PCOS and Alcohol: Do I need to stop drinking alcohol?

We often focus on how what we eat can impact PCOS but you might be wondering if you can drink alcohol when you have PCOS.

In this blog, I'll be exploring the ins and outs of alcohol when you have PCOS, along with some steps you can take to manage your PCOS while still enjoying your favourite tipple.

Understanding PCOS

PCOS is a hormonal condition that affects women of reproductive age. Symptoms of PCOS can vary from person to person, but can include: irregular or no periods, oily skin or acne, having more facial or body hair than is usual for you, loss of hair on your head, weight gain, and difficulty getting pregnant. Symptoms of PCOS can be improved by making changes to your diet and lifestyle.

The Effects of Alcohol on PCOS

Now, let's talk about alcohol. Like many of us, you might enjoy a nice glass of wine or a fun cocktail with friends at a BBQ or family gathering over the summer months, but it’s important to understand how alcohol can affect your PCOS symptoms.

Insulin Resistance

Many women with PCOS struggle with insulin resistance. Insulin is a hormone that helps to manage blood sugar levels. If you are insulin resistant, your body doesn’t respond to insulin as efficiently as it should when blood sugar levels are at a certain level. This means that blood sugar levels stay high for longer than we’d expect after eating (1).

Alcohol, especially in excess, can worsen insulin resistance, making it harder for your body to regulate blood sugar, causing blood sugar levels to rise rapidly. Alcohol can also interfere with your liver’s ability to produce glucose, leading to blood sugar levels dipping too low (2).

This unstable cycle of peaks and troughs in blood sugar levels can worsen your PCOS symptoms. To prevent this from happening, be mindful of sugary mixed drinks, sweet wines and beer, and avoid drinking on an empty stomach.

Mental Health

Depression and mood disorders are common in women with PCOS. Alcohol can affect or worsen symptoms of depression, including feelings of low mood and anxiety (3). Reducing your alcohol intake can help support your overall emotional well-being.

Sleep

Due to hormonal imbalances, it’s not uncommon for women with PCOS to have difficulties sleeping (4). Having an alcoholic drink might help you to fall asleep, however, alcohol can interfere with your sleep quality. Sleep disruptions and decreases in sleep quality are common after drinking, which can leave you feeling groggy and tired the next day. A cup of herbal tea, such as chamomile tea, or a warm milky drink before bed can be good alternatives.

Fertility

Research is mixed on whether or not alcohol affects fertility in women with PCOS. However, research has shown that women who drink five or more alcoholic drinks per week are more likely to experience fertility complications and it can take longer to conceive. Alcohol can affect ovulation and menstrual cycle regularity, as well as reproductive hormones, making it difficult to fall pregnant. Studies have found that there is “no safe dose” of alcohol regarding fertility The advice in the UK suggests avoiding alcohol if you’re actively trying to conceive (5, 6). This is to minimise the risk of alcohol being passed to the unborn baby.

Metformin and Alcohol

Metformin is often prescribed to women with PCOS to manage their insulin resistance. If you're taking this medication, it’s important to be aware of the risks associated with drinking alcohol and taking metformin.

Excessive alcohol intake while taking metformin can cause extremely low blood sugar levels (called hypoglycaemia) and a condition called lactic acidosis. Lactic acidosis is rare, but it can be serious. It occurs when there’s a build up of lactic acid which can damage your kidneys, lungs and heart. Due to these risks, the NHS (7,8) recommends drinking no more than 2 units of alcohol per day whilst taking metformin (see info on units below!).

So, do I need to stop drinking alcohol?

Not necessarily. If you have PCOS and enjoy having a drink, do so in moderation.

Here’s some tips below to help you drink safely.

Tips for Managing PCOS and Alcohol

• Moderation is key: The NHS recommend women to limit their intake to 14 units of alcohol a week, spread across 3 days or more. But what does a unit of alcohol look like? Check out the image below (9) for more information.

• Never drink on an empty stomach: Always try to eat before you start drinking. Have something to eat before you drink, to slow the absorption of alcohol into your bloodstream and minimise the effect on your blood sugar levels.

• Stay hydrated: Always have a glass or bottle of water with you or a jug of water on the table as well to make sure you stay hydrated, especially during the summer months.

• Smarter choices: Opt for drinks with lower sugar content to avoid spikes in blood sugar levels. Think vodka soda with a splash of lime or a mocktail instead of sugary cocktails.

• Space out: A ‘spacer’ is a non-alcoholic drink that you take between alcoholic ones; you space them out. By doing this, you can slow down your drinking. You’ll be surprised how good and refreshing a spacer can be between alcoholic drinks.
  

• Seek support: Let your friends and family know you are trying to cut down and that it's important to you, so they can support you in the best way.

Key Takeaways

Alcohol can affect your PCOS symptoms. However, that doesn’t mean that you have to cut it out completely. You can still enjoy a drink if you have PCOS, but drink in moderation. Avoid drinking on an empty stomach, stay hydrated, opt for lower sugar options, and if you’re taking medication or looking to conceive, consult with a healthcare professional for further advice, if required.

References

1. Tannus, S., et al. (2017). Effect of alcohol consumption on insulin sensitivity and glycemic control in women with polycystic ovary syndrome: A systematic review and meta-analysis. Diabetes Metabolic Syndrome and Obesity, 10, 269-275.

2. Husted, S., & Thorbjarnardottir, T. (2015). Alcohol and endocrine disorders: Focus on polycystic ovary syndrome. Alcohol Research: Current Reviews, 37(2), 107-115.

3. Gémes, K., et al., Moderate alcohol consumption and depression – a longitudinal population-based study in Sweden. Acta Psychiatrica Scandinavica, 2019. 139(6): p. 526-535.

4. Cowan, S. M., & Hart, R. (2017). Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. Human Reproduction Update, 23(2), 125-141.

5. Van Heertum, K., & Rossi, B. (2017). Alcohol and fertility: How much is too much? Fertility and Sterility, 108(3), 436-438.

6. Teede, H. J., et al. (2023). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 10, October 2023, Pages 2447–2469.

7. NHS (2022) Common questions about metformin, Available at: https://www.nhs.uk/medicines/metformin/common-questions-about-metformin (Accessed 01/07/24).

8. NHS (2021) Alcohol units. Available at: https://www.nhs.uk/live-well/alcohol-advice/calculating-alcohol-units/ (Accessed 01/07/24).

9. Drinkaware (2023) What is an alcohol unit? Available at: https://www.drinkaware.co.uk/facts/information-about-alcohol/alcoholic-drinks-and-units/what-is-an-alcohol-unit/ (Accessed 01/07/24).