Alcohol use may impact the health and well-being of postmenopausal women through the direct interaction of alcohol with organ systems when alcohol is ingested, transported through the blood, and processed for removal, and by indirect means through the modification of blood concentrations of sex hormones. Circulating hormones are known to affect risk for coronary heart disease, osteoporosis, and breast cancer, which are major causes of significant illness and death in postmenopausal women. The effects of alcohol consumption on these three diseases in postmenopausal women are reviewed, along with limitations in interpreting results of studies of alcohol's effects on postmenopausal women's health.