Menopause, Alcohol and Alzheimer’s: The Brain Health Conversation Women Need to Have
My mom died from Alzheimer’s disease on February 9, 2025. To say this disease is horrific feels like an understatement. Two years before my mom died, her identical twin sister, my aunt, died from the same disease. Identical twins. Same disease. Very different experiences.
My mom became more childlike as Alzheimer’s progressed. My aunt became angry. Watching both of them lose pieces of themselves in completely different ways was heartbreaking, terrifying and impossible to witness without wondering:
Could this happen to me?
That question has gotten louder for me as I’ve entered perimenopause.
I don't pretend to be a doctor, researcher or menopause expert. I'm a daughter who watched her mother die from Alzheimer's. I'm a woman in perimenopause. I'm also someone who has been alcohol-free for nearly six years and has become increasingly fascinated by what happens to our bodies and brains during midlife.
The more I learn, the more I believe we need to start connecting some dots.
Two-thirds stopped me in my tracks
Almost two-thirds of Americans living with Alzheimer’s are women.
Read that again.
Nearly two-thirds.
According to the Alzheimer’s Association, of the 7.4 million Americans age 65 and older living with Alzheimer’s in 2026, approximately 4.5 million are women. Women in their 60s are also about twice as likely to develop Alzheimer’s during the remainder of their lives as they are to develop breast cancer.
We talk constantly about women protecting themselves from breast cancer. We get mammograms. We know our family histories. We talk about screening and prevention.
Where is that same urgency around our brains?
Researchers are still working to understand exactly why women are disproportionately affected by Alzheimer’s. Longevity explains some of it, but scientists are also looking at biological differences, genetics and what happens to the female brain during the menopausal transition.
This is where things started getting REALLY interesting to me.
Menopause isn't just happening to our reproductive system
I recently finished Dr. Mary Claire Haver’s The New Menopause. That book led me to Dr. Lisa Mosconi’s The XX Brain.
OMG. Read them both.
One of the biggest mindset shifts for me was realizing how incomplete our cultural conversation about menopause has been.
We tend to think ovaries, periods, hot flashes and reproductive health. Our hormones don't operate in some little isolated reproductive department of our bodies. Our brains have estrogen receptors, too.
Research funded by the National Institute on Aging has found changes in the brain's structure, connectivity and energy metabolism before, during and after the menopausal transition. Researchers are actively studying how menopause, sleep, vascular symptoms, hormones and other midlife factors may influence women's later brain health.
More than 850 million women worldwide are currently between ages 40 and 60, meaning an enormous number of us are in or approaching this transition.
That is not a niche women's health issue. That is a massive public health conversation.
For those of us with Alzheimer's in our families, it feels especially personal.
Our moms were given a very different menopause story
My mother's generation experienced menopause in an entirely different medical and cultural environment than we do.
Hormone therapy became surrounded by fear, particularly after early findings from the Women's Health Initiative were widely interpreted as showing increased health risks. For years, many women heard a much simpler message: hormones equal danger.
The science and medical conversation today are far more nuanced. Researchers now understand that age, timing, formulation, dosage and an individual's health history matter.
Current research is even examining whether the timing of menopausal hormone therapy could matter for Alzheimer's risk. This does not mean hormone therapy prevents Alzheimer’s. We simply know more today than we did when our mothers were navigating menopause, and researchers continue to learn more.
That distinction matters.
Hormone therapy is not an Alzheimer's prevention drug.
Menopause isn't irrelevant to our brains, either.
Then there is alcohol
Here's another dot I think we need to connect.
Guess which generation isn't exactly leading the sober revolution? Hello, Gen X.
While alcohol consumption has recently declined among younger American adults, adults ages 50 to 64 were the only age group whose drinking continued to increase in recent data. Researchers also found concerning increases in heavy drinking in this age group.
Who is sitting squarely in that demographic? Women going through menopause. Think about the cultural collision happening here.
We have women experiencing fluctuating hormones, disrupted sleep, anxiety, brain fog, hot flashes, changing bodies, aging parents, kids leaving home, career pressure and a thousand other midlife transitions.
We have normalized wine as the answer to virtually all of it.
Hard day? Wine.
Hot flash? Wine.
Kids driving you crazy? Wine.
Kids finally moved out? Definitely wine.
Girls' weekend? Wine.
Can't sleep? Have a glass before bed.
Except alcohol isn't actually helping us sleep. The National Institute on Aging notes that even small amounts of alcohol can make it harder to stay asleep.
Sleep matters to brain health.
Research specifically examining alcohol and menopause is still evolving. A 2026 review of 57 studies found that evidence around alcohol's effects on individual menopause symptoms isn't always consistent, but heavier alcohol consumption was associated with worse mood and cognitive complaints.
Then zoom out from menopause to long-term brain health.
The Lancet Commission on dementia has identified excessive alcohol consumption as a modifiable dementia risk factor, citing evidence connecting heavy drinking with brain changes, cognitive impairment and dementia.
Suddenly these conversations don't feel so separate.
Menopause. Sleep. Hormones. Alcohol. Cardiovascular health. Brain health. Alzheimer's.
Science hasn't tied them together in one neat little bow, but there is enough overlap that I want to pay attention.
Which brings me to an uncomfortable doctor's appointment
Last week, I had an experience with my OB-GYN that left me angry.
In addition to hormone replacement therapy, I chose to pursue testosterone treatment. Testosterone for menopausal women is not FDA-approved in the United States, and I knew that going into my decision.
My doctor disagreed with my choice.
That's okay.
I actually want doctors who will challenge me when they believe the evidence warrants it. I want questions. I want risks explained. I want someone to tell me what I may not know.
What I wasn't expecting was judgment.
When I told her about my decision, she put her head down on the table, sighed loudly and made it very clear she didn't agree.
I was stunned.
Then I got curious. I asked questions. I listened.
Underneath the curiosity? I was pissed.
I left that appointment still believing I had made the right decision for ME, based on the information I had, the conversations I'd had with medical professionals and my own assessment of risks and benefits.
Then I did something I almost never do. I filled out the patient survey. Yes, I made the phone call. I officially became: "Can I speak to the manager?"
This wasn't about getting someone in trouble. It was about the woman who comes after me.
Women deserve to ask questions about their bodies without being made to feel stupid, irresponsible or ashamed. A physician absolutely should tell us when they disagree with a treatment choice. Disagreement and humiliation are not the same thing.
Give me the science. Tell me the risks. Tell me what you would recommend and why.
Then allow me to participate in making decisions about my own body.
I want my memories
My reaction to all of this is probably stronger because I've seen what losing your memories actually looks like.
I've seen a mother stop being the mother I knew. I've watched two identical twin sisters travel different paths through the same devastating disease. I know my family history.
I can't control my genetics. I can't guarantee that being alcohol-free will prevent Alzheimer's. It won't. I can't guarantee that hormone therapy will protect my brain. Science doesn't support making that promise either.
There is no certainty. There is, however, information.
I can get curious. I can learn. I can ask better questions. I can protect my sleep, move my body and pay attention to cardiovascular health. I can reconsider substances that affect my brain. I can talk with knowledgeable medical professionals about menopause and hormones. I can understand my family history and keep paying attention as the science evolves.
That's what feels empowering to me about this conversation. Not fear.
Agency.
For generations, women have been taught to tolerate enormous changes in our bodies because they're "normal."
Brain fog. Can't sleep. Exhausted. Hot flashes. Mood changes.
Just suck it up. Maybe pour yourself a glass of wine.
No thanks.
I don't want women terrified that menopause means Alzheimer's. It doesn't. I don't want women reading this thinking hormone therapy guarantees protection. It doesn't. I certainly don't want someone thinking one glass of wine is going to give them dementia. That's not what the science says either.
I want us asking more questions.
When nearly two-thirds of Americans living with Alzheimer's are women, more than 850 million women worldwide are moving through the midlife window surrounding menopause, and the generation occupying much of that window is drinking at concerning rates, I think the conversation is worth having.
Especially while we still have the ability to make choices about what comes next.
I watched Alzheimer's take my mom's memories.
I'm going to do everything reasonably within my power to protect mine.
