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December 4, 1996, Vol 276, No. 21 >
ARTICLE | December 4, 1996

Effects of Alcohol Ingestion on Estrogens in Postmenopausal Women FREE

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
[+] Author Affiliations

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


JAMA. 1996;276(21):1747-1751. doi:10.1001/jama.1996.03540210055034
Text Size: A A A
Published online
Article
References

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.

REFERENCES

1 +
US Dept of Commerce, Bureau of the Census. Population projections of the United States by age, sex, race and hispanic origin 1993-2050. In: Current Population Reports, Series P-25, No. 1104. Washington, DC: US Government Printing Office; July 1995.
2 +
Wysowski DK, Golden L, Burke L.  Use of menopausal estrogens and medroxyprogesterone in the United States, 1982-1992 . Obstet Gynecol . 1995;;85:6-10.
3 +
Felson DT, Zhang Y, Hannan MT, et al.  The effect of postmenopausal estrogen therapy on bone density in elderly women . N Engl J Med . 1993;;329:1141-1146.
4 +
Genant RK, Baylink DJ, Gallagher JC, et al.  Effect of estrone sulfate on postmenopausal bone loss . Obstet Gynecol . 1990;;76:579-584.
5 +
Cauley JA, Seeley DG, Ensrud K, et al.  Estrogen replacement therapy and fractures in older women . Ann Intern Med . 1995;;122:9-16.
6 +
Lindsay R, Tohme JF.  Estrogen treatment of patients with established postmenopausal osteoporosis . Obstet Gynecol . 1990;;76:290-295.
7 +
Henderson BE, Ross RK, Paganini-Hill A, Mack TM.  Estrogen use and cardiovascular disease . Am J Obstet Gynecol . 1986;;154:1181-1186.
8 +
Henderson BE, Paganini-Hill A, Ross RK.  Decreased mortality in users of estrogen replacement therapy . Arch Intern Med . 1991;;151:75-78.
9 +
Stampfer MJ, Colditz GA, Willett WC, et al.  Postmenopausal estrogen therapy and cardiovascular disease . N Engl J Med . 1991;;325:756-762.
10 +
Nabulsi A, Folsom AR, White A, et al, the Atherosclerosis Risk in Communities Study Investigators.  Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women . N Engl J Med . 1993;;328:1069-1075.
11 +
Boston Collaborative Drug Surveillance Program.  Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy . N Engl J Med . 1974;;290:15-19.
12 +
Colditz GA, Hankinson SE, Hunter DJ, et al.  The use of estrogens and progestins and the risk of breast cancer in postmenopausal women . N Engl J Med . 1995;;332:1589-1593.
13 +
Bergkvist L, Adami H-O, Persson I, et al.  The risk of breast cancer after estrogen and estrogenprogestin replacement . N Engl J Med . 1989;;321:293-297.
14 +
Colditz GA, Stampfer MJ, Willett WC, et al.  Prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women . JAMA . 1990;;264:2648-2653.
15 +
Brinton LA, Hoover R, Fraumeni JF Jr.  Menopausal oestrogens and breast cancer risk . Br J Cancer . 1986;;54:825-832.
16 +
Steinberg KK, Thacker SB, Smith SJ, et al.  A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer . JAMA . 1991;;265:1985-1990.
17 +
Stampfer MJ, Colditz GA, Willett WC, et al.  A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women . N Engl J Med . 1988;;319:267-273.
18 +
Criqui MH, Ringel BL.  Does diet or alcohol explain the French paradox? Lancet . 1994;;344:1719-1723.
19 +
Longnecker MP, Berlin JA, Orza MJ, Chalmers TC.  A meta-analysis of alcohol consumption in relation to risk of breast cancer . JAMA . 1988;;260:652-656.
20 +
Willett WC, Stampfer MJ, Colditz GA, et al.  Moderate alcohol consumption and the risk of breast cancer . N Engl J Med . 1987;;316:1174-1180.
21 +
Longnecker MP, Newcomb PA, Mittendorf R, et al.  Risk of breast cancer in relation to lifetime alcohol consumption . J Natl Cancer Inst . 1995;;87:923-929.
22 +
Longnecker MP.  Do hormones link alcohol with breast cancer? J Natl Cancer Inst . 1993;;85:692-693.
23 +
Gapstur SM, Potter JD, Sellers TA, Folsom AR.  Increased risk of breast cancer with alcohol consumption in postmenopausal women . Am J Epidemiol . 1992;;136:1221-1231.
24 +
Mendelson JH, Lukas SE, Mello NK, et al.  Acute alcohol effects on plasma estradiol levels in women . Psychopharmacology . 1988;;94:464-467.
25 +
Ginsburg ES, Walsh BW, Gao X, et al.  The effects of acute ethanol ingestion on estrogen levels in postmenopausal women using transdermal estradiol . J Soc Gynecol Invest . 1995;;2:26-29.
26 +
Gavaler JS, Deal SR, Van Thiel DH, et al.  Alcohol and estrogen levels in postmenopausal women: the spectrum of effect . Alcohol Clin Exp Res . 1993;;17:786-790.
27 +
Zajchowski DA, Sager R.  Induction of estrogenregulated genes differs in immortal and tumorigenic human mammary epithelial cells expressing a recombinant estrogen receptor . Mol Endocrinol . 1991;;5:1613-1623.
28 +
Selby PL, McGarrigle HHG, Peacock M.  Comparison of the effects of oral and transdermal oestradiol administration on oestrogen metabolism, protein synthesis, gonadotrophin release, bone turnover and climacteric symptoms in postmenopausal women . Clin Endocrinol . 1989;;30:241-249.
29 +
Yen SSC, Martin PL, Burnier AM, et al.  Circulating estradiol, estrone and gonadotropin levels following the administration of orally active 17β estradiol in postmenopausal women . J Clin Endocrinol Metab . 1975;;40:518-521.
30 +
Powers MS, Schenkel L, Darley PE, et al.  Pharmacokinetics and pharmacodynamics of transdermal dosage forms of 17β-estradiol . Am J Obstet Gynecol . 1985;;152:1099-1106.
31 +
Mendelson JH, Mello NK, Cristofaro P, et al.  Alcohol effects on naloxone-stimulated luteinizing hormone, prolactin and estradiol in women . J Stud Alcohol . 1987;;48:287-294.
32 +
Mendelson JH, McGuire M, Mello NK.  A new device for administering placebo alcohol . Alcohol . 1984;;1:417-419.
33 +
Goldstein DB.  Pharmacokinetics of alcohol . In: Mendelson JH, Mello NK, eds. Medical Diagnosis and Treatment of Alcoholism . New York, NY: McGraw-Hill Inc;1992;:25-54.
34 +
Ginsburg ES, Walsh BW, Gao X, et al.  The effects of ethanol on the clearance of estradiol in postmenopausal women . Fertil Steril . 1995;;63:1227-1230.
35 +
Mendelson JH, Mello NK, Ellingboe J.  Acute alcohol intake and pituitary gonadal hormones in normal human females . J Pharmacol Exp Ther . 1981;;218:23-26.
36 +
McNamee B, Grant J, Ratcliff J, Ratcliff W, Oliver J.  Lack of effect of alcohol on pituitarygonadal hormones in women . Br J Addict . 1979;;74:316-317.
37 +
Mendelson JH, Mello NK, Teoh SK, Ellingboe J.  Alcohol effects on luteinizing hormone releasing hormone stimulated anterior pituitary and gonadal hormones in women . J Pharmacol Exp Ther . 1989;;250:902-909.
38 +
Teoh SK, Mendelson JH, Mello NK, et al.  Alcohol effects on hCG-stimulated gonadal hormones in women . J Pharmacol Exp Ther . 1990;;254:407-411.
39 +
Gavaler JS, Rosenblum E.  Exposure-dependent effects of ethanol on serum estradiol and uterus mass in sexually mature oophorectomized rats . J Stud Alcohol . 1987;;48:295-303.
40 +
Reichman ME, Judd JE, Longcope C, et al.  Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women . J Natl Cancer Inst . 1993;;85:722-727.
41 +
Martins OO, Dada OA.  The effect of alcohol on the in vitro absorption of estradiol and estrone sulphate in rat intestine . J Steroid Biochem . 1982;;16:265-268.
42 +
Cronholm T, Rudqvist U.  Effects of ethanol metabolism on oxidoreduction and intermolecular hydrogen transfer at C-17 in steroid 3-sulfates in vivo . Biochim Biophys Acta . 1982;;711:159-165.
43 +
Fishman J, Hellman L, Zumoff B, Gallagher TF.  Influence of thyroid on hydroxylation of estrogen in man . J Clin Endocrinol Metab . 1965;;25:365-368.
44 +
Van Thiel DH, Tarter RE, Rosenblum E, Gavaler JS.  Ethanol, its metabolism and gonadal effects . Adv Alcohol Subst Abuse . 1988;;7:131-169.
45 +
Lufkin EG, Wahner HW, O'Fallon WM, et al.  Treatment of postmenopausal osteoporosis with transdermal estrogen . Ann Intern Med . 1992;;117:1-9.
46 +
Jurgens RW, Downey LJ, Abernathy WD, Cutler NR, Conrad J.  A comparison of circulating hormone levels in postmenopausal women receiving estrogen replacement therapy . Am J Obstet Gynecol . 1992;;167:459-460.
47 +
Walsh BW, Schiff I, Rosner B, et al.  Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins . N Engl J Med . 1991;;325:1196-1204.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Dept of Commerce, Bureau of the Census. Population projections of the United States by age, sex, race and hispanic origin 1993-2050. In: Current Population Reports, Series P-25, No. 1104. Washington, DC: US Government Printing Office; July 1995.
2 +
Wysowski DK, Golden L, Burke L.  Use of menopausal estrogens and medroxyprogesterone in the United States, 1982-1992 . Obstet Gynecol . 1995;;85:6-10.
3 +
Felson DT, Zhang Y, Hannan MT, et al.  The effect of postmenopausal estrogen therapy on bone density in elderly women . N Engl J Med . 1993;;329:1141-1146.
4 +
Genant RK, Baylink DJ, Gallagher JC, et al.  Effect of estrone sulfate on postmenopausal bone loss . Obstet Gynecol . 1990;;76:579-584.
5 +
Cauley JA, Seeley DG, Ensrud K, et al.  Estrogen replacement therapy and fractures in older women . Ann Intern Med . 1995;;122:9-16.
6 +
Lindsay R, Tohme JF.  Estrogen treatment of patients with established postmenopausal osteoporosis . Obstet Gynecol . 1990;;76:290-295.
7 +
Henderson BE, Ross RK, Paganini-Hill A, Mack TM.  Estrogen use and cardiovascular disease . Am J Obstet Gynecol . 1986;;154:1181-1186.
8 +
Henderson BE, Paganini-Hill A, Ross RK.  Decreased mortality in users of estrogen replacement therapy . Arch Intern Med . 1991;;151:75-78.
9 +
Stampfer MJ, Colditz GA, Willett WC, et al.  Postmenopausal estrogen therapy and cardiovascular disease . N Engl J Med . 1991;;325:756-762.
10 +
Nabulsi A, Folsom AR, White A, et al, the Atherosclerosis Risk in Communities Study Investigators.  Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women . N Engl J Med . 1993;;328:1069-1075.
11 +
Boston Collaborative Drug Surveillance Program.  Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy . N Engl J Med . 1974;;290:15-19.
12 +
Colditz GA, Hankinson SE, Hunter DJ, et al.  The use of estrogens and progestins and the risk of breast cancer in postmenopausal women . N Engl J Med . 1995;;332:1589-1593.
13 +
Bergkvist L, Adami H-O, Persson I, et al.  The risk of breast cancer after estrogen and estrogenprogestin replacement . N Engl J Med . 1989;;321:293-297.
14 +
Colditz GA, Stampfer MJ, Willett WC, et al.  Prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women . JAMA . 1990;;264:2648-2653.
15 +
Brinton LA, Hoover R, Fraumeni JF Jr.  Menopausal oestrogens and breast cancer risk . Br J Cancer . 1986;;54:825-832.
16 +
Steinberg KK, Thacker SB, Smith SJ, et al.  A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer . JAMA . 1991;;265:1985-1990.
17 +
Stampfer MJ, Colditz GA, Willett WC, et al.  A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women . N Engl J Med . 1988;;319:267-273.
18 +
Criqui MH, Ringel BL.  Does diet or alcohol explain the French paradox? Lancet . 1994;;344:1719-1723.
19 +
Longnecker MP, Berlin JA, Orza MJ, Chalmers TC.  A meta-analysis of alcohol consumption in relation to risk of breast cancer . JAMA . 1988;;260:652-656.
20 +
Willett WC, Stampfer MJ, Colditz GA, et al.  Moderate alcohol consumption and the risk of breast cancer . N Engl J Med . 1987;;316:1174-1180.
21 +
Longnecker MP, Newcomb PA, Mittendorf R, et al.  Risk of breast cancer in relation to lifetime alcohol consumption . J Natl Cancer Inst . 1995;;87:923-929.
22 +
Longnecker MP.  Do hormones link alcohol with breast cancer? J Natl Cancer Inst . 1993;;85:692-693.
23 +
Gapstur SM, Potter JD, Sellers TA, Folsom AR.  Increased risk of breast cancer with alcohol consumption in postmenopausal women . Am J Epidemiol . 1992;;136:1221-1231.
24 +
Mendelson JH, Lukas SE, Mello NK, et al.  Acute alcohol effects on plasma estradiol levels in women . Psychopharmacology . 1988;;94:464-467.
25 +
Ginsburg ES, Walsh BW, Gao X, et al.  The effects of acute ethanol ingestion on estrogen levels in postmenopausal women using transdermal estradiol . J Soc Gynecol Invest . 1995;;2:26-29.
26 +
Gavaler JS, Deal SR, Van Thiel DH, et al.  Alcohol and estrogen levels in postmenopausal women: the spectrum of effect . Alcohol Clin Exp Res . 1993;;17:786-790.
27 +
Zajchowski DA, Sager R.  Induction of estrogenregulated genes differs in immortal and tumorigenic human mammary epithelial cells expressing a recombinant estrogen receptor . Mol Endocrinol . 1991;;5:1613-1623.
28 +
Selby PL, McGarrigle HHG, Peacock M.  Comparison of the effects of oral and transdermal oestradiol administration on oestrogen metabolism, protein synthesis, gonadotrophin release, bone turnover and climacteric symptoms in postmenopausal women . Clin Endocrinol . 1989;;30:241-249.
29 +
Yen SSC, Martin PL, Burnier AM, et al.  Circulating estradiol, estrone and gonadotropin levels following the administration of orally active 17β estradiol in postmenopausal women . J Clin Endocrinol Metab . 1975;;40:518-521.
30 +
Powers MS, Schenkel L, Darley PE, et al.  Pharmacokinetics and pharmacodynamics of transdermal dosage forms of 17β-estradiol . Am J Obstet Gynecol . 1985;;152:1099-1106.
31 +
Mendelson JH, Mello NK, Cristofaro P, et al.  Alcohol effects on naloxone-stimulated luteinizing hormone, prolactin and estradiol in women . J Stud Alcohol . 1987;;48:287-294.
32 +
Mendelson JH, McGuire M, Mello NK.  A new device for administering placebo alcohol . Alcohol . 1984;;1:417-419.
33 +
Goldstein DB.  Pharmacokinetics of alcohol . In: Mendelson JH, Mello NK, eds. Medical Diagnosis and Treatment of Alcoholism . New York, NY: McGraw-Hill Inc;1992;:25-54.
34 +
Ginsburg ES, Walsh BW, Gao X, et al.  The effects of ethanol on the clearance of estradiol in postmenopausal women . Fertil Steril . 1995;;63:1227-1230.
35 +
Mendelson JH, Mello NK, Ellingboe J.  Acute alcohol intake and pituitary gonadal hormones in normal human females . J Pharmacol Exp Ther . 1981;;218:23-26.
36 +
McNamee B, Grant J, Ratcliff J, Ratcliff W, Oliver J.  Lack of effect of alcohol on pituitarygonadal hormones in women . Br J Addict . 1979;;74:316-317.
37 +
Mendelson JH, Mello NK, Teoh SK, Ellingboe J.  Alcohol effects on luteinizing hormone releasing hormone stimulated anterior pituitary and gonadal hormones in women . J Pharmacol Exp Ther . 1989;;250:902-909.
38 +
Teoh SK, Mendelson JH, Mello NK, et al.  Alcohol effects on hCG-stimulated gonadal hormones in women . J Pharmacol Exp Ther . 1990;;254:407-411.
39 +
Gavaler JS, Rosenblum E.  Exposure-dependent effects of ethanol on serum estradiol and uterus mass in sexually mature oophorectomized rats . J Stud Alcohol . 1987;;48:295-303.
40 +
Reichman ME, Judd JE, Longcope C, et al.  Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women . J Natl Cancer Inst . 1993;;85:722-727.
41 +
Martins OO, Dada OA.  The effect of alcohol on the in vitro absorption of estradiol and estrone sulphate in rat intestine . J Steroid Biochem . 1982;;16:265-268.
42 +
Cronholm T, Rudqvist U.  Effects of ethanol metabolism on oxidoreduction and intermolecular hydrogen transfer at C-17 in steroid 3-sulfates in vivo . Biochim Biophys Acta . 1982;;711:159-165.
43 +
Fishman J, Hellman L, Zumoff B, Gallagher TF.  Influence of thyroid on hydroxylation of estrogen in man . J Clin Endocrinol Metab . 1965;;25:365-368.
44 +
Van Thiel DH, Tarter RE, Rosenblum E, Gavaler JS.  Ethanol, its metabolism and gonadal effects . Adv Alcohol Subst Abuse . 1988;;7:131-169.
45 +
Lufkin EG, Wahner HW, O'Fallon WM, et al.  Treatment of postmenopausal osteoporosis with transdermal estrogen . Ann Intern Med . 1992;;117:1-9.
46 +
Jurgens RW, Downey LJ, Abernathy WD, Cutler NR, Conrad J.  A comparison of circulating hormone levels in postmenopausal women receiving estrogen replacement therapy . Am J Obstet Gynecol . 1992;;167:459-460.
47 +
Walsh BW, Schiff I, Rosner B, et al.  Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins . N Engl J Med . 1991;;325:1196-1204.

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