The obstetrician/gynecologist (OB/GYN) is, in a sense, the primary health care provider for many women of all ages. These specialists see patients for annual routine examinations and pre-and postnatal visits and often serve as counselors for questions related to the women's general health and reproduction. Some of these questions deal, directly or indirectly, with aspects and effects of the women's alcohol consumption. Discussions about infertility, birth control, or pregnancy provide the OB/GYN with an opportunity to assess the patient's alcohol consumption and to advise her about potential risks of alcohol use. In this way, necessary lifestyle changes can be initiated early, and problems in conceiving and delivering a healthy child, as well as other alcohol-related health problems, can be avoided.
For women with alcohol problems, the OB/GYN often makes the diagnosis of alcohol abuse or alcohol dependence and provides initial intervention. However, to counsel patients with drinking problems successfully, the OB/GYN must not only be able to identify alcohol abuse and alcohol-related problems but also must be familiar with different treatment and referral options.
This article describes alcohol-related problems encountered in an OB/GYN practice and the medical consequences associated with them. It also reviews screening tools available to the OB/GYN to assess alcohol consumption and addresses intervention options and considerations relevant to a successful treatment outcome.
KINDS AND PREVALENCE OF ALCOHOL PROBLEMS
The Institute of Medicine (1990) defines alcohol problems as "problems that may arise in individuals around the use of beverage alcohol and that may require an appropriate treatment response for their optimum management" (p. 25). This very broad definition takes into account the extreme diversity of alcohol problems and their manifestations, whether social, physical, or psychological. It does not, however, include "indirect" consequences of alcohol abuse, such as physical or sexual abuse by an alcoholic spouse or partner. Although these problems may be present quite frequently among OB/GYN patients, they will not be addressed in the following discussion.
Problems encountered by the OB/GYN that are directly related to a woman's alcohol use can range from the consequences of risky sexual behavior after alcohol consumption (e.g., unwanted pregnancy or sexually transmitted diseases) to severe physiological dysfunctions (e.g., irregular menstruation or infertility). An increased risk for breast cancer also has been associated with alcohol abuse (Longnecker et al. 1988; Rosenberg et al. 1993).
The prevalence of patients with alcohol-related problems in an OB/GYN practice is difficult to estimate. The diagnoses of alcohol abuse and alcohol dependence apply to 12 to 16 percent of OB/GYN patients (Halliday et al. 1986; Russell and Bigler 1979). And in a recent population-based survey, up to 25 percent of pregnant women reported alcohol consumption (Serdula et al. 1991).
MEDICAL CONSEQUENCES OF ALCOHOL CONSUMPTION
The predominant effects of alcohol consumption seen by the OB/GYN are related to problems in fertility, pregnancy, and the development of the fetus. A putative effect is an increased risk of breast cancer.
EFFECTS ON THE ENDOCRINE AND REPRODUCTIVE SYSTEMS
Excessive(1) alcohol consumption can reduce a woman's fertility (Possati 1992; Gavaler 1991). Alcohol interferes with the female endocrine system and alters the amounts of reproductive hormones such as progesterone and estrogens (Gavaler 1991). Because of these changes, the menstrual cycle can become irregular or the menstrual period may be absent completely in chronic alcoholic women (Possati 1992; Becker et al. 1989). Excessive alcohol use also can lead to lack of ovulation, abnormalities of the ovaries, and even early onset of menopause (Possati 1992). The consequences of all these effects can range from infertility to an increased tendency for spontaneous abortions. …