By Lydia Wang
The issue began in her early 30s: Jennifer, 38, noticed that she wasn’t sleeping well after drinking even a small amount of alcohol. She’d struggle with insomnia, or wake up too early. The next morning, “I’d feel really fatigued and out of it,” she recalls. “Not necessarily hungover, but just tired and overall not good.”
In her early 20s, she’d drink a ton of water before bed and then feel “totally normal” the next morning, but “that’s just not even close to the experience anymore,” Jennifer says. This is a big part of why now, at 38, she rarely drinks alcohol. And she’s not the only one.
Jill, 50, noticed a similar but “gradual” shift in the way she felt after drinking, which worsened in her late 40s. “Alcohol primarily affected my sleep — I would say that was the number one symptom that increased over those years,” she says. Then, about a year and a half ago, she “began to experience all of these perimenopausal symptoms, and alcohol seemed to exacerbate those a lot,” she explains. “Now, if I have a glass of red wine with dinner, I don’t feel good by the end of the meal, 80 percent of the time.”
For Ilana, 38, the change was as mental as it was physical. Like Jennifer and Jill, she started noticing extreme exhaustion after drinking around age 34; then, the next day, she’d feel intense anxiety. “For me, [it looked like] a frustrating mix of wanting to sleep and relax but being unable to. My mind races, while my body is completely drained,” she says. She still enjoys alcohol, but approaches it differently than she did in her 20s. Now, whenever she plans a night of drinking, she’s also sure to set aside the next day to rest and recover.
So why, exactly, does drinking feel so much worse as you get older? In short, it’s because our ability to metabolize alcohol declines over time.
Alcohol is primarily broken down by an enzyme called ADH (alcohol dehydrogenase), which is found in the liver and the stomach lining. That said, people assigned male at birth have much more ADH in their stomach lining, explains Kathleen T. Brady, MD, PhD, a board-certified psychiatrist and professor at the Medical University of South Carolina. “So, women — when they drink the same amount of alcohol as a man — sometimes have twice as high blood [alcohol] content because they don’t have that first initial metabolism in the GI tract,” Dr. Brady says.
Meanwhile, “As we age, the ability of the liver to function declines,” says Sherry McKee, PhD, a professor of psychiatry at the Yale Medical School. In other words, the alcohol you drink will stay in your bloodstream for a longer amount of time — which, research shows, can lead to increased or worsened side effects like hangovers and sleeping problems.
Also important to know: Alcohol is water-soluble, meaning it circulates in your body’s total water content, says Dr. Brady. In general, women have less body water than men. This is why, “even if a man and a woman are the same weight, a woman will achieve a higher concentration of alcohol in her bloodstream after drinking an equivalent amount of alcohol,” Dr. McKee explains.
As you age, your body’s total water content decreases, meaning a night of drinking will make your blood alcohol content higher than it would have been in your younger years, says Dr. Brady. If you find yourself suddenly feeling intoxicated after, say, just one drink, this could be the reason.
Going through menopause or perimenopause can impact the way alcohol is metabolized, too. “Estrogen also impacts how the body processes alcohol,” says Dr. Brady. “So when estrogen levels drop, metabolism slows down as well — and people may become intoxicated more quickly and feel the effects of alcohol more strongly.” It’s also common for certain menopause symptoms, like hot flashes and night sweats, to worsen after alcohol consumption.
Unfortunately, drinking as you get older doesn’t just make you feel bad the next day. Experts warn that it can also increase your risk of myriad health concerns, especially for women. “Alcohol has been linked to over 200 medical and disability conditions, and women experience exacerbated alcohol-related health risks, often after lower doses and after shorter durations of use,” says Dr. McKee. Excessive drinking can increase your risk of brain damage, cognitive and cardiovascular conditions, and certain cancers (particularly, breast cancer), she adds.
This doesn’t mean you have to cut out alcohol entirely, though. “Binge-drinking in particular is a drinking pattern identified with much more significant health risk. So, I would absolutely caution people from consuming alcohol excessively within a single episode,” says Dr. McKee. She notes that the current U.S. dietary guidelines recommend no more than one drink per day for women.
Dr. Brady also recommends drinking less in order to minimize your health risk, and staying hydrated. “For every ounce of alcohol that one drinks, you should plan on having at least 8 oz. of water,” she says. “Try to keep that ratio high.”
Women who have decided to cut back on drinking, though, have very few regrets. Hilary, 36, didn’t even notice how much her casual drinking was impacting her life until she embarked on her first Dry January in her late 20s. “I experienced clearer skin, an elevated mood, and better sleep,” she says. “Now I barely drink. If I have a drink or two, the next day, I am really lethargic, really slow — it’s not like my 20s, where I could bounce back, go to an early morning workout, and feel productive for the rest of the day, or brush it off with a large coffee.”
Jennifer has also only had “a handful of drinks” over the past few years. “To have the crummy sleep and [then] recovering the next day, even from one drink at dinner or one glass of wine — it just wasn’t worth it,” she says.
To find in-person or virtual alcohol support, visit the National Institute on Alcohol Abuse and Alcoholism’s treatment navigator.