Think about a time when your heartbeat felt a little unusual — but not painful — for a few minutes or even a few seconds. That’s a heart palpitation. About 20 percent to 40 percent of women experience heart palpitations during perimenopause, according to a study in Current Obstetrics and Gynecology Reports. Heart palpitations become even more common during menopause.

Heart palpitations may just be a symptom of lower estrogen levels, but they could also mean something’s wrong with your heart, your thyroid, or another part of your body. This article will help you understand the connection between heart palpitations and perimenopause, how to manage heart palpitations, and when to talk to a doctor.

What Are Heart Palpitations?

The phrase “heart palpitations” refers to a variety of irregular heartbeats. These irregular heartbeats can feel different from person to person. Some common descriptions include:

• Racing
• Pounding
• Fluttering
• Skipping a beat
• Adding a beat
• Flip-flopping

People tend to become more aware of their heartbeat during palpitations. The beat feels exaggerated and sometimes extends to the neck or throat.

Heart palpitations are often harmless and may last only seconds to a few minutes. But they can sometimes last longer. What matters most is whether you have other warning signs (like chest pain, jaw and shoulder pain, fainting, or trouble breathing) or risk factors your doctor cares about. The symptoms of heart palpitations can overlap with more serious medical conditions, such as:

• Tachycardia — When the heart beats faster than 100 beats per minute at rest
• Atrial flutter — When the upper chambers of the heart contract at more than 250 beats per minute
• Atrial fibrillation — When the heart beats out of rhythm
• Ventricular tachycardia — When the heart beats fast and out of rhythm due to electrical problems in the lower chambers of the heart

Talk to your doctor to make sure your heart palpitations aren’t a sign of a more serious medical condition.

How Can Menopause Lead to Heart Palpitations?

Heart palpitations in perimenopause are believed to be related to falling estrogen levels. They’re considered a vasomotor symptom, which means they’re closely related to hot flashes and night sweats.

In fact, some women tend to experience heart palpitations during hot flashes.

What ThisIsMenopause Survey Participants Said About Heart Palpitations

“The hot flashes are the most annoying part. I get red and sweat, my heart races, and my ears ring harder.”

“When I started perimenopause I was getting severe hot flashes. I couldn’t function correctly as it made me nauseous. I had blurry vision, … heart palpitations, … shortness of breath, and was very, very tired.”

Researchers have long recognized that vasomotor symptoms align closely with declining estrogen levels in perimenopause. This hormonal shift may also affect the autonomic nervous system, making it harder for the body to regulate its instinctive fight-or-flight response. A rapid heartbeat is part of that response.

What Else Can Cause Heart Palpitations?

Many factors can cause heart palpitations, including:

• Stress, anxiety, or fear
• Depression
• Exercise
• Pregnancy
• Dehydration
• Spicy foods
• Sleeping on your side
• Fever
• Thyroid problems
• Blood loss
• Low blood sugar
• Anemia (low blood iron)
• Low blood oxygen
• Caffeine
• Alcohol
• Nicotine
• Recreational stimulant drugs
• Certain asthma, thyroid, and high blood pressure medications
• Certain decongestants or other cough and cold medications
• Certain nutritional or herbal supplements

Having other heart problems, like a history of heart attack, may increase your risk of heart palpitations.

Because heart palpitations can have many causes and may indicate more serious health conditions, your doctor will want to rule out nonhormonal causes. They’ll ask about your symptoms and what typically leads up to the heart palpitations. Your doctor will also review your diet, medications, and recreational drug use.

In some cases, you may need some diagnostic tests to rule out underlying conditions. These tests may include:

• Blood tests
• Urine tests
• A stress test
• Electrocardiogram (ECG)
• Echocardiogram (an ultrasound of the heart)
• A temporary heart monitor

Can You Do Anything To Manage Heart Palpitations?

If heart palpitations are distracting or distressing, you may want to find a way to manage them. For perimenopausal and menopausal women, treatment options include hormone replacement therapy, medication, or lifestyle changes.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) can help decrease the frequency and intensity of vasomotor symptoms like heart palpitations. HRT balances your body’s decreasing estrogen production with synthetic estrogen and/or progesterone/progestin. These hormones are available in various forms, including pills, skin patches, gels, sprays, and vaginal rings.

HRT isn’t safe for everyone. Whether it’s a good choice depends on your health history (including heart disease or blood clots), your age, how long it’s been since menopause, and the type of hormone therapy. Your clinician can help you weigh the risks and benefits and choose the safest option for you.

Medication

Medication may help if your heart palpitations tend to manifest as tachycardia (an unusually high heartbeat) or an arrhythmia (an out-of-sync heartbeat). Your doctor may consider prescribing medications like:

• Sodium channel blockers
• Beta-blockers
• Potassium channel blockers
• Calcium channel blockers
• Anticoagulants (blood thinners)

Some medicines help control the heart rhythm or slow a fast heartbeat. Blood thinners don’t stop the palpitations themselves. They’re used for certain rhythm problems (like atrial fibrillation) to lower the risk of stroke when a doctor thinks they’re needed.

Lifestyle Changes

Certain lifestyle changes may also help reduce heart palpitations. Start by evaluating your diet. Caffeine and alcohol can trigger palpitations for some people. Too much sodium can raise blood pressure, which affects heart health, even if it doesn’t directly stimulate the heart the way caffeine can.

• Sodium — The American Heart Association suggests aiming for 1,500 milligrams of sodium per day and staying under 2,300 milligrams per day. Note that food labels list sodium, not salt.
• Caffeine — Limit caffeine to 400 milligrams per day or less to balance its positive and negative effects, and watch for hidden sources in chocolate, certain types of tea, and some protein bars.
• Alcohol — No amount of alcohol is considered safe for the heart, so try to avoid it completely.

Stimulants found in some nutritional supplements and cold or cough medicines may also cause heart palpitations, so consider shopping for alternatives. A medical professional can advise you on what to look for.

Nicotine also causes a rapid heartbeat. One study found that smoking cigarettes causes the heart rate to quickly spike, while absorbing nicotine through the skin elevates the heart rate for up to 48 hours. This suggests that switching from one form of nicotine to another isn’t likely to improve your heart health. Try to quit entirely.

Finally, take steps to reduce stress and anxiety in your life. Both can trigger the fight-or-flight response. Prioritizing sleep, nutrition, exercise, and other forms of self-care can make it easier to cope with stress. Breathing and visualization strategies can help regulate anxiety. A healthcare professional can offer more solutions for managing anxiety and stress.

When To Talk to a Doctor

Although heart palpitations are usually nothing to worry about, mention them to your doctor anyway. They can rule out other causes — such as an overactive thyroid or a heart valve defect — and start treatment if needed. Your doctor can also help you identify potential lifestyle changes that could make a difference.

Certain co-occurring symptoms could indicate a problem that requires immediate attention. Talk to a doctor right away if your heart palpitations are accompanied by any of the following:

• Chest pain
• Back pain
• Shortness of breath or difficulty breathing
• Dizziness or lightheadedness
• Confusion
• Fainting
• Nausea or vomiting
• Swelling of your legs, ankles, feet, or hands
• Fatigue, especially if it comes on suddenly
• Unusual sweating

Tell your doctor or cardiologist if your heart palpitations start to happen more often, last longer than usual, or feel more intense. The cause of your heart palpitations can evolve over time, so it may be worth repeating diagnostic tests in the future.