Alcohol Use in Women Needs More Attention From HCPs

Alcohol is often overlooked as a critical health issue for women, but the French National Authority for Health (HAS) aims to change this perception. HAS seeks to integrate alcohol consumption into routine health considerations for women at all life stages, and to support this initiative, it has published a series of documents intended for primary care clinicians. 

In an interview with Medscape’s French edition, Dr Marie-Olivia Chandesris, project manager at HAS, who led the drafting process, shared insights.

How are alcohol consumption patterns evolving among women?

Alcohol consumption trends are shifting, particularly among women. Binge drinking (consuming large amounts of alcohol in a short time) is increasing among women. Underage drinking and alcohol misuse among higher socioeconomic groups are growing concerns.

What are the situations that encourage alcohol use among women?

Women share general risk factors for alcohol use, but some, such as trauma (physical, psychologic, sexual, and gynaecologic and obstetric violence), are more common. 

A history of trauma, particularly in childhood, is associated with a higher risk for alcohol misuse, even if individuals do not always recognise this connection. 

Concerns about body image, somatic distress, and eating disorders, which are also more common in women, can contribute to alcohol consumption. In extreme cases, this manifests as alcoholorexia (restricting food intake to enhance alcohol absorption), which poses significant neurologic risks. Anxiety and mood disorders are key contributors to alcohol consumption.

What are the specificities of women’s alcohol exposure?

Women are more vulnerable to alcohol toxicity and experience faster and more severe effects from the same amount of alcohol. Their physiologic vulnerability is well documented, particularly in terms of liver toxicity. Gender-based discrimination worsens the psychosocial impact of alcohol consumption among women.

Alcohol is a known carcinogen linked to an increased risk for breast cancer, which is the most common cancer among women. Notably, one third of alcohol-related breast cancers arise from mild-to-moderate consumption, even within the "low-risk" guidelines.

However, alcohol-related mortality remains lower in women because they consume less alcohol than men. Of the 50,000 alcohol-related deaths that occur each year, two thirds occur in men.

How do gender inequalities manifest in healthcare management?

Women often face harsher judgment for drinking and may avoid seeking help due to fear of being misunderstood, misjudged, and stigmatised, such as being labelled as bad mothers.

Healthcare providers hesitate to discuss alcohol consumption with women, limiting information, delaying detection, and altering support compared with men.

While men are encouraged to reduce their consumption, women are expected to stop entirely.

Public health messaging on alcohol consumption among women primarily addresses pregnancy and breastfeeding, often overlooking the broader lifelong health risks. It is crucial to address women's health and quality of life beyond pregnancy.

What are women’s specific needs in terms of care

Although general identification and support principles apply to women, some aspects require special attention. These include ensuring privacy, maintaining confidentiality, and guaranteeing anonymity if needed. Support should consider their families and professional responsibilities. Alcohol Info Service, France’s remote support for alcohol and addiction treatment, offers accessible help without the need for appointments or time limits. 

Emotional and sexual health should also be addressed, with midwives and gynaecologists involved as needed. Finally, addressing their priority needs is crucial, particularly in preventing control, violence, and discrimination. 

What new elements do these documents bring to alcohol and perinatal health?

Despite extensive research on alcohol-related risks, other aspects of alcohol consumption remain unknown. Alcohol exposure risks begin before conception, affecting gametes, and persist throughout parenthood, influencing the child’s development.

These risks exist across all patterns of alcohol consumption, regardless of the quantity, frequency, or method. They also extend to paternal alcohol consumption, as the epigenetic toxicity of alcohol through sperm contributes to foetal alcohol spectrum disorders (FASD), including malformations, neurotoxicity, and growth retardation.

Alcohol toxicity impairs fertility by affecting sperm volume, motility, and viability. Additionally, from the initiation of conception, alcohol exposure affects the prognosis of pregnancy by promoting miscarriages, intrauterine growth retardation, and premature and foetal deaths.

Until now, the message has been "don't drink alcoholic beverages if you are pregnant." However, the risks during pregnancy begin not only once a woman knows she is pregnant but also from the moment of conception. The first weeks of pregnancy are critical in terms of embryogenesis, and therefore, teratogenic risks (sources of malformations) are present from this early stage.

Additionally, perinatal life involves not only the mother but also the parents and the entourage of the pregnant woman. Behavioural risks are significant, as the presence of alcohol use in the woman’s entourage can encourage her to consume alcohol and may promote situations of neglect or even violence toward her.

For whom are the documents published by the HAS intended?

These guidelines are for all frontline healthcare professionals who discuss alcohol consumption with women, particularly general practitioners, gynaecologists, and midwives. However, all professionals involved in women's health, including dietitians, nurses, and pharmacists, can address this issue and play a role in early detection through brief interventions. Discussing alcohol consumption in emergency departments is essential due to its frequent link to accidents, trauma, assaults, and violence. 

The resources developed by HAS include tools, sheets, guides, and summaries, providing a comprehensive set of tools to support risk reduction. Healthcare professionals should tailor their approach to ensure each patient receives appropriate support.

What are the main messages to be remembered?

The key message is that alcohol should be discussed routinely, like diet, exercise, smoking, or medication use. Regular discussions with patients, regardless of their circumstances, help to prevent stigma.

Currently, less than 20% of general practitioner consultations include alcohol screenings, despite patients’ expectations for such discussions. Many hesitate to bring it up due to fear of judgment, yet they recognise primary care professionals’ role in addressing it. Physicians should not wait for complications to arise, as harm may already be present. Early and regular information helps individuals assess their alcohol consumption and make informed choices with minimal disturbance to their lifestyles.

Raising awareness of the risks of alcohol consumption among women requires educating both women and society at large. Alcohol consumption is shaped by social, emotional, familial, and professional factors, requiring a comprehensive approach that considers all aspects of an individual’s life. This requires addressing broader issues, such as social isolation, economic instability, and exposure to violence, to build a supportive framework for reducing alcohol-related risks.

This article was translated from Medscape’s French edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.