The effects of alcohol may be more severe or more readily observed in women than in men. Women achieve higher concentrations of alcohol in the blood and become more impaired than men after drinking equivalent amounts of alcohol. It is becoming increasingly important and valuable to compare the patterns, predictors, and consequences of women’s and men’s alcohol use across varying cultural contexts.

Genetic factors related to risk of alcoholism—or the patterns of transmitting these risk factors—could differ for men and women. Twin and adoption studies have established an important role for genetic influences in the etiology of alcoholism in men. The evidence for genetic influence on alcoholism development in women is less consistent.

Women appear to be more vulnerable than men to many adverse consequences of alcohol use. Epidemiologic evidence clearly indicates that the adverse consequences of alcohol consumption, including severe liver disease, such as alcoholic cirrhosis, develop more quickly and require lower levels of alcohol exposure for females than for males.

Alcohol use increases the risk of breast cancer. Alcohol consumption is associated with a linear increase in breast cancer incidence in women over the range of consumption reported by most women. Among women who consume alcohol regularly, reducing alcohol consumption is a potential means to reduce breast cancer risk.

Women reach their peak bone mass by about age 35. After that age, a woman’s bone mass slowly declines until after menopause, when the loss becomes more rapid. Chronic alcohol consumption compromises bone health, resulting in a weakening of the bones’ mechanical structure.

Mild–to–moderate alcohol use affects female reproductive function throughout the life cycle. Animal studies show that alcohol consumption disrupts female puberty, and drinking during this period also may influence growth and bone health. After puberty, alcohol also has been found to disrupt normal menstrual cycling and reproductive function and to affect important hormone levels in postmenopausal women.

Women tend to have hardier immune systems than men, especially during their reproductive years, apparently because women’s high levels of estrogen help stimulate immunity and fight disease. Alcohol use dramatically compromises immune responses.

Children prenatally exposed to alcohol may exhibit a number of developmental deficits. The terms applied to these children vary depending on the severity of the deficits; they include fetal alcohol syndrome, fetal alcohol effects, alcohol–related birth defects, and alcohol–related neurodevelopmental disorder. Maternal alcohol use during pregnancy contributes to a range of effects in exposed children, including hyperactivity and attention problems, learning and memory deficits, and problems with social and emotional development. As alcohol–exposed children grow older, deficits in socioemotional function become increasingly salient, particularly with regard to social judgment, interpersonal skills, and antisocial behavior.

Despite the lack of scientific evidence to support the claim that alcohol is a galactagogue, lactating women have been advised to drink alcohol as an aid to lactation for centuries. Recommending alcohol as an aid to lactation may be counterproductive. In the short term, mothers may be more relaxed, but the hormonal milieu underlying lactational performance is disrupted, and, in turn, the infant’s milk supply is diminished.

Older women may be at particular risk for alcohol–related problems. They are more likely than men to outlive their spouses and to face other losses that typically lead to loneliness and depression—factors that may prompt alcohol use. The growing population of older adults reflects the need for new, innovative prevention and intervention techniques and approaches targeted to older at–risk drinkers.