Alcohol use and misuse among women is increasing, and this trend is concerning because women are more susceptible to the negative consequences of alcohol consumption than men.

While men are still more likely to die from alcohol-related diseases, the gender gap is narrowing. Women now raise their glass almost as frequently as men: 49 per cent of women drink alcohol versus 55 per cent of men.

In the USA, excessive alcohol use is associated with more than 43,000 yearly deaths among women, and poses unique health and safety risks to them.

This rising negative health toll is mostly noted in middle and senior-aged women.

Why are women more susceptible to alcohol-related adverse health effects than men?

1, Biological differences

Although men are more likely to drink alcohol and consume larger amounts, women have biological differences in body structure and chemistry that make them more susceptible to the negative effects of alcohol

• They tend to have less water in their bodies than men who weigh comparably, which causes higher concentrations of alcohol in the blood

•Women's bodies metabolise alcohol slower than men's, leading to a longer exposure to its toxic by-products

• While oestrogen has been shown to have some protective effect against alcohol, especially on the liver, the decline in oestrogen levels during and after menopause may contribute to the increased risk of alcohol-related diseases in older women

2, Underlying health conditions

There are conditions that are more present in women than in men such as obesity and genetic predisposition perhaps, that can exacerbate alcohol-associated diseases like heart muscle weakness and liver fatty infiltration that are detailed below.

3, Changing drinking patterns

There is an increase in the number of women who consume alcohol regularly and engage in heavy drinking. The reasons for that are multifactorial:

•Anxiety and depression are increasing among adult women, leading to more women resorting to alcohol to escape mental stressors. However, studies have shown that in the long run, alcohol use exacerbates mood disorders and insomnia

• Increased economic independence from men, especially in developing countries, making access to alcohol easier

•Peer pressure and social influence

· Marketing and advertising targeting women

What are the negative health effects of alcohol on women?

1, Liver disease

Women are at greater risk of developing alcohol-associated liver diseases such as alcoholic hepatitis and cirrhosis than men.

2, Heart problems

Damage to the heart muscle (cardiomyopathy), coronary disease and high blood pressure can occur more often and faster, even if women consume less alcohol than men and for a shorter period of time.

Prior reports had showed a U or J-shaped relationship of alcohol and heart disease in women, where one to two standard drinks per day are associated with a lower risk of heart conditions, and more than two drinks become problematic.

Recent reports and recommendations by multiple heart societies have refuted these findings as newer evidence shows a “linear”, or proportional relationship between alcohol and cardiac illnesses, regardless of the level of alcohol consumed.

With that, the guidelines have changed to deter women, and men to that effect, from alcohol consumption if they have not started yet, and if they have already done so, to limit alcohol use to the minimum amount possible.

3, Infertility

Chronic use of alcohol may lead to irregular menstrual cycles and ovulation patterns, reduce fertility, and lead to an earlier onset of menopause.

4, Cancer

Alcohol is classified as a Group 1 human carcinogen by the International Agency for Research on Cancer (IARC). More than 10 per cent of alcohol-attributable cancer cases arise from drinking just one 500ml bottle of beer or two 200ml glasses of wine per day.

Alcohol increases the risk of cancers of the mouth, throat, oesophagus, liver and colon. In particular, drinking alcohol in women is associated with a rising trend in breast cancer. Several mechanisms contribute to this association:

•Hormonal imbalances as mentioned above

•Weight gain: Alcohol is empty calories and can lead to unwanted weight gain. Excess fat can contribute to increased cancer risk, including breast cancer

• Folic acid levels: Alcohol users are more likely to have increased amounts of folic acid in their system which can lead to increased cancer risk

5, Brain and cognitive function

Alcohol-related cognitive decline and shrinkage of the brain develop more quickly for women than for men, leading to more delirium and dementia. Drinking more than 14 standard alcoholic beverages per week has been associated with a higher risk of dementia in older adults, including women.

6, Motorised vehicle accidents

These are on the rise in women who drink alcohol and drive.

In conclusion, the rising alcohol use in women is a concerning trend that has negative health tolls in this population. Women are more susceptible to the long-term negative health effects of alcohol compared with men, and excessive alcohol use poses unique health and safety risks to females. It is important for women to be aware of these health risks and to drink responsibly.

• Joe Yammine, MD is a consultant cardiologist at the Bermuda Hospitals Board. The information here is not intended as medical advice or as a substitute for professional medical opinion. Always seek the advice of your physician