As someone who lives with PCOS and provides nutrition counseling to individuals with PCOS every day, I know firsthand how complex the relationship between food, drinks, and PCOS can be, especially alcohol and PCOS.
Alcohol and PCOS is a particularly tricky subject.
On one hand, you may want to enjoy a glass of wine with dinner or a cocktail on a night out with friends.
On the other hand, you might worry if alcohol will have a negative impact on your symptoms, like insulin resistance, fertility or weight.
The good news is that with the right information you can make an informed choice.
It is totally possible to enjoy alcohol responsibly without significantly worsening your PCOS symptoms. So in this article, I’ll share evidenced-based information and personal tips on how to choose the best types of alcohol for PCOS and your health goals.
How much alcohol can you have with PCOS?
It’s always a good idea to start off clarifying what is considered moderate alcohol intake.
The US Dietary Guidelines indicate for individuals that choose to drink, should do so in moderation, which looks like 1 drink or less per day for women.
According to the NIH, one standard drink is equivalent to:
- 12 fl oz of regular beer (about 5% alcohol)
- 8–10 fl oz of malt liquor or flavored malt beverages such as hard seltzer (about 7% alcohol)
- 5 fl oz of table wine (about 12% alcohol)
- 3–4 fl oz of fortified wine such as sherry or port (about 17% alcohol)
- 2–3 fl oz of cordial, liqueur, or aperitif (about 24% alcohol)
- 1.5 fl oz of brandy or cognac (about 40% alcohol)
- 1.5 fl oz shot of distilled spirits like gin, rum, tequila, vodka, whiskey, etc. (about 40% alcohol)
Understanding the Impact of Alcohol on PCOS: Is Alcohol Really Bad for PCOS?
Can drinking alcohol make PCOS worse?
Yes and no. I wish there was a simple answer, so let me explain. Moderate alcohol consumption has actually been shown to improve insulin resistance.
However, alcoholic drinks with high sugar juices, mixers and sodas, add a lot of extra calories and sugar into your diet. The extra sugar will spike blood glucose levels and insulin levels. When insulin levels are high, this is when weight gain happens and it increase our testosterone, leading to all the symptoms we hate like irregular period, hair growth, acne, ect.
Alcohol is high in calories, so if you are over consuming your calorie needs with a few class of wine or beer each day, this could lead to weight gain, also making PCOS symptoms worse.
So, can you still drink alcohol when you have PCOS? Yes! You just need to do so in moderation and be mindful of all the sugary additions like soda, mixers and juices.
Alcohol and Insulin Resistance in PCOS
One of the biggest questions I get about alcohol and PCOS is how it affects insulin resistance and blood sugars.
Interestingly, alcohol can actually decrease your blood sugars after an initial jump in blood sugar levels. Sounds weird, I know.
This drop in blood sugar can become dangerous if your blood sugar levels drop too low, which is called hypoglycemia.
Interestingly, research shows that moderate alcohol consumption can decrease fasting insulin and A1C levels and improve insulin resistance. (1)
It is important to note that when alcohol is mixed with sugary mixers like soda, syrups, sour mix, daiquiri mix, to make those delicious cocktails we know and love, this is when it can lead to spikes in blood sugar, making insulin resistance worse.
From my own experience and working with clients, I’ve found that moderate alcohol intake and choosing lower-sugar options can help keep blood sugar levels more stable.
If you are looking for more ways to improve insulin resistance in PCOS with nutrition, check out my PCOS food list.
PCOS Weight Management and Alcohol
Managing weight is a common struggle for those of us with PCOS, and alcohol can add extra calories without much nutritional benefit. This is one of the reasons why I don’t suggest drinking alcohol when trying to lose weight.
Alcohol itself is calorie-dense, with seven calories per gram (more calories per gram than carbs!), and when you add in sugary mixers or high-carb beers, the calorie count can quickly rise as well as the blood sugar and insulin spikes. This can make weight management even more challenging.
In my practice, I often recommend that clients pay close attention to what they’re drinking and how much. Opting for lower-calorie and lower-sugar options can make a big difference.
Later in this article, I’ll share some realistic tips on how to drink alcohol with PCOS.
Alcohol and Sleep
Sleep quality is critical for managing PCOS symptoms (2), yet alcohol can significantly disrupt sleep patterns. (3)
While alcohol might make you feel drowsy initially, it can interfere with deep sleep stages, leading to restless nights and feeling less rested in the morning.(4)
Poor sleep can exacerbate insulin resistance, increase cravings, and make it harder to manage weight, all of which are particularly challenging for those with PCOS. (5)
To protect your sleep quality, I recommend limiting alcohol intake, especially close to bedtime, and paying attention to how your body reacts to different types of alcohol.
Alcohol and Fertility
Does alcohol affect fertility? The research into alcohol use and female fertility isn’t concrete on its recommendations at this time due to limited research in the area. (6)
Researchers have seen changes to ovulation and menstrual cycles in chronic alcohol intake in human and animal models. However, a limitation in this research is the amount of alcohol intake is not specified. (7)
While occasional drinking might not have a significant impact, it’s best to limit alcohol if you’re actively trying to get pregnant. Discussing your alcohol intake with your healthcare provider can also provide personalized guidance based on your fertility goals.
Alcohol and Medication Interactions- Metformin, GLP-1, ect
Many women with PCOS are prescribed Metformin or a GLP-1 medication like Ozempic or Mounjaro to help manage insulin resistance and regulate blood sugar levels.
Both alcohol and Metformin or a GLP-1 can lower blood sugar, so consuming them together might increase the risk of hypoglycemia (low blood sugar).
Alcohol can interact with Metformin in ways that might increase the risk of lactic acidosis, a rare but serious condition where lactate builds up in the blood.
If you’re taking Metformin or a GLP-1, it’s important to be cautious with alcohol. I suggest talking to your healthcare provider about safe alcohol consumption while on these medications to avoid any potential risks.
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PCOS and NAFLD
Individuals with PCOS have a 4 times higher likelihood for developing Non-Alcoholic Fatty Liver Disease. (8)
At this time, the effects of moderate alcohol intake on NAFLD has not been determined, but I would suggest being mindful of alcohol intake if you have been diagnosed with NAFLD and PCOS.
Nutritional Breakdown of Different Alcoholic Beverages
I’m the last person that wants to ruin your fun during “Girls Night” with a calorie count of your favorite mojito but it’s important to be aware of just how many calories and how much added sugar you are drinking. Personally, I would rather get dessert than have another drink, but you do you!
When choosing an alcoholic beverage, you may want to be mindful or at least be aware of the calorie, carbohydrate and sugar content. Especially if you plan on having multiple in an evening or day (Sunday Funday anyone!).
For example, a glass of dry wine typically has around 120-130 calories and 3-4 grams of carbs, while a regular beer might have 150 calories and 13 grams of carbs. Cocktails can have even more calories, especially if they include sugary mixers.
Sweet wines, cocktails, and certain beers can contain significant amounts of sugar, which can lead to spikes in blood sugar levels and insulin levels.
When you have PCOS, it’s best to stick with drinks that are lower in sugar.
For instance, I often recommend dry wines or spirits mixed with soda water and a squeeze of citrus instead of sugary sodas or juices. These options have less sugar, which is better for keeping your blood sugar stable
Here’s a chart comparing the calories, carbohydrates, added sugars, and other nutritional aspects, including antioxidants, for various types of wines, spirits, beers, and popular hard seltzers:
| Alcoholic Beverages | Serving Size | Calories | Carbs (g) | Added Sugar | Other |
| Red Wine (dry) | 5 oz | ~125 | 4 | 0 | Contains resveratrol (antioxidant), iron, potassium |
| White Wine (dry) | 5 oz | ~121 | 4 | 0 | Contains some antioxidants, lower in resveratrol |
| Sweet Wine | 5 oz | ~165 | 14 | 8-10 | Higher sugar content, minimal antioxidant benefits |
| Vodka | 1.5 oz | ~96 | 0 | 0 | – |
| Gin | 1.5 oz | ~96 | 0 | 0 | – |
| Tequila | 1.5 oz | ~98 | 0 | 0 | – |
| Whiskey/Bourbon | 1.5 oz | ~105 | 0 | 0 | – |
| Light Beer | 12 oz | ~100 | 5 | 0 | Low in calories and carbs, minimal nutritional content. |
| Regular Beer | 12 oz | ~150 | 13 | 0 | Higher in carbs, some B vitamins |
| Hard Seltzer (Low-Calorie) | 12 oz | ~100 | 2 | 0-1 | Low in calories, some contain added electrolytes |
| Hard Cider | 12 oz | ~180 | 24 | 19-21 | High in sugar, some vitamin C |
| Champagne (Dry) | 5 oz | ~95 | 2 | 0 | Contains some antioxidants, lower calorie |
Choosing the Best Alcohol for PCOS
Why Dry Wines Are a Better Choice
Dry wines, especially red wines, are generally lower in sugar and have the added benefit of containing antioxidants like resveratrol, which has been shown to reduce testosterone, luteinizing hormone and DHEAS. (9, 10, 11)
Dry white wines or champagne are also good choices. If you really enjoy a sweet dessert wine, like Moscato, just be mindful of how many you drink as they have more sugar in them. I also recommend drinking it with food so it doesn’t raise your blood sugar or insulin levels as much.
Hard Liquor/Spirits with Low-Sugar Mixers
Spirits like vodka, gin, and tequila are naturally low in carbs, but it’s the mixers that can make or break your drink.
I always suggest pairing spirits with soda water, seltzer, diet sodas or freshly squeezed citrus juice to keep the sugar content low.
You can even add a “splash” of juice to the soda water to mix things up a bit. This way, you can enjoy your drink without the added sugars that could disrupt your insulin levels.
My personal favorite is vodka with soda water, 2-3 limes wedges, mint and a splash of cranberry juice. The tartness of the cranberry balances the vodka without needing extra sugar.
Light Beers vs. Regular Beers
If you enjoy beer, light beers are a better choice compared to regular ones. Light beers typically have fewer carbs and calories, making them a more PCOS-friendly option.
However, I recommend consuming them in moderation, as even light beers can still contribute to weight gain if consumed in large quantities.
Hard Seltzers
Hard seltzers are a great choice for women with PCOS because they are usually low in calories, carbs, and sugars.
A typical 12 oz serving contains about 100 calories, 2 grams of carbs, and little to no added sugars. With various refreshing flavors and minimal added sugars, they offer a lighter alternative to sugary cocktails.
Just be mindful of moderation because it is really easy to over do these on a hot summer day. Also, you may want to check labels for any artificial sweeteners that might affect you differently.
Limit Ciders and Sweet Wines
These tend to be higher in sugars and carbs, making them less ideal for those managing PCOS or watching their blood sugar levels.
Tips for Drinking Alcohol with PCOS
Moderation is Key
When it comes to alcohol and PCOS, moderation is key. The American Heart Association, CDC and the US Dietary Guidelines recommends no more than one drink per day for women.
For those of us with PCOS, sticking to this guideline—or even drinking less—can help minimize the impact of alcohol on our symptoms.
Eat When Drinking
Don’t drink on an empty stomach. Simple but important advice.
By eating before you go drinking or while you are drinking, can help control blood sugars.
It will also help slow the digestion of alcohol. Drinking can sabotage any health goals when you lose your inhibitions. I’ve never been able to say no to street corner pizza at 2am when I am drunk. Have you?
Stay Hydrated
I always make sure to drink plenty of water alongside any alcoholic beverages. If you are going to be drinking more than 1 alcoholic beverage in a day, you may want to consider spacing them out with a glass of water in between.
Staying hydrated can help reduce the dehydrating effects of alcohol and prevent headaches or hangovers.
Recognize Your Body’s Response
Finally, it’s important to listen to your body. If you notice that alcohol makes your PCOS symptoms worse, consider cutting back or choosing different types of drinks.
Everyone’s body reacts differently, and what works for one person may not work for another.
PCOS-Friendly Low-Sugar Cocktail Recipes
Here are some of my favorite low-sugar cocktails that I enjoy making at home. They’re delicious, refreshing, and won’t wreak havoc on your blood sugar levels.
Cucumber Mint Gin Fizz
- Ingredients: 1.5 oz Gin, soda water, fresh cucumber, mint leaves, lime juice
- Instructions: Muddle cucumber and mint, add gin and lime juice, top with soda water.
Spicy Skinny Margarita
- Ingredients: 1.5 oz Tequila, fresh lime juice, jalapeno slices, soda water, touch of stevia
- Instructions: Shake all ingredients with ice, strain into a glass, top with soda water.
Berry Basil Vodka Spritzer
- Ingredients: 1.5 oz Vodka, fresh berries, 2-3 fresh basil leaves, soda water, lemon juice
- Instructions: Muddle berries and basil, add vodka and lemon juice, top with soda water.
These cocktails are perfect for when you want to enjoy a drink without the guilt. Plus, they’re easy to customize based on your taste preferences.
Delicious PCOS Friendly Mocktail Ideas
For those times when you want to skip the alcohol altogether, these mocktails are just as satisfying:
Citrus Ginger Sparkler
- Ingredients: Fresh orange juice, ginger beer (non-alcoholic), soda water, orange slices
- Instructions: Combine all ingredients over ice, garnish with orange slices.
Cucumber Lime Cooler
- Ingredients: Fresh cucumber, lime juice, soda water, mint leaves
- Instructions: Muddle cucumber and mint, add lime juice, top with soda water.
Berry Basil Smash
- Ingredients: Fresh berries, basil leaves, soda water, lemon juice
- Instructions: Muddle berries and basil, add lemon juice, top with soda water.
These mocktails are a fantastic way to enjoy a flavorful drink while staying hydrated and avoiding alcohol.
Making Informed Choices About Alcohol with PCOS
Navigating alcohol consumption with PCOS can be challenging, but it’s entirely possible to enjoy a drink or two without compromising your health.
By choosing lower-sugar, lower-carb options, drinking in moderation, and listening to your body, you can manage your PCOS symptoms more effectively while still enjoying your social life.
Remember, the key is balance and making informed choices that align with your health goals. And if you ever need more personalized advice or help with figuring out what to eat and meal planning, I’m always here to help guide you on your PCOS journey.
Meggie Connelly MS, RD, LDN is a Registered Dietitian Nutritionist, PCOS Advocate and Culinary Nutritionist who helps individuals with PCOS and chronic dieters go from confused, frustrated and exhausted to confident and balanced.
