What Causes Heart Palpitations During Perimenopause?

May 01, 2023.

Medically reviewed by Patricia Shelton, MD

During perimenopause (the period leading up to menopause), it’s common for women to experience a variety of symptoms. Among the most concerning to many women is heart palpitations in perimenopause. This is the sensation that the heart is racing, fluttering, pounding, or skipping beats.

Some women may experience palpitations while they’re having a hot flash. In addition to sweating and feeling excessively warm, you may also feel like your heart is racing or pounding at this time. However, palpitations may also occur separately from hot flashes.

What does it mean if you feel heart palpitations during menopause? Is there a reason to be concerned about this symptom?

What causes heart palpitations during perimenopause?

Researchers are still investigating the connection between heart palpitations and menopause. However, it appears that heart palpitations occur when levels of estrogen drop suddenly. Changes in estrogen levels can affect the heart, leading to changes in the heartbeat.

Beyond the direct effects on the heart due to dropping hormone levels, it’s believed that other changes during menopause may also have an impact on the heartbeat. For example, many women have trouble sleeping during perimenopause. Lack of sleep can impact the heart rhythm, and may also lead to increased caffeine consumption, which is known to cause heart palpitations. 

Many women also experience increased levels of stress during this period, which can also lead to heart palpitations. In addition, depression and anxiety can both be associated with heart palpitations, and both of these become more common during perimenopause.

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Do heart palpitations in menopause indicate heart disease?

In most cases, heart palpitations are not a reason for concern. As long as they occur infrequently and last for only a few seconds at a time, palpitations don’t necessarily indicate underlying heart disease.

Heart palpitations that occur along with certain other symptoms are more concerning. These symptoms include:

  • Chest pain (which may be felt as pain in the back, jaw, or left arm or shoulder)
  • A sensation of severe pressure in the chest
  • Shortness of breath (feeling like you can’t get enough air)
  • Feeling dizzy or lightheaded, or fainting

If your palpitations occur along with these symptoms, they may indicate a more serious problem with the heart, such as an arrhythmia (an irregularity in the heart rhythm). If you feel any of these symptoms along with your palpitations, then you should definitely discuss it with your doctor.

Although heart palpitations are usually not a concerning symptom, they can sometimes be an indication of a serious underlying condition. Besides heart problems, palpitations sometimes indicate other types of medical issues, such as abnormal thyroid hormone levels.

If you’ve recently begun to notice palpitations, it’s a good idea to bring this up with your doctor, so they can evaluate you for any indications that there’s a problem with your heart. If you’re experiencing heart palpitations more frequently or the episodes last for longer, it’s also a good idea to talk with your doctor about them. Most likely, your heart palpitations don’t indicate anything serious, but it’s better to get a medical evaluation to be sure.

What can you do about heart palpitations in perimenopause?

Once you’ve verified with your doctor that your palpitations aren’t an indication of a serious underlying medical condition, then there are a few potential steps that you can take to address this symptom. These include:

  • Limit caffeine intake. As tempting as caffeine can be when you haven’t slept well, it can definitely cause heart palpitations, especially when you consume too much of it.
  • If you smoke, quit smoking. Nicotine is also a stimulant, and can cause heart palpitations. This is another excellent reason to quit the habit.
  • Reduce or eliminate alcohol consumption, which can also affect the heart.
  • Check any medications that you may take, to see if they can lead to palpitations. For example, common over-the-counter medications like decongestants and antihistamines (anti-allergy medications) can cause palpitations.
  • Reduce stress as much as possible. Techniques like meditation, yoga, and biofeedback may be helpful.
  • If you’re experiencing depression and/or anxiety, discuss this with your doctor so that you can receive appropriate treatment.

In most cases, heart palpitations during menopause aren’t a sign of any underlying serious condition. Although they can be bothersome, they usually aren’t dangerous. It’s always recommended that you talk with your doctor about any heart-related symptoms that you’re having, just to make sure. However, you usually shouldn’t worry too much that your palpitations indicate a serious heart problem.

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Carpenter JS. Correlates of palpitations during menopause: A scoping review. Womens Health (Lond). 2022; 18: 17455057221112267. doi: 10.1177/17455057221112267.

Giada F, Raviele A. Clinical Approach to Patients with Palpitations. Card Electrophysiol Clin. 2018 Jun;10(2):387-396. doi: 10.1016/j.ccep.2018.02.010.

Goyal A, Robinson KJ, et al. Palpitation. StatPearls (National Library of Medicine). https://www.ncbi.nlm.nih.gov/books/NBK436016/. Accessed 5 April 2023.

Sheng Y, Carpenter JS, et al. Review of menopausal palpitations measures. Womens Midlife Health. 2021 May 31;7(1):5. doi: 10.1186/s40695-021-00063-6.

Sheng Y, Carpenter JS, et al. Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric. 2022 Apr;25(2):128-140. doi: 10.1080/13697137.2021.1948006.

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Patricia Shelton

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