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Elizabeth S. Ginsburg, MD; Nancy K. Mello, PhD; Jack H. Mendelson, MD; Robert L. Barbieri, MD; Siew Koon Teoh, MD; Micol Rothman; Xiaoying Gao, MD; J. Wallis Sholar

JAMA. 1996;276(21):1747-1751.

Abstract
Objective.
—To determine if moderate alcohol drinking increases circulating estradiol levels in postmenopausal women who are taking estrogen replacement.

Design.
—Randomized, double-blind, placebo-controlled crossover study of the effects of alcohol ingestion on plasma estradiol and estrone.

Setting.
—Inpatient Clinical Research Center.

Participants.
—Twelve healthy postmenopausal women receiving oral estrogen (estradiol, 1 mg/day) and progestin (medroxyprogesterone acetate) replacement therapy were compared with 12 postmenopausal women who were not using estrogen replacement therapy (ERT).

Intervention.
—Each group drank alcohol (0.7 g/kg) and an isoenergetic (isocaloric) placebo (randomized sequence) on consecutive days. Women who were taking ERT were studied during the estrogen-only portion of their replacement cycle, and estrogen was administered each evening at 2100 hours.

Main Outcome Measure.
—The impact of alcohol ingestion on plasma estradiol and estrone levels.

Results.
—Alcohol ingestion lead to a 3-fold increase in circulating estradiol in women on ERT; however, alcohol did not change estradiol significantly in control women who were not on ERT. In women using ERT, estradiol levels increased from 297 to 973 pmol/L (81 to 265 pg/mL) within 50 minutes (P<.001) during the ascending limb of the blood alcohol curve and remained significantly above baseline for 5 hours (P<.001). No significant increase in circulating estrone was detected in either group. However, estrone levels decreased after alcohol and placebo in women on ERT (P<.05). Blood alcohol levels did not differ significantly in women who used ERT and those who did not. Peak blood alcohol levels of 21 mmol/L were attained in each of the 2 groups within 50 to 60 minutes after drinking began. Changes in estradiol were significantly correlated with changes in blood alcohol levels on both the ascending (P<.001) and descending (P<.001) limb of the blood alcohol curve.

Conclusions.
—Acute alcohol ingestion may lead to significant and sustained elevations in circulating estradiol to levels 300% higher than those targeted in clinical use of ERT. Potential health risks and benefits of the interactions between acute alcohol ingestion and ERT should be further evaluated.

Author Affiliations
From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Drs Ginsburg, Barbieri, and Gao), and the Drug and Alcohol Abuse Research Center, McLean Hospital, Belmont, Mass (Drs Mello, Mendelson, and Teoh, and Messrs Rothman and Sholar).

Footnotes
Reprints: Elizabeth S. Ginsburg, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

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