One glass hits like two at 44 — and that is not imagination. Perimenopause changes how your body metabolises alcohol through three simultaneous mechanisms: declining estrogen slows liver enzyme activity, reduced lean muscle mass lowers body water, and alcohol dehydrogenase production in women is already lower than men's. The result is higher blood alcohol concentration at equivalent doses and slower clearance. Alcohol also worsens hot flashes, sleep, and anxiety — the very sy