Heart palpitations in perimenopause: When to get help

Your heart is a hard-working muscle that’s busy pumping blood around your body night and day, delivering oxygen to your cells to keep you alive and well. A normal resting heart rate is anywhere between 60 and 100 beats per minute (bpm), totaling about 100,000 beats per day.

Most of the time, your heart works flawlessly, so you rarely notice it. But it’s not uncommon to get the occasional racing heart — also known as heart palpitations — when your heart beats faster than usual or skips a beat, and you become aware of it in your chest. Lots of things can cause your heart to do this, including exercise, caffeine, alcohol, anxiety, fear, and stress, and it’s usually nothing to worry about. 

However, if it suddenly feels like your heart’s doing backflips in your chest, it can be a little alarming. So, assuming you haven’t just been for a run, what’s the cause? One possible explanation is that it could be related to your hormones. If you’re anywhere between your late 30s and your 50s and you’ve noticed it feels like your heart is skipping a beat, it might be linked to perimenopause, especially if you’ve also got other telltale symptoms such as hot flashes and irregular periods. Perimenopause signals the start of your journey through menopause, so keep reading if you think this might be what’s going on for you. 

Almost half (42%) of women say they’ve had heart palpitations during perimenopause, so you’re not alone if you have too. They usually happen alongside vasomotor symptoms, common signs of perimenopause, which include hot flashes, night sweats, and changes to your blood pressure. 

If your symptoms do turn out to be perimenopause-related, there are plenty of ways to manage heart palpitations. Here, Dr. Amanda Kallen, associate professor of obstetrics, gynecology, and reproductive sciences, University of Vermont Larner College of Medicine, Vermont, US, shares everything you need to know about the link between heart palpitations and perimenopause. 

But before you read on, it’s a good idea to consider whether you might be experiencing these feelings in your chest for another reason. Here, we’ll focus on health palpitations during perimenopause, but if your symptoms get more intense or they’re accompanied by chest pain and shortness of breath, prioritize reaching out to your doctor to rule out anything more serious. 

Key takeaways: Heart palpitations in perimenopause

• Almost half (42%) of perimenopausal women experience heart palpitations. 
• Heart palpitations can feel like your heart is pounding or racing.
• If heart palpitations are impacting your quality of life, there are ways to manage and treat them.
• There are various treatment options for heart palpitations, including lifestyle adjustments, avoiding possible triggers like caffeine and stress, and hormone therapy (HT, previously called hormone replacement therapy). However, HT would only ever be suggested for heart palpitations if you got them alongside hot flashes. The best thing to do is to chat with your doctor about which treatment may be right for you.
• You can use a period-tracking app like Flo to log cycles and symptoms all the way through perimenopause. Plus, you can share your experiences with others who are going through similar experiences in the app’s Secret Chats space.  

What are heart palpitations? 

Heart palpitations are basically any changes to your heartbeat that are significant enough for you to notice. If you get them, you might be familiar with a pounding feeling in your chest, or perhaps it feels more like your heart is skipping a beat. “Heart palpitations are the sensation that your heart is beating unusually fast, hard, or irregularly,” says Dr. Kallen. “[It] can feel like your heart is racing or thumping unexpectedly. They’re usually brief, but the sensation can be alarming.”

Heart palpitations can affect anyone at any time, but they are common and can arise as a perimenopause symptom in women — often accompanied by a hot flash that feels like a sudden sensation of heat in your body. If this sounds familiar and leaves you feeling worried or stressed, or if you’ve noticed other symptoms like shortness of breath, check in with your doctor. They’ll be able to look into the cause and offer treatment options.

What is perimenopause? 

Do you feel unclear on perimenopause versus menopause? You’re probably familiar with the term menopause, a process that everyone born with a female reproductive system will go through. “Menopause is the end of a woman’s menstrual cycle,” explains Dr. Kallen, adding that it’s confirmed when you go for “12 consecutive months without a period.” 

Menopause usually happens between the ages of 45 and 55, but your cycles don’t just switch off overnight. In fact, you may start noticing symptoms earlier than you might think, during what’s called perimenopause. Perimenopause is your transition through menopause. It covers the years leading up to menopause and the 12 months after, at which point you can be sure you’ve had your final period. “[During this time], estrogen levels start to fluctuate and ultimately decline,” says Dr. Kallen.

Everyone’s different, which means perimenopause doesn’t look the same for us all. For example, it can start anywhere between your late 30s and 50s, but it’s most likely to happen in your mid-40s. Usually, it lasts around four to eight years, but again, it can vary. 

During this time, the amount of hormones you produce begins to change. In particular, the levels of estrogen released by your ovaries start to rise and drop unevenly before eventually reducing for good. Estrogen plays an important role in lots of your body’s functions, which is why symptoms of perimenopause, menopause, and postmenopause can affect so many systems and parts of the body. “Menstrual cycles can become irregular, and symptoms like hot flashes, mood swings, and sleep disturbances may appear,” adds Dr. Kallen.

Not everyone experiences symptoms, but if you do and you’re finding them difficult to manage,  there’s usually something that can be done about it. Chat with your doctor to find out what your options are.

The possible link between heart palpitations and perimenopause 

Like many other areas of female health, more research is needed to find out about the link between heart palpitations and perimenopause. But just like other common signs of perimenopause, like vaginal dryness and brain fog, heart palpitations are thought to be linked to shifting hormones. 

Often, heart palpitations reported in perimenopause happen alongside hot flashes. As your estrogen levels drop in the lead-up to menopause, it’s thought that your hypothalamus — your body’s internal thermostat — becomes more sensitive to small changes in body temperature. So, if your hypothalamus thinks you’re getting too warm, it triggers a hot flash in an attempt to cool you down.

As well as making you sweat, hot flashes can also cause an increase in heart rate, which can trigger heart palpitations. With up to 80% of women in perimenopause getting some level of hot flashes, it’s no surprise that heart palpitations can happen more often around this time, too.

When you move past perimenopause and become postmenopausal, your lowered estrogen levels can start to increase your risk of heart disease, according to recent research. This is because estrogen is known to protect your heart in a few different ways:

• “It relaxes blood vessels and improves blood flow,” explains Dr. Kallen. 
• “Estrogen also regulates cholesterol levels, which helps prevent the buildup of fatty deposits in arteries,” she adds. 
• “Estrogen has anti-inflammatory and antioxidant properties, protecting blood vessels from damage and reducing the risk of cardiovascular disease,” she says. 
• “It also contributes to regulating blood pressure,” says Dr. Kallen. 

But this doesn’t mean that all women will develop heart disease once they reach menopause or beyond. Your risk level will depend on a number of factors including your family history, ethnicity, and your lifestyle. 

And heart palpitations themselves aren’t necessarily a sign that there’s anything wrong with your heart. Therefore, if you had heart palpitations during perimenopause alongside hot flashes, it doesn’t mean you’ll have a higher chance of developing heart disease after menopause. 

But if you’re having heart palpitations and they’re causing you stress or making you worry about your heart health, the best thing you can do is to speak to your doctor. They can give you a better idea of your personal risk factors and can talk you through ways to keep your heart healthy. “Heart palpitations during perimenopause are usually harmless, but they shouldn’t be ignored,” warns Dr. Kallen. “It’s a good idea to discuss your symptoms with your doctor to ensure there’s no underlying heart condition or other health issue.” 

In the meantime, there are plenty of things you can do to reduce your risk of heart disease. These apply to anyone at any age and include things like being physically active, eating a healthy, balanced diet, and quitting smoking.

Other potential causes of heart palpitations 

It’s always important to consider whether you might be experiencing heart palpitations for reasons other than perimenopause. If any of the following sound possible, get checked out by your doctor. 

Increased stress 

Anxiety is the most common cause of heart palpitations outside of heart problems. Many of us are juggling multiple life stresses by the time we reach perimenopause. Things like caring for aging parents, working at demanding jobs, or parenting teens can all increase stress and anxiety. If this sounds like you, there may be ways to tackle it, so reach out to your doctor for help. Both medication and talking therapy have been found to relieve symptoms of stress and anxiety, so remember help is available.

Underlying heart disease

Heart palpitations can sometimes signal heart trouble. You might experience chest flutters if you have an abnormal heart rhythm, known as arrhythmia, for example. There are different types of arrhythmia, and while some don’t always require treatment, others can put you at risk of cardiac arrest, so it’s important that you get it checked out. And if you have symptoms of a heart attack such as chest pain, shortness of breath, and dizziness, call your emergency services number or head to your local hospital emergency department.

Caffeine 

Life can feel tiring, which can mean those daily coffees become more and more relied upon. But did you know that caffeine, nicotine, energy drinks, and even some cold medicines can all trigger heart palpitations and make your heart beat faster than usual? So, if a pounding chest is a problem for you, it may be worth cutting back on your daily espresso count.

Overactive thyroid function 

Heart palpitations might mean you have an overactive thyroid — also known as hyperthyroidism. This is when you produce too much of the thyroid hormone, which speeds up your metabolism and causes your heart to beat rapidly. If you spot other symptoms of hyperthyroidism, such as hand tremors or losing weight without trying, prioritize making an appointment with your doctor. 

What to do if you have heart palpitations in perimenopause

Occasional heart palpitations are not usually cause for concern, but that doesn’t make them any less alarming when they happen. The good news is, there are ways to deal with them. 

“Treatments for perimenopause-related heart palpitations can involve managing hormone levels with hormone therapy,” suggests Dr. Kallen. That said, HT isn’t for everyone, and it’s normally only offered if you’re experiencing hot flashes, night sweats, or vaginal dryness, so it may not be an option for heart palpitations alone. But if you’re offered HT and you’re thinking about taking it, it’s a good idea to discuss the risks as well as the benefits with your doctor to determine what may be right for you. If you decide HT isn’t for you, it isn’t your only option. 

Dr. Kallen suggests you could also rethink some of your daily habits. “Other treatments include lifestyle adjustments and avoiding triggers like caffeine and stress,” she says. Doing your best to be healthy is a good idea at any age, but it’s particularly important during perimenopause. “Lifestyle changes can make a big difference,” Dr. Kallen says. “Regular exercise, a balanced diet, staying hydrated, reducing caffeine and alcohol intake, and managing stress through techniques like meditation or deep breathing can all help.”

If perimenopause has brought with it heart palpitations or any other symptoms, it can help to keep notes of it all in case you need to chat with your doctor about treatments. A cycle-tracking app like Flo can be useful for tracking perimenopause-specific symptoms like brain fog and vaginal dryness; plus, you can talk to others about what you’re going through in our anonymous Secret Chats space.

Heart palpitations relief tips

If you’re experiencing heart palpitations right now, try the following tips to relieve your symptoms: 

• “Take slow, deep breaths to calm your body and reduce stress,” suggests Dr. Kallen. “Sit or lie down, especially if you feel lightheaded.” 
• “Avoid stimulants like caffeine, and drink water to stay hydrated,” she adds. “If the palpitations persist or are accompanied by chest pain or dizziness, see your doctor.”