You’re sitting still, and suddenly your heart is pounding, skipping or fluttering. For many women in perimenopause, this is a new and unsettling experience. Most of the time it’s harmless — but it’s worth understanding, and occasionally worth checking.
Why it happens
Fluctuating estrogen affects the autonomic nervous system, which controls heart rate. Palpitations often travel with hot flashes: the same surge that widens blood vessels can push the heart rate up. Anxiety, poor sleep, caffeine and alcohol can all add to it.
In studies, a substantial share of women in the menopause transition report palpitations, making them one of the more common — and less talked about — symptoms.
Usually harmless
Palpitations are more likely to be benign when they:
- Are brief, lasting seconds to a few minutes
- Come with hot flashes or stress
- Happen without chest pain, fainting or breathlessness
When to seek care
Get urgent medical help for palpitations with chest pain, shortness of breath, fainting or near-fainting, or confusion.
Book a regular appointment if palpitations are frequent, last longer, feel irregular, or are new and unexplained. A clinician may check your thyroid (an overactive thyroid causes palpitations), iron levels, and heart rhythm with an ECG or a wearable monitor.
A broader point about heart health
Menopause is a turning point for cardiovascular risk. After menopause, LDL cholesterol and blood pressure tend to rise, and heart disease is the leading cause of death for women. Palpitations are a good prompt to check your numbers — blood pressure, cholesterol and blood sugar — even if the palpitations themselves turn out to be benign.
What helps
Cutting back on caffeine and alcohol, managing stress, improving sleep and staying active all reduce palpitations for many women. If hot flashes are frequent, treating them often reduces palpitations too.