Foundation Trust.

Created Winter 2018/2019

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