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. Author manuscript; available in PMC: 2008 Jun 1.
Published in final edited form as: Fertil Steril. 2007 Feb 2;87(6):1483–1486. doi: 10.1016/j.fertnstert.2006.11.033

Current Alcohol Use, Hormone Levels, and Hot Flashes in Midlife Women

Chrissy Schilling a, Lisa Gallicchio b, Susan R Miller c, Patricia Langenberg d, Howard Zacur c, Jodi A Flaws a,d,e
PMCID: PMC1949018  NIHMSID: NIHMS25438  PMID: 17276432

Abstract

Current alcohol use is associated with a lower risk of hot flashes through a mechanism that does not include changes in sex steroid hormone levels.

Keywords: Alcohol, Hormones, SHBG, Hot Flashes, Menopause

The menopausal hot flash is described as a sensation of heat in the upper torso, neck, or face that is often followed by sweating or chills (1). For millions of women, this sensation of heat can be so disruptive that it negatively impacts their quality of life (1, 2). Thus, hot flashes are a major reason that women seek medical attention during the menopausal transition (3). Although this is an issue of public health concern, little is known about the factors that may precipitate hot flashes in certain women.

Several modifiable health factors have been examined in association with the risk of hot flashes. Body mass index (4-8), smoking (7-10) and alcohol use (4, 5, 11, 12) are some of the most commonly studied modifiable risk factors for hot flashes. Both body mass index (4-8) and smoking (7-10) have been consistently associated with an increased risk of experiencing hot flashes. In contrast, data regarding the effects of alcohol use on the risk of hot flashes have been equivocal. Studies in pre-menopausal and post-menopausal women have shown a higher risk of hot flashes with alcohol use (4, 11). Conversely, alcohol use has been associated with a lower risk of experiencing hot flashes in peri-menopausal women (5, 12).

The mechanism of the association between alcohol use and hot flashes is unknown. Some studies have shown that alcohol use alters sex steroid hormone levels (13-16), and sex steroid hormones have been shown to be associated with the risk of hot flashes (17). Previously, we showed that levels of estradiol, estrone, and testosterone were not significantly different between current alcohol users and never users of alcohol (12) and did not explain the observed decrease in the risk of hot flashes among current alcohol users compared to never users. Therefore, the purpose of this study was to examine other sex steroid hormone levels (progesterone, dehydroepiandrosterone-sulfate, androstenedione, sex hormone binding globulin) as well as the free estradiol index (FEI) and free testosterone index (FTI), their associations with alcohol use and hot flashes, and their potential as mediating variables.

Sample methods have been previously described in detail elsewhere (12). All participants in this study gave written informed consent according to the procedures and protocol approved by the University of Maryland School of Medicine and Johns Hopkins University Institutional Review Boards. All clinic visits were scheduled in the morning and participants had their blood drawn for hormone assays, were weighed, and had their height measured. Participants completed the study survey, which included questions regarding alcohol use and a detailed hot flash history. Based on responses to the questions, never users were defined as those women who had not consumed at least 12 alcoholic beverages in their entire life, former users those who had at least 12 alcoholic beverages in any one year, but not in the past 12 months, and current users as those who had consumed at least 12 alcoholic beverages in the previous 12 months.

Serum concentrations of sex hormone binding globulin (SHBG), estradiol, estrone, testosterone, androstenedione, progesterone, and dehydroepiandrosterone-sulfate (DHEA-S) were measured using enzyme-linked immunosorbent assays (ELISA). The assays were run using the manufacturers' instructions. To estimate the amount of estradiol unbound by SHBG (FEI), and therefore thought to be biologically active, a ratio of total estradiol to SHBG was calculated using a conversion factor to change pg/ml of estradiol to nmol/L: 100 × (total estradiol × 0.003671) / SHBG (18). The free testosterone index (FTI) was also estimated using a conversion factor to change ng/ml of testosterone to nmol/L: 100 × (total testosterone × 3.467) / SHBG (18). Other hormones measured do not bind appreciably to SHBG (19, 20); therefore free index calculations were not performed.

Geometric means of hormone levels were calculated using a general linear model with adjustment for age, smoking status, race, body mass index (BMI), and number of days since last menstrual period. Hormone variables, BMI, and number of days since last menstrual period were log-transformed because none were normally distributed. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated using a generalized linear model with log link and binomial error distribution (21) to assess the association between alcohol intake and the occurrence, severity, and frequency of hot flashes controlling for confounders. Risk ratios were adjusted for participant age and smoking status. Analyses were performed using SPSS Version 11.0 (Chicago, IL) and SAS Version 9.1 (Cary, NC). A p-value of less than 0.05 was considered to be statistically significant.

The levels of sex steroid hormones based on alcohol use categories are shown in Table 1. Never, former, and current users of alcohol had similar progesterone, DHEA-S, androstenedione, and FEI levels. Current users of alcohol, however, had higher SHBG levels and lower FTI levels compared to never users of alcohol. Previously, we showed that current and never users of alcohol had similar levels of estradiol, estrone, testosterone, estradiol/estrone ratio, and estradiol/testosterone ratio (12). In addition, when data were examined based on number of drinks per week, never users of alcohol, those who consumed ≤2 drinks per week, and those who consumed >2 drinks per week had similar progesterone, androstenedione, SHBG, FEI, and FTI levels (data not shown). Levels of DHEA-S, however, were significantly higher in women who consumed >2 drinks per week compared to women who never used alcohol (p=0.03).

Table 1. Association between current alcohol use and sex hormone levels.

n Geometric Mean* (95% CI) p-value
Progesterone (ng/ml)
Alcohol Use 0.8
 Never 35 0.70 (0.43, 1.14)
 Former 178 0.81 (0.65, 1.00)
 Current 410 0.81 (0.71, 0.94)
DHEA-S (ng/ml)
Alcohol Use 0.7
 Never 35 393.86 (323.76, 478.66)
 Former 178 366.87 (336.97, 399.02)
 Current 410 380.70 (359.96, 402.22)
Androstenedione (ng/ml)
Alcohol Use 0.5
 Never 35 1.96 (1.65, 2.32)
 Former 178 1.96 (1.82, 2.11)
 Current 410 2.06 (1.96, 2.16)
SHBG (nmol/L)
Alcohol Use 0.003
 Never 35 42.73 (35.73, 51.06)
 Former 178 55.92 (51.78, 60.40)
 Current 410 59.20 (56.26, 62.30)
Free Estradiol Index (FEI)
Alcohol Use 0.2
 Never 35 0.84 (0.61, 1.15)
 Former 178 0.64 (0.56, 0.74)
 Current 410 0.61 (0.55, 0.66)
Free Testosterone Index (FTI)
Alcohol Use 0.03
 Never 35 4.12 (3.11, 5.46)
 Former 178 2.82 (2.49, 3.18)
 Current 410 2.77 (2.56, 3.00)
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*

Adjusted for age, smoking status, race, BMI, and time since last menstrual period.

Risk ratios and 95% CIs were calculated for any, moderate to severe, and daily hot flashes. Consistent with our previous report (12), we saw a lower risk of hot flashes for women who currently use alcohol compared to women who never use alcohol. When any of the hormones or their indices (estradiol, testosterone, SHBG, FEI, FTI) were added individually to the adjusted RR model, however, the RR and 95% CI did not change appreciably (data not shown).

In this study, current users of alcohol had higher SHBG levels, lower FTI, and a lower risk of hot flashes compared to never users. Neither SHBG levels nor the FTI explained the association between alcohol use and hot flashes. Our results are similar to those of several studies that showed no association between alcohol consumption and progesterone (14, 22), androstenedione (16, 22), and FEI (22) levels. While our results are similar to studies showing no difference in DHEA-S levels between never users compared to current users of alcohol (14, 16, 23), we also observed higher DHEA-S levels in women who consumed >2 drinks per week compared to never users. These results agree with several studies that have shown higher DHEA-S levels with alcohol consumption (13, 22).

Conversely, our results differ from those of other studies that examined alcohol use and hormone levels. Further, previous studies of pre-menopausal women differ from our results and conflict with each other regarding androstenedione levels and alcohol use. In pre-menopausal women, Garcia-Closas et al. (14) reported higher androstenedione levels in alcohol users, but Sarkola et al. (23) showed lower androstenedione levels. In our study of midlife women, we saw no change in androstenedione levels with alcohol use. Previous studies have reported no change in SHBG (16, 22) or FTI (16, 22, 23) levels with alcohol use, although our study showed higher SHBG and lower FTI levels with alcohol use. The reasons for the differences between our findings and those of some other studies are unknown. Our study, however, was much larger than previous studies and would therefore have greater power to detect small differences in hormone levels.

Current alcohol use in this study was associated with a lower risk of hot flashes compared to never use of alcohol. This is consistent with a previous study showing a lower risk of hot flashes in peri-menopausal women (5), but contrary to studies in pre-menopausal (4) and post-menopausal (11) women that have shown a higher risk of hot flashes with alcohol use. Differences between studies may be due to smaller sample size, categorization of alcohol use, and populations studied.

Our data indicate that limited alcohol use may be associated with a lower risk of hot flashes in midlife women, although the association is not explained by changes in levels of sex steroid hormones. Therefore, it may be possible that alcohol use is associated with hot flashes through another mechanism. Previous studies indicate that alcohol consumption increases glucose levels in blood (24), and that women who had experimentally elevated glucose levels experience fewer hot flashes compared to being given only saline (25). Thus, women who consume alcohol may have higher blood glucose levels and therefore experience fewer hot flashes than women who do not consume alcohol.

The results of this study suggest that light, infrequent alcohol consumption may benefit some women experiencing hot flashes. Future studies should be conducted to confirm our findings and focus on the mechanism by which alcohol use could affect the risk of hot flashes.

Acknowledgments

Financial Support: This work was supported by NIH AG18400 and a grant from the Women's Health Research Group at the University of Maryland.

Footnotes

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