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Objectives: The purpose of this study was to provide baseline data for management policies by exploring the association between alcohol and mental health in menopause and andropause middle-aged Methods: This study used the data from from the 8th National Health and Nutrition Examination Survey (2019-2021). Adults between the ages of 40 and 64 were considered menopause and andropause middle-aged and 7,704 of the total number of 8,549 subjects were selected as the final study subjects without missing data. Mental health was defined as depression diagnosis and suicidal thoughts, and drinking was defined as current drinking and high-risk drinking. SAS 9.4 was used for all statistical analyses. Results: There were significant differences between menopause middle-aged men and women in current drinking (83.4% for men and 66.6% for women) and in high-risk drinking (24.2% for men and 4.9% for women). The significant factors affecting the depression diagnosis were identified as economic activity, income level, and subjective health status for men and economic activity, income level, subjective health status, and smoking for women (p < .05). The significant factors affecting suicidal ideation included economic activity, income level, and subjective health status for men and economic activity, high-risk drinking, current smoking, and subjective health status for women (p < .05). Conclusion: As a result of analyzing the association between alcohol and mental health in menopause and andropause middle-aged adults, Drinking alcohol and high-risk drinking in women were associated with mental health, but insignificantly in men. Based on this study, it is necessary to program development and health education for the physical and mental health of menopausal middle-aged women exposed to alcohol, and to develop menopausal mental health management policies that take into account the gender differences.