Research shows that alcohol use and misuse among women are increasing. While alcohol misuse by anyone presents serious public health concerns, women who drink have a higher risk of certain alcohol-related problems compared to men. To make informed decisions about alcohol use, it is important that women be aware of these health risks and of the Dietary Guidelines for Americans, 2020–2025 for adult women of legal drinking age—they can choose not to drink or to drink in moderation by limiting intake to 1 drink or less in a day, when alcohol is consumed. Drinking less is better for health than drinking more. Some individuals should avoid alcohol completely, such as those who are pregnant or might be pregnant.

Why Do Women Face Higher Risks?

Studies show that women start to have alcohol-related problems sooner and at lower drinking levels than men and for multiple reasons. On average, women weigh less than men. Also, alcohol resides predominantly in body water, and pound for pound, women have less water in their bodies than men. This means that after a woman and a man of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration (BAC, the amount of alcohol in the blood) will tend to be higher, putting her at greater risk for harm. Other biological differences may contribute as well.

What Are the Long-Term Health Risks?

Alcohol Use Disorder

Alcohol use disorder (AUD) is a chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. (To be diagnosed with AUD, a person must meet certain diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

Liver Damage

Women who regularly misuse alcohol are more likely than men who drink the same amount to develop alcoholic hepatitis, a potentially fatal alcohol-related liver condition. This pattern of drinking can also lead to cirrhosis (permanent liver scarring).

Heart Disease

Long-term alcohol misuse is a leading cause of heart disease. Women are more susceptible to alcohol-related heart disease than men, even though they may consume less alcohol over their lifetime than men.

Brain Damage

Research suggests that alcohol misuse produces brain damage more quickly in women than in men. In addition, a growing body of evidence shows that alcohol can disrupt normal brain development during the adolescent years, and there may be differences in the impact of alcohol on the brains of teen girls and boys who drink. For example, in one study, teen girls who reported binge drinking, but not teen boys who reported binge drinking, showed less brain activity and worse performance on a memory test than peers who drank lightly or abstained. Similarly, teenage girls who drank heavily showed a greater reduction in the size of important brain areas involved in memory and decision-making than teenage boys who engaged in heavy drinking. Women also may be more susceptible than men to alcohol-related blackouts, which are gaps in a person’s memory for events that occurred while they were intoxicated. These gaps happen when a person drinks enough alcohol to temporarily block the transfer of memories from short-term to long-term storage—known as memory consolidation—in a brain area called the hippocampus.

Breast Cancer

There is an association between drinking alcohol and developing breast cancer. Studies demonstrate that women who consume about 1 drink per day have a 5 to 9 percent higher chance of developing breast cancer than women who do not drink at all. That risk increases for every additional drink they have per day.

Alcohol and Pregnancy

Any drinking during pregnancy can be harmful. Prenatal alcohol exposure can cause physical, cognitive, and behavioral problems in children, any of which can be components of fetal alcohol spectrum disorders (FASD). (See https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/fetal-alcohol-exposure for more information on fetal alcohol syndrome and FASD.) Drinking during pregnancy can also increase the risk for preterm labor.

Some women should avoid alcohol entirely, including:

• Anyone who is pregnant or trying to conceive
• Anyone younger than age 21
• Anyone who takes medications that can interact negatively with alcohol, such as sedative drugs, sleeping pills, pain relievers, and anti-anxiety medications

Drinking alcohol is a common activity in most cultures around the world, for both women and men. However, while drinking in moderation may be considered generally safe, alcohol abuse poses many risks to a woman's health. For example, although men are more likely to drink alcohol than are women, and men often drink more and more frequently, women are more vulnerable to some of alcohol's harmful effects. These effects are based on both gender- and sex-based factors, and they include differences in metabolism. In addition, alcohol use by women is also linked to many other physical and psychosocial health issues, such as unprotected sex, illicit drug use, and intimate partner violence. Here are some of the facts about women and alcohol use.

• Moderate, or low-risk, drinking for women is defined as no more than three drinks on any single day and no more than seven drinks per week.
• Low to moderate alcohol consumption in women, defined as fewer than three drinks per day, increases the risk of certain cancers, including breast cancer.
• After drinking similar amounts, women have higher blood levels of ethanol than do men, and women are more susceptible to alcoholic liver disease such as hepatitis.
• A woman's moderate alcohol intake may reduce her coronary heart disease risk, although details remain unclear.
• Research showed that female college-student drinkers exceeded NIH-defined guidelines for weekly drinking more frequently than did their male counterparts, which may have long-term consequences on drinking behavior in these women.
• The drug naltrexone is used to treat alcohol dependence, but it does not work for everyone. A small study showed that naltrexone worked better in women to reduce alcohol's positive subjective effects, suggesting it may be useful in therapy for alcohol dependence in women.
• Research with the model organism Drosophila (fruit flies) showed that female fruit flies are more prone to the sedative effects of alcohol than are male flies.
• No amount of drinking during pregnancy is safe. However, 20 to 30 percent of women drink at some time during pregnancy, which includes the period of time before a woman knows she is pregnant.

Alcoholism is also called alcohol use disorder. Alcohol use disorder is a medical diagnosis from a doctor. Alcohol use disorder is a condition in which a person cannot control how much alcohol she drinks. The condition also causes distress or harm in your life.

Alcohol use disorder is chronic, or lifelong, and it can get worse over time and be life threatening. It is a condition that happens in the brain.

No one factor can predict whether a woman will have trouble with alcohol. Women who are or have been abused are more likely to develop an alcohol use disorder.

• About 16 million people 21 or older in the United States have used alcohol heavily in the last month, including about 5 million women. For women, this means drinking 4 or more drinks at the same time, or within a couple hours, on 5 or more days in the last month.
• Alcohol use can start early in life. In one survey, more than 1 in 5 girls and teens ages 12 to 20 said they’d had a drink in the past month.
• Lesbians and bisexual women (especially young women) are at higher risk for drug abuse, heavy drinking, and binge drinking than other women are.
• Among women who drink, 13% have more than 7 drinks per week. According to a recent survey, binge drinking is also on the rise in older women. Drinking 4 or more drinks on any given day or drinking more than 7 drinks in a week raises a woman’s risk of developing alcohol use disorder.

Men are more likely than women to misuse alcohol and have alcohol use disorder, but women are more likely to experience harmful health effects from alcohol. Women absorb more alcohol pound for pound than men, and it takes longer for women’s bodies to digest alcohol.

Women who drink while pregnant also put their babies at risk for fetal alcohol spectrum disorder (FASD), which can cause serious problems for the baby during and after pregnancy. FASD can cause physical, mental, and behavioral disabilities. There is no amount of alcohol that has been proven safe to drink during pregnancy.

Women who misuse alcohol are more at risk of:

• Alcoholic liver disease. Women are more likely than men to develop liver inflammation (alcoholic hepatitis) and to die from cirrhosis (chronic liver disease).
• Brain disease. Alcoholism can cause diseases of the brain, such as dementia and memory loss, by changing how your cells work or by damaging brain cells.
• Cancer. Alcohol can cause several different types of cancer, including breast cancer. The more alcohol you drink, the higher your risk of a cancer caused by alcohol. Just one drink a day can increase your risk of breast cancer by 5% before menopause and 9% after menopause.
• Heart disease. Long-term, heavy drinking is a leading cause of heart disease.
• Osteoporosis. Long-term, heavy drinking, especially during adolescence or young adulthood, greatly weakens bones, increasing the risk of a broken bone later in life.

If you think you have a problem with alcohol, get help now.

Answering the following questions can help you find out whether you or someone close to you has a problem with drinking or drugs.

• Have you ever felt that you drink too much and should cut down?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink as soon as you woke up to steady your nerves or to get rid of a hangover?
• Have you ever used a drug for non-medical reasons?
• Has using drugs or alcohol created problems for you at home or at work?
• Does your family or friends complain about your drug or alcohol use?
• Have you gotten in fights or broken the law because you were on drugs or drunk?
• Do you continue to use drugs or alcohol even though you know it’s harmful?

One “yes” answer suggests a possible problem. If you responded yes to more than one question, it is very likely that you have a problem. Talk to a doctor, nurse, or mental health professional as soon as possible. You may need to talk to a psychiatrist, psychologist, or substance abuse counselor. Your doctor may also want to test your blood or urine to help design a treatment program for you.

If you can answer yes to at least two of the following questions, you may have an alcohol use disorder. The more questions you answer yes to, the more serious your alcohol use disorder may be.

In the past 12 months, have you:

• Ended up drinking more or longer than you meant to?
• Wanted to cut down on or stop drinking or tried to but found you couldn’t?
• Spent a lot of time drinking, being sick from drinking, or experiencing other side effects from drinking?
• Wanted to drink so badly you couldn’t think of anything else?
• Had trouble at home, work, or school because of drinking or being sick from drinking?
• Continued to drink even though it caused problems with friends or family?
• Cut back on activities or hobbies that you liked in order to spend time drinking?
• Gotten into a dangerous situation as a direct result of your drinking (such as driving while drunk or having unsafe sex)?
• Kept drinking despite feeling that it was making you depressed or anxious?
• Had a memory blackout?
• Had to drink a lot more to get the same effect?
• Found that when you weren’t drinking, you had withdrawal symptoms, like shakiness, trouble sleeping, or nausea?

If you can answer “yes” to at least two of these questions, talk to your doctor, nurse, or a mental health professional as soon as possible. You may have an alcohol use disorder.

It is possible to misuse alcohol but not have alcohol use disorder, such as by occasional binge drinking. Binge drinking is also harmful to your health. Alcohol use disorders can also be mild, moderate, or severe.

Treatment for an alcohol use disorder depends on how severe it is. Talk to your doctor or nurse about how much you drink. Your doctor or nurse can help find the ways alcohol negatively affects your life and can help you make a plan to stop.

Treatment for alcohol use disorder can include counseling, behavior therapy, and medicine. Some people may need to stay at a treatment center (including sleeping there). Many people also attend support groups, such as Alcoholics Anonymous, to talk to others and get support from people who have had similar problems in the past.

After treatment, some people stop drinking and stay sober. Others have periods of being sober but then start drinking again and may need treatment again. You can get better with treatment and support.