Alcohol and Hormone Replacement Therapy

Every year, doctors improve countless lives through hormone replacement therapy — HRT, for short. Over 20% of women will take estrogen and progesterone to combat the symptoms of menopause. Other people receive hormones as a form of gender-affirming care, a treatment program that alleviates gender dysphoria, depression, and anxiety.

While these medications make an incredible difference for people around the world, they’re still prescription-only drugs that can interact with other substances. Today we’ll discuss whether it’s safe to combine alcohol and HRT.

Types of Hormone Replacement Therapy

First, let’s consider the most common hormone-replacement drugs. As we mentioned, HRT has two popular applications: gender-affirming care and the resolution of menopause symptoms. The most prescribed hormones are estrogen (estradiol) and progesterone (progestin).

Estradiol (Estrogen)

Supplemental estradiol is available under the brand names Cenestin, Estrace, and Ogen. This estrogen derivative serves multiple functions in the reproductive system. In women, it causes egg cells to mature and release, while also creating the conditions that allow an egg to implant in the uterine lining. Because the ovaries produce estradiol, its supply wanes as women age. Men have estradiol, too; their supply facilitates brain function and bone health. A lack of estradiol is associated with acne, mood swings, osteoporosis, low sex drive, and depression.

Progestin (Progesterone)

Progesterone is a steroid hormone mimicked by synthetic progestin drugs like Provera. While they may have contraceptive benefits, many women take these medications in the event of menopause. Progesterone thickens the uterine lining and inhibits ovulation; additionally, it treats hot flashes, vaginal dryness, and other postmenopausal issues. In men, progesterone serves as a sort of proto-testosterone, offsetting the effects of estrogen. Signs of poor progesterone production include low sex drive, weight gain, fatigue, and bone loss.

HRT frequently combines estradiol and progesterone. When taking these drugs, we can expect side effects like anxiety, nausea, breast tenderness, itching, chills, weight gain, dizziness, confusion, headache, pelvic pain, abnormal vaginal discharge, and body aches. We should talk to our doctors about any concerns we have regarding these symptoms and what we can do to minimize our risk of negative outcomes.

What To Avoid During HRT

When beginning any medication regimen, we want to prioritize nutrition and physical activity. We also want to steer clear of substances that may cause unfavorable interactions. Here’s what to avoid during HRT.

• An unbalanced diet. Our dietary choices matter, especially when striving for optimal estrogen and progesterone levels. While no one meal plan reigns supreme, our medical team can recommend daily priorities that work for our needs. Most advise HRT program participants to focus on consuming fruits, vegetables, and whole grains while limiting processed foods and sugars.
• Grapefruit juice. Grapefruit is one of the most common causes of drug interactions. This humble citrus fruit inhibits the function of a liver enzyme responsible for breaking down many common medications. This inhibition increases the amount of medication in our blood — and that applies to progesterone and estrogen. Those elevated serum levels may place us at risk of heart attack, blood clots, or stroke.
• Caffeine. Caffeinated beverages wear away at our bones by increasing the rates of calcium expulsion in our urine. This is of special concern to those of us attempting to overcome osteoporosis, who should take a calcium supplement instead of drinking coffee, tea, or soda.
• A sedentary lifestyle. Regular, vigorous activity keeps us independent, mentally sharp, and physically fit. Sitting still hastens the onset of age-related symptoms like cognitive decline, recurring urinary tract infections, and neurological issues. (Postmenopausal ladies: be sure to follow your physician’s advice about hazardous exercises!)
• Carcinogens, including alcohol. HRT slightly elevates our chance of developing certain health problems, including breast and ovarian cancer. Alcohol, on the other hand, can make us many times more susceptible to these conditions.

Potential Interactions: Alcohol and HRT

HRT and alcohol rely on many of the same bodily functions. Both enter the body through the mouth if we’re prescribed an oral form, and both end up in the bloodstream whether we take the oral form or the injection form.

No matter which type of HRT we take, it must be metabolized by the liver. When this organ is busy filtering out alcohol, all its resources are occupied, reducing its ability to effectively process estrogen and progesterone. As a result, we face a heightened vulnerability to various cancers.

Progesterone and Alcohol

Moderate to heavy alcohol consumption may diminish natural progesterone production, even if we’re taking hormonal medication. Researchers attribute this phenomenon to decreased steroid catabolism — basically, the liver’s alcohol-induced inability to metabolize. Suffice it to say that progesterone and alcohol aren’t a good combo.

Estradiol and Alcohol

Drinking amplifies the body’s estrogen levels. This occurs because the liver is too busy breaking down alcohol to process supplements, which triples the amount of estrogen in the blood within 50 minutes. The body also begins converting testosterone into estrogen.

This all sounds like a good thing if we’re trying to boost our estrogen levels, doesn’t it? Estradiol and alcohol must be a useful mixture, right? Unfortunately, heightened levels of this hormone can quickly multiply our chance of disorders like breast cancer, especially after menopause.

Estrogen is responsible for the inception and advancement of breast cancer. A study of over 40,000 postmenopausal women found that concurrent exposure to hormone therapy and alcohol doubled the risk of this particular form of cancer. Fortunately, the researchers found that susceptibility dwindled after HRT concluded.

Is Drinking While Taking Hormones Dangerous?

Thanks to the liver-hampering effects outlined above, drinking while taking any medication can come with serious consequences. The same is true of HRT.

We recommend against consuming alcohol while taking hormones for the following reasons:

1. Drinking can reduce the potency of HRT, changing the body’s hormone levels and lessening hormone therapy’s therapeutic effects.

2. Combining any medication with alcohol may increase the severity of side effects like dizziness, increasing the likelihood of complications.

3. Drinking while on hormones places us at risk of liver problems, breast cancer, and other serious conditions.


The evidence backing this advice is pretty clear. But does alcohol interact with different hormones in different ways?

Can You Drink Alcohol While Taking Progesterone?

While it’s technically possible to drink on this hormone med, we’re better off abstaining. Alcohol decreases the body’s natural progesterone production, working against the medication we’re taking. On top of that, drinking blocks the liver from metabolizing the supplements we take.

Finally, alcohol and progesterone share side effects like drowsiness, meaning that mixing the two may lead to distressing symptoms. Before deciding to drink while taking progesterone, we should have a conversation with our primary care provider.



Can You Drink Alcohol While Taking Estradiol?

Whenever possible, we should try not to consume both alcohol and estradiol. As mentioned above, alcohol can amplify the side effects associated with estrogen. Even if these substances don’t produce strong interactions in the moment, continually combining them may increase our risk of cancer.

Can you drink alcohol while taking estradiol? The answer depends on our specific situation. The medical team overseeing our care can provide guidance about the dangers of drinking while taking this medication.



The Bottom Line: Can You Drink During Hormone Replacement Therapy?

Whenever possible, it’s best to entirely avoid drinking on HRT. Consuming even one to two units of alcohol per day can triple our risk of breast cancer. Drinking more than that quintuples the risk of this particular cancer in women.

If you really want to drink — maybe to celebrate a milestone or other special event — try to limit yourself to (at most) one unit of alcohol. Do your best not to exceed a single alcoholic beverage per day.

Disclaimer: Each person will have a different reaction to alcohol and HRT. Your medication regimen, drinking habits, and genetic makeup can all affect your risk of complications. When in doubt, consult your doctor before making a choice about whether or not to have a drink while taking this medication.

How Long After HRT Can You Drink?

In most cases, there isn’t a concrete recommendation for how long HRT lasts. That’s a decision we’ll make with our doctor based on our specific situation. For example, those of us going through menopause will usually wait until our symptoms conclude to stop taking estrogen and progesterone, which could take several years.

Those of us who have been prescribed hormones for gender-affirming care may also need to take them for years at a time, if not the rest of our lives. We’ll need to make a cessation plan with our providers. Once HRT has concluded, we can reintroduce alcohol into our daily life.

Change Your Drinking, Change Your Life

Whether we’re going through “The Change” or changing our gender expression, hormone replacement therapy can be a lifesaving intervention. Unfortunately, alcohol can undermine what we’re working toward. When taking HRT, we may want to avoid drinking but struggle with cutting back on our own. That’s where Reframe comes in.

If you feel it’s time to change your relationship with alcohol (and yourself!), Reframe is a support system in your pocket. By downloading this lightweight app, you gain access to science-based insights and 24/7 community conversations (as in forums filled with people just like you). No matter which stage of life you’re in, you can find understanding and accountability with fellow Reframers. To learn more, visit the App Store or Google Play.