Heart palpitations in perimenopause
A sudden flutter, a pounding heart at 2 a.m., a racing pulse during a hot flash. Palpitations are common in perimenopause and usually harmless, but worth checking once.
The short answer: palpitations are common in perimenopause, often during hot flashes or at night, and most are harmless. Because thyroid problems, anemia and heart rhythm problems can cause similar symptoms, they should be checked once. Palpitations with chest pain, fainting or severe shortness of breath need emergency care.
Call 911 if palpitations come with chest pain or pressure, fainting or nearly fainting, severe shortness of breath, or a very fast heartbeat that won't settle.
Why they happen
Estrogen affects the heart and the part of the nervous system that controls heart rate. As levels swing in perimenopause, many women notice their heart racing, pounding or skipping, especially during a hot flash, when the body's temperature control briefly speeds the heart.
Other common triggers pile on at this age: caffeine, alcohol, poor sleep, stress and anxiety, and dehydration. Most palpitations turn out to be harmless extra beats or a normal but fast rhythm.
What we check
- An ECG to look at your heart rhythm
- Thyroid function, since an overactive thyroid is a classic cause. Thyroid or perimenopause?
- A blood count and iron, as anemia from heavy periods speeds the heart
- Electrolytes and blood pressure
- A wearable heart monitor, if symptoms need to be caught as they happen, with cardiology input when needed
Why it's worth one check
The risk of heart rhythm problems such as atrial fibrillation rises with age, and heart disease risk climbs after menopause. Most palpitations in your 40s are benign, but a quick evaluation means you can stop worrying, or catch something early. Heart health after menopause
Peace of mind is one visit away.
Most new patients are seen within a week, in person in Bridgewater or Nutley, or by video anywhere in New Jersey.
What helps
- Treat the hot flashes. When palpitations come with hot flashes, hormone therapy or a non-hormonal medicine often settles both. Hormone therapy
- Cut back on caffeine and alcohol, especially later in the day.
- Improve sleep, which steadies the nervous system.
- Treat anxiety if it's part of the picture. Perimenopause anxiety
- Correct low iron or thyroid problems if we find them.
Keeping a palpitation diary
Before your visit, note when palpitations happen, how long they last, what they feel like (fluttering, pounding, skipping or racing), and what you were doing. Many smartwatches can record a heart rhythm strip during an episode, which can be very useful to bring along.
Keep reading
Palpitation questions
Can perimenopause cause heart palpitations?
Yes. Palpitations, a racing, pounding or fluttering heartbeat, are common in perimenopause, often during hot flashes or at night. Changing estrogen levels affect heart rate and the nervous system that controls it.
Are perimenopause palpitations dangerous?
Usually not. Most are harmless extra beats or a faster heartbeat during a hot flash. They should still be checked once, because thyroid problems, anemia and heart rhythm problems can cause similar symptoms.
When should I go to the ER for palpitations?
Call 911 or go to the emergency room if palpitations come with chest pain, fainting or nearly fainting, severe shortness of breath, or a very fast heartbeat that won't settle.
What tests check palpitations?
Usually an ECG, blood tests for thyroid function, blood count and electrolytes, and sometimes a wearable heart monitor for a day or more to catch symptoms as they happen. We arrange cardiology input when it's needed.
Does hormone therapy help palpitations?
When palpitations come with hot flashes, treating the hot flashes, for example with hormone therapy, often reduces them too. Cutting back on caffeine and alcohol and improving sleep also help.
- El Khoudary SR, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. A Scientific Statement From the American Heart Association. Circulation 2020;142(25):e506–e532.
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767–794.
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