The world’s population is aging. By 2050, over 2 billion individuals will be 60 years or older, a number that is nearly double current estimates (World Health Organization, 2024). Nearly half of the population is female, yet relatively little attention has been directed to the study of females, especially aging females. Even with the 2016 mandate of Considering Sex as a Biological Variable (SABV) by the National Institutes of Health, studies are still lagging in their inclusion of females, and especially, older females (Rechlin et al., 2022, Shansky and Murphy, 2021). Alcohol research studies are beginning to include older females, which is crucially important, as they represent a unique and growing population (Epstein et al., 2007).

As outlined in a recent review, both men and women in the Baby Boomer generation (born 1946–1964) drink more than those in previous and subsequent generations (White et al., 2023). In fact, according to data acquired between 2000 and 2016, the largest increase in the prevalence of alcohol use and binge drinking occurred in the 50+ age group (Grucza et al., 2018). Binge drinking is defined as 4+ drinks for women (5+ for men) in a 2 h period and achieving greater than 0.08 mg% blood ethanol concentration (NIAAA, 2004). Moreover, although binge drinking is lowest in the 65+ age group, those individuals did so more frequently than the younger age cohorts (Kanny et al., 2018). Plus, rates of binge drinking in this group appear to be increasing. Binge alcohol use increased 3.7% in the 65+ population across 2022–2023, though age data were not broken out further by sex (SAMHSA, 2024). These numbers are thought to be underestimates as women may be less likely to disclose their alcohol drinking habits due to stigma (Blow et al., 2000, Epstein et al., 2007).

Given that the Baby Boomers account for the majority of the 65+ population, their higher alcohol consumption is of particular concern, because relatively little is known about how binge alcohol interacts with brain aging, especially in females. Indeed, morbidity and mortality related to excessive alcohol consumption is greatest in older individuals (Spillane et al., 2020). Furthermore, this problem does not seem to be going away. Recent data support that more people in general are drinking alcohol: across 2022 to 2023, there was a 2.5% increase in the number of women aged 26+ who report drinking alcohol in their lifetime. Over 48% of women aged 26+ years report drinking alcohol in the past month, of that over 40% drink in a binge pattern (SAMHSA, 2024). Although binge alcohol use is slightly lower in older females versus males currently, in adolescents and emerging adults (18–26), females currently drink more than males (SAMHSA, 2024). It will be interesting to see how this young cohort consumes alcohol as they age and if their higher alcohol consumption trends maintain. If current female alcohol consumption trends continue with age, it will be even more important to study how alcohol affects brain aging in women.

The evidence available to date indicates that alcohol use disorder (AUD) accelerates the aging process, but how exactly it does so remains unclear (Sullivan and Pfefferbaum, 2019, Sullivan and Pfefferbaum, 2023). Aging is associated with marked neuroendocrine changes, especially in the hypothalamic-pituitary–gonadal (HPG) and hypothalamic–pituitary–adrenal (HPA) axes. Changes in these sexually dimorphic systems have specific consequences for brain aging in women, which makes this demographic notably different from both males and younger females. The extent to which alcohol interacts with aging-related changes in the female HPA and HPG is largely unknown – a crucial knowledge gap. For example, aging-related cessation of ovarian hormone output is believed to contribute to the elevated risk and increased severity of Alzheimer’s disease (AD) in women (Andersen et al., 1999, Craig and Murphy, 2009, Gale et al., 2016, Mosconi and Brinton, 2018, Riedel et al., 2016, Snyder et al., 2016), while alcohol may increase the risk of dementia (Guggenmos et al., 2017, Lao et al., 2021, Pfefferbaum et al., 1992, Woods et al., 2016, Zahr et al., 2019). Thus, the combined risk factors of reduced ovarian output plus alcohol create an AD risk profile unique to aging women. Also unclear is whether binge pattern drinking, which is increasing in older women, accelerates natural aging processes. While binge drinking is not in and of itself considered to be an AUD, it is high risk drinking behavior. Strikingly, binge drinking in older adults (above the age of 50) increased more in women than men as well as AUD diagnosis in this age group, which increased in women by 84 % in the last decade (SAMHSA, 2019, Peltier et al., 2019, White, 2020).

Given the lack of attention to this emerging public health problem, the objective of this review is to lay out the current state of knowledge of alcohol effects on the aging female brain. We focus on neuroendocrine systems profoundly affected by both aging and alcohol. We emphasize potential treatment opportunities offered by the unique landscape of the aging female brain, and the life experience and circumstances of aging women.