Heart Palpitations During Menopause: Causes and When to Worry
Pounding or fluttering at night? Palpitations are common in perimenopause, but some signs can point to a heart problem. Learn which ones need a doctor.
If you have chest pain, fainting, severe shortness of breath, or palpitations that don’t stop, call 911 or go to the emergency room.
This article is general information, not medical advice. We are not medical professionals. Any new palpitations should be checked by a doctor. Read our Medical Disclaimer.
A sudden pounding in your chest while you’re lying in bed. A fluttering feeling, or a sense that your heart skipped a beat. Many women notice these sensations for the first time in their 40s and early 50s, and it can be frightening.
The reassuring part: heart palpitations are a commonly reported symptom of perimenopause and menopause, and most of the time they’re harmless. The important part: palpitations can also be a sign of a heart rhythm problem or other condition, and heart disease risk rises after menopause. That’s why new palpitations deserve a doctor’s check, even if they turn out to be nothing.
What Palpitations Feel Like
People describe palpitations as:
- A racing or pounding heartbeat
- A fluttering in the chest
- A feeling that the heart skipped a beat or added an extra one
- A heartbeat you can feel in your throat or neck
They can last seconds or minutes and often happen at night or alongside hot flashes.
Why They Happen Around Menopause
Hormonal changes
Estrogen affects the heart and blood vessels, and the nervous system that controls heart rate. As levels fluctuate during perimenopause, many women notice their heart rate becomes more reactive.
Hot flashes and night sweats
Palpitations often come with hot flashes. During a hot flash, blood vessels widen and the heart rate can rise. See our guide to hot flashes and what helps.
Stress and anxiety
Anxiety, which can increase during the menopause transition, triggers the body’s stress response and raises heart rate.
Poor sleep
Being overtired makes the heart more sensitive to other triggers. See why you wake at 3am.
Common Triggers
- Caffeine (coffee, tea, energy drinks, some sodas)
- Alcohol
- Nicotine
- Dehydration
- Heavy meals, especially late at night
- Intense exercise without a proper cool-down
- Some medications and supplements, including decongestants, some asthma inhalers, thyroid medication at too high a dose, and some weight-loss or “energy” supplements
- Stress
Keeping a two-week log of when palpitations happen and what came before them can reveal a pattern, and it’s useful information for your doctor.
Other Causes to Rule Out
| Cause | Notes |
|---|---|
| Overactive thyroid | Can cause a fast heartbeat, weight loss, heat intolerance and anxiety. A blood test checks it |
| Anemia (low iron) | Common with heavy periods; can cause a fast heartbeat and breathlessness. See iron deficiency vs perimenopause |
| Heart rhythm problems | Such as atrial fibrillation, which becomes more common with age and needs treatment |
| Low blood sugar | Can cause shakiness and a racing heart |
| Dehydration | Low fluid volume makes the heart work harder |
| Panic attacks | Can cause a pounding heart, breathlessness and a sense of dread |
Heart Health After Menopause
After menopause, women’s risk of heart disease rises and becomes a leading health concern. That’s not a reason to panic about every flutter, but it is a reason to take heart health seriously:
- Know your blood pressure, cholesterol and blood sugar numbers
- Stay physically active
- Don’t smoke
- Keep alcohol moderate
- Manage your weight
- See your doctor regularly
Keep track of your numbers with our free blood pressure log.
What Helps
- Cut back on caffeine and alcohol and see if things improve.
- Stay hydrated through the day. Our water intake calculator gives a personal estimate.
- Slow breathing when palpitations start: breathe in slowly through your nose, out longer through your mouth.
- Get regular exercise, which improves heart health and stress resilience.
- Protect your sleep.
- Review your medications and supplements with a pharmacist.
- Talk to your doctor about menopause symptoms. If palpitations come with hot flashes, treating those may help.
How Doctors Check Palpitations
Your doctor may:
- Ask about your symptoms, triggers and family history
- Check your pulse and blood pressure
- Order blood tests (thyroid, iron, electrolytes)
- Do an ECG (electrocardiogram), a quick test of your heart’s electrical activity
- Ask you to wear a heart monitor for a day or longer to catch palpitations as they happen
Bringing your symptom log helps.
When to Get Help
Call 911 or go to the ER right away if palpitations come with:
- Chest pain, pressure or tightness
- Fainting or nearly fainting
- Severe shortness of breath
- Pain spreading to the arm, jaw, neck or back
- Sudden weakness, confusion, or trouble speaking
- A very fast heartbeat that doesn’t settle
Women’s heart attack symptoms can be less obvious than the classic crushing chest pain, and may include nausea, unusual fatigue, or pain in the back, jaw or arm. Don’t wait to see if it passes.
Make a doctor’s appointment if:
- Palpitations are new for you
- They’re becoming more frequent or lasting longer
- You have dizziness with them
- You have a history of heart disease or a family history of sudden heart problems
- You have high blood pressure, diabetes, or thyroid problems
Frequently Asked Questions
Can menopause cause heart palpitations?
Yes. Palpitations are a commonly reported symptom of perimenopause and menopause, often linked to hormonal changes and hot flashes.
Are menopause palpitations dangerous?
Usually not, but they can also be caused by heart rhythm problems or other conditions, so new palpitations should be checked by a doctor.
Why are palpitations worse at night?
Lying still makes you more aware of your heartbeat, and night sweats, poor sleep and evening caffeine or alcohol can all contribute.
How long do menopause palpitations last?
Individual episodes often last seconds to minutes. Some women notice them on and off throughout perimenopause.
What tests check palpitations?
Common tests include an ECG, blood tests, and sometimes a wearable heart monitor.
Can anxiety cause palpitations?
Yes, but it’s still important to rule out other causes before assuming anxiety is the reason.
The Short Version
Heart palpitations are common during perimenopause and are often linked to hormonal changes, hot flashes, stress, caffeine and alcohol. Most are harmless, but new palpitations should be checked by a doctor, because thyroid problems, anemia and heart rhythm conditions can cause them too. Chest pain, fainting or severe breathlessness with palpitations is an emergency: call 911. For the bigger picture, see early signs of perimenopause.
Sources
- Office on Women’s Health: Menopause Symptoms and Relief — https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief
- NHLBI: Arrhythmias — https://www.nhlbi.nih.gov/health/arrhythmias
- MedlinePlus: Heart Palpitations — https://medlineplus.gov/ency/article/003081.htm
- CDC: Women and Heart Disease — https://www.cdc.gov/heart-disease/about/women-and-heart-disease.html
- NHLBI: Heart Attack Symptoms — https://www.nhlbi.nih.gov/health/heart-attack/symptoms
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