Why does heart palpitations occur during menopause? Causes and when is it dangerous?

The sensation of a strong, racing, jumping, or skipping heartbeat can indeed occur during perimenopause and menopause. The current guidelines from the European Society of Endocrinology list palpitations as a possible symptom of the menopausal transition. They often occur alongside hot flashes, sweating, sleep disturbances, or anxiety. [1]

But there's a crucial caveat: palpitations are a sensation, not a diagnosis, and not even necessarily tachycardia. During an attack, the heart may indeed beat faster, extrasystoles or other arrhythmias may occur, but sometimes a person feels strong thumps despite a completely normal sinus rhythm. It's impossible to reliably distinguish between these variations based on subjective sensations. [2]

Therefore, new palpitations after age 45-50 should not be automatically attributed to "hormones." It's wise to discuss recurring episodes with a doctor, and usually at least one electrocardiogram should be performed. If palpitations are accompanied by chest pain or pressure, severe shortness of breath, fainting, or pre-syncope, urgent medical evaluation is required. [3]

What do women call a heartbeat?

The word "heartbeat" can encompass a wide range of sensations. Some describe a sudden acceleration of the pulse, others a strong pounding of the heart in the chest or throat, and still others experience a "fluttering," a "somersault," a "skipping beat," or several rapid beats in a row.

In medical terminology, palpitations refer to an unpleasant or unusually pronounced awareness of one's own heartbeat. It can occur with a fast, slow, irregular, or even normal rhythm. Therefore, the phrase "I have palpitations" doesn't answer the question of what was happening with the heart's electrical activity at that moment. [4]

For example, with a single premature extrasystole, a person often feels the subsequent contraction more strongly than the initial beat itself. In another case, the attack may resemble normal sinus tachycardia during a hot flash or anxiety attack. And in a third patient, the same symptoms may mask supraventricular tachycardia or atrial fibrillation.

Therefore, one of the main tasks of the examination is to compare the subjective attack with the real electrocardiographic rhythm. [5]

Why Heart Palpitations Are Actually Linked to Menopause

The connection exists at the symptom level. The European Society of Endocrinology, in its 2025 guidelines, classifies palpitations as symptoms that occur during perimenopause and menopause. The NHS also notes that during this period, a woman may experience a faster, slower, or simply more noticeable heartbeat. [6]

The longitudinal study SWAN (Study of Women's Health Across the Nation) followed 3,276 women throughout the menopausal transition. Researchers found several symptom trajectories: some women had a higher incidence of palpitations during perimenopause and early postmenopause and then experienced a decrease. Palpitations were more often associated with vasomotor symptoms, sleep disturbances, stress, depressive symptoms, and higher blood pressure. [7]

However, these are observational data. They confirm that the symptom does cluster around the menopausal transition, but they don't prove a simple "estrogen decline directly causes arrhythmia" chain.

Moreover, in the same SWAN, heart rate patterns were not associated with the studied indicators of subclinical atherosclerosis or arterial stiffness. This is a useful reassuring result, but it does not mean that all heart rate patterns are safe or that an individual woman cannot simultaneously have a true arrhythmia. [8]

Heart palpitations during high tide

If the heart begins to beat strongly or rapidly at the same time as sudden heat, sweating and flushing of the face or chest, the most obvious connection is with a vasomotor symptom - a hot flash.

The NHS describes a hot flash as an episode of sudden heat or cold in the face, neck, and chest, which may be accompanied by sweating, dizziness, anxiety, and palpitations. The Menopause Society also notes that some women experience an increased heart rate during a hot flash. [9]

This explains a common picture: a woman is sitting quietly or sleeping, suddenly feels a wave of heat, then her heart begins to beat strongly, sweat appears, and after a few minutes the condition gradually passes.

But even this temporary connection doesn't mean every attack is harmless. If the heartbeat becomes severely irregular, lasts significantly longer than the hot flash itself, or is accompanied by other alarming symptoms, the doctor may want to record the rhythm.

What happens to the nervous system and heart?

One of the hypotheses being discussed links vasomotor symptoms with changes in the autonomic nervous system—the system that automatically regulates heart rate, vascular tone, sweating, and many other functions.

During the menopausal transition, estrogen signaling, thermoregulation, and the interaction between the sympathetic and parasympathetic nervous systems are altered. Reviews have examined changes in autonomic regulation as a possible link between vasomotor symptoms and cardiovascular physiology. [10]

However, this mechanism cannot be considered a definitively proven explanation for menopausal palpitations.

A 2026 systematic review comparing heart rate variability in women with and without vasomotor symptoms is particularly revealing. Pooled analysis found no significant differences in the primary outcome measures, and there was very high heterogeneity between studies. The authors concluded that larger, more standardized studies are needed. DOI: 10.14814/phy2.70907. [11]

So the popular explanation is:

"Estrogen dropped, the sympathetic system kicked in, and tachycardia set in."

Too categorical.

To be more scientifically accurate, hormonal transitions can alter vasomotor and autonomic regulation, but the precise mechanism of a woman's heartbeat is often impossible to determine without assessing the rhythm itself.

Why does heart palpitations often occur along with anxiety?

Anxiety and heart palpitations are indeed closely related, but the connection can work both ways.

When you're anxious, the sympathetic nervous system is activated, your attention to bodily sensations increases, and a normal heartbeat can be perceived as significantly more intense. However, a sudden, unusual heartbeat can itself be frightening, causing anxiety to increase the heart rate even more.

Studies of menopausal women have found a link between heart rate and vasomotor symptoms and a number of psychoemotional factors, but data on the independent role of anxiety are mixed. A scoping review of 84 studies found a more convincing link with the severity of hot flashes, sleep disturbances, and quality of life, while for anxiety and stress, the evidence was insufficient to draw a definitive conclusion. [12]

Therefore, you should not use the phrase:

"It's just nerves."

The modern approach is the opposite: if palpitations recur, medical causes and rhythm are assessed first, with a psychological component considered as one possible part of the picture. The 2024 AAFP review also emphasizes that a psychosomatic cause should be considered, but not instead of excluding clinically significant cardiac pathology. [13]

Why lack of sleep can worsen the problem

Menopausal hot flashes, night sweats, and chronic insomnia can severely fragment sleep. Sleep deprivation itself increases subjective sensitivity to stress and bodily sensations, so a woman may be more sensitive to normal heart rate fluctuations.

A review of correlates of palpitations during menopause did find a fairly consistent association between poorer sleep and greater palpitation severity. But this is again an association: studies do not allow us to conclude that sleep disturbance is directly responsible for every attack. [14]

Almost a combination of:

Hot flashes → poor sleep → anxiety and fatigue → more noticeable heartbeat

It is quite possible.

But if the palpitations are persistent or pronounced, sleep correction is not a substitute for an electrocardiographic evaluation.

Palpitations are not the same as tachycardia.

This is one of the most important differences for the reader.

Tachycardia is an objectively accelerated heart rate. Heart palpitations are a subjective sensation.

A person can feel every contraction very strongly when the pulse rate is normal. The opposite is also possible: some arrhythmias are barely felt.

In the 2025 Menopause Racing Heart Pilot Study, a small study of 30 middle-aged women wore a long-term electrocardiographic monitor. Women with palpitations reported episodes both during abnormal rhythms and during normal sinus rhythm; at night, sinus rhythm was found to be particularly frequent during subjective episodes. [15]

In the group with palpitations, the researchers found some differences, including longer episodes of atrial tachycardia and lower heart rate variability. However, the study included only 30 women and is specifically positioned by the authors as a hypothesis-generating pilot study—it generates hypotheses rather than establishes clinical rules. [16]

The main practical conclusion is much more reliable:

It is impossible to tell by sensation whether an attack is arrhythmia.

What are extrasystoles and why do they feel like a "skip"?

One of the common cardiac causes of the sensation of interruptions is premature atrial or ventricular contractions - extrasystoles.

A woman might describe them as:

• "my heart stopped for a second"
• "Something turned over in my chest,"
• "missed a blow, then hit hard."

Extrasystoles are common even in people without structural heart disease. Their clinical significance depends on the type, number, symptoms, and condition of the heart itself. Reviews of palpitations include atrial and ventricular premature contractions among the common cardiac causes of the symptom. [17]

It is possible to establish that the sensation actually corresponds to an extrasystole only by recording the electrical rhythm.

Are arrhythmia and menopause the same thing?

No. Menopausal palpitations and cardiac arrhythmia are different concepts, although they can coincide in the same person.

Arrhythmia refers to an objective disturbance of the heart's electrical rhythm: it may be too fast, too slow, or irregular. Palpitations are just one possible symptom of arrhythmia. [18]

In middle age, the likelihood of various diseases that can manifest as palpitations increases, so the mistake “I’m 52 years old, so it’s all because of menopause” is especially undesirable.

Possible cardiac causes include, but are not limited to, premature beats, supraventricular tachycardias, and atrial fibrillation. However, the words "flutter" or "flutter" do not indicate the specific rhythm present.[19]

What causes should be ruled out besides menopause?

Menopause is only one point in a rather broad differential series.

A modern review of palpitations identifies cardiac, endocrine and metabolic, medicinal, and psychoemotional causes. These include anemia, hyperthyroidism, electrolyte imbalances, medications and stimulants, and various arrhythmias. [20]

Four alternatives are particularly practical.

Thyroid disease. Excess thyroid hormones can cause rapid pulse and heartbeat. If symptoms occur, thyroid function is tested in a laboratory. [21]

Anemia. If menstrual flow becomes significantly heavier during perimenopause, iron deficiency or anemia develops, and the heart may work harder to compensate. A complete blood count is one of the standard tests considered in diagnosing recurrent palpitations. [22]

Caffeine, nicotine, alcohol, and stimulants are well-known triggers of palpitations. Some over-the-counter cold medications also contain stimulants. [23]

Medications. Therefore, at the appointment, it is useful to list not only prescription medications, but also over-the-counter medications, supplements, and energy products. [24]

Could the thyroid gland, not menopause, be to blame?

Yes. Symptoms of hyperthyroidism can partially resemble those of menopause: fever, sweating, anxiety, sleep disturbances, and palpitations.

Therefore, if palpitations predominate over other symptoms or are accompanied by other signs of thyroid disease, the doctor may order a thyroid-stimulating hormone test and other tests as indicated. A modern review of palpitations diagnostics includes thyroid function in the targeted laboratory testing. [25]

The European Menopause Guidelines also specifically remind that menopause-like symptoms sometimes require exclusion of other endocrine conditions rather than automatically being attributed to the oestrogen transition.[26]

Could anemia be the cause due to heavy periods?

Yes, especially during perimenopause, when some women experience heavier or longer bleeding.

Anemia is included in the differential diagnosis of palpitations. Therefore, with an appropriate history, a complete blood count is one of the most logical laboratory tests. [27]

If a woman simultaneously reports:

• "My periods have become much heavier,"
• "I get tired quickly"
• "weakness appeared"
• "I get out of breath during normal exercise"
• "my heart started beating strongly"
• It is reasonable to assess not only perimenopause but also blood loss.

However, the heartbeat alone is not enough to diagnose anemia.

Coffee may be tolerated differently

Caffeine is a recognized trigger of heart palpitations, although sensitivity varies widely between individuals.[28]

So, a woman who has been happily drinking four cups of coffee for years may notice that, in the face of poor sleep, hot flashes, and anxiety, the same amount has become significantly more unpleasant.

This doesn't prove that menopause altered caffeine metabolism so much that it became "dangerous." It's much easier to use a practical test: if attacks consistently occur after coffee or an energy drink, temporarily reducing the amount and monitoring the frequency of symptoms is a reasonable step.

But severe palpitations should not be treated for months by simply avoiding coffee without a basic medical evaluation.

How to distinguish palpitations during a hot flash from arrhythmia

Reliable diagnosis is only achieved by recording the rhythm. However, a description of the episode helps the doctor choose the appropriate examination.

Situation	What does she suggest?	What do they usually do?
Palpitations appear along with heat and sweating and disappear along with hot flashes	Possible connection with vasomotor symptom	Menopausal symptoms are assessed and, if they recur, the rhythm
Several single "skips" or strong blows	Extrasystoles are possible	Electrocardiogram; monitoring if necessary
Suddenly a very fast rhythm begins and ends just as suddenly	Requires exclusion of tachyarrhythmia	It is advisable to record the episode on an electrocardiogram.
The rhythm seems chaotically irregular	Arrhythmia is possible, but the sensation is unreliable	Electrocardiographic recording
Heart palpitations appear during physical exertion	Requires a more careful cardiac assessment	The doctor decides on monitoring and stress testing
The attack is accompanied by fainting, chest pain or severe shortness of breath	Potentially dangerous situation	Urgent assessment

Diagnostic recommendations are based primarily on the history, physical examination, 12-lead electrocardiogram and, when the attack cannot be detected, ambulatory monitoring. [29]

When to seek urgent medical attention

Palpitations require urgent evaluation if signs of possible hemodynamic instability, ischemia, or serious arrhythmia occur simultaneously.

Of particular importance are:

• pain, pressure, or severe discomfort in the chest;
• severe shortness of breath;
• loss of consciousness or near fainting;
• severe dizziness during an ongoing attack;
• sudden weakness or collapse.

The NHS recommends seeking emergency care if palpitations persist and are accompanied by chest pain, shortness of breath, or fainting. The American Heart Association also lists fainting, severe shortness of breath, and chest pain or pressure as important symptoms of a possible arrhythmia or other cardiovascular condition. [30]

For the international reader, the correct action in this situation is to call the local emergency medical service rather than driving yourself.

If dangerous symptoms have already stopped, but occurred along with palpitations, urgent medical evaluation is still required. [31]

When a heartbeat is not an emergency but still requires medical attention

A planned or expedited outpatient evaluation is needed if attacks:

They occur more frequently, last longer than usual, occur without an obvious trigger, appear during physical activity, or are present in a person with a known heart condition.

The NHS also recommends seeing a doctor if attacks are repeated, become more frequent, last longer than a few minutes, or if there is heart disease or a significant family history of heart disease.[32]

A family history of sudden death at a young age or hereditary cardiac arrhythmias deserves special attention. This changes the threshold for a more detailed examination. [33]

How is the heartbeat examined?

The first step is to understand what exactly was happening to the heart at the time of the symptom. Most modern algorithms include a detailed history, physical examination, and a 12-lead electrocardiogram (ECG). [34]

The doctor will typically ask about the duration of the episode, suddenness of onset and end, sensation of regularity, relationship with exercise, hot flashes or stress, medications, caffeine, alcohol and nicotine, family history and known heart disease.

A standard electrocardiogram can detect arrhythmia, conduction disturbances, or other changes. But there's an obvious limitation: if the attack occurred yesterday and the electrocardiogram is performed today, the rhythm may appear completely normal.

A normal electrocardiogram between attacks therefore does not always exclude paroxysmal (episodic) arrhythmia. If suspicion remains, a longer recording is used. [35]

Holter or longer monitor

If symptoms occur daily, 24-hour or bi-daily monitoring may be sufficient. For less frequent episodes, a short Holter monitor can easily miss the event.

A current 2024 AAFP review therefore recommends tailoring monitoring duration to symptom frequency. For intermittent unexplained palpitations, longer external monitors or patches are often used, and for very rare significant episodes, other devices are also available. [36]

The main goal remains simple:

Catch the moment when the woman felt her heartbeat and see what rhythm was registered at the same time.

It is precisely this comparison that most reliably separates arrhythmia from the subjective sensation of normal rhythm. [37]

What tests may be needed?

There is no universal "heartbeat panel"; the tests chosen depend on the patient's history and symptoms.

The 2024 AAFP review notes that there is no single consensus on laboratory testing, but a reasonable targeted evaluation may include a complete blood count, electrolytes, thyroid function tests, and other tests as appropriate for the clinical situation.[38]

The practical meaning is this:

A complete blood count helps to detect anemia;

Thyroid stimulating hormone and other thyroid tests are considered when thyroid disease is suspected;

Electrolytes may be important in certain heart rhythm disorders, diseases, or medications.

If chest pain or suspected acute cardiac disease is present, the diagnostic strategy is different and may include urgent cardiac biomarkers and other tests. [39]

Should I have estradiol and FSH tests done because of my heart palpitations?

After age 45, with a typical perimenopausal picture, such tests are usually not needed to prove that a woman is in the menopausal transition.

The European Society of Endocrinology recommends that perimenopause should usually be diagnosed clinically after age 45, as follicle-stimulating hormone fluctuates significantly and a single normal value does not exclude the transition. [40]

Moreover, the results of estradiol or FSH do not show what the rhythm was during the attack.

Therefore, when you have a heartbeat, it is much more useful to first answer the question:

"What does the heart do during a symptom?"

And not:

"What are your estrogen levels today?"

Is echocardiography necessary?

Not every person with brief palpitations requires a cardiac ultrasound.

Echocardiography becomes more relevant if the history, examination, or electrocardiogram raises suspicion of structural heart disease, such as a new abnormal murmur, signs of heart failure, syncope, or other relevant findings.[41]

That is the scheme:

Menopause + heart palpitations = everyone needs an echocardiogram

Does not correspond to the modern approach.

The study should answer a specific clinical question.

Is it necessary to do a stress test?

If palpitations occur during or shortly after physical exertion, the diagnostic approach becomes more cautious.

The AAFP recommends considering exercise testing for palpitations during or immediately after physical activity and for clinical suspicion of coronary artery disease.[42]

This is different from the typical short palpitations that occur with a hot flash in bed at night.

In both cases, the symptom may be benign, but the clinical context changes the likelihood of different causes.

Are smart watches useful?

They can be useful if they can record an electrocardiogram during an attack, but they are not a substitute for medical diagnosis.

Modern wearable devices have been well studied, primarily for detecting possible atrial fibrillation. For other types of arrhythmias, their diagnostic capabilities are significantly less certain, and false-positive alerts do occur. [43]

If the watch offers a single-channel electrocardiographic recording made directly at the time of the symptom, it makes sense to save it and show it to the doctor.

However, the message:

"The watch said the pulse was high."

Does not establish the cause.

Conversely, the absence of a warning from the watch does not guarantee the absence of short-term arrhythmia.

What is useful to write down during an attack?

A small symptom log is extremely useful for a physician. It doesn't need to become a constant, anxious monitoring; simply recording a few key characteristics of recurring episodes is sufficient.

Record the date and time, approximate duration, events immediately preceding the attack, whether you had a hot flash, coffee, alcohol, or exercise, whether your pulse seemed regular or irregular, and whether you experienced dizziness, pain, or shortness of breath. If you have a blood pressure reading or an electrocardiogram (EKG) from your watch, you can also save the results.

This diary helps you choose the right type of monitoring and correlate your heart rate with other menopausal symptoms.

It does not replace an electrocardiogram, but it makes its interpretation much more informative.

What to do during a common short attack

If the heartbeat is brief, familiar, and there is no chest pain, severe shortness of breath, fainting, or other dangerous symptoms, it makes sense to stop exercising, sit down, and pay attention to the nature of the attack.

There's no need to panic and count every heartbeat for twenty minutes. It's more helpful to assess whether the symptom resolves on its own and whether there are any accompanying signs of impaired circulation.

If possible, you can measure your pulse and blood pressure or perform an electrocardiographic recording on a device capable of doing this.

Do not self-administer antiarrhythmic medications or increase the dose of a previously prescribed cardiac medication simply because "climacteric tachycardia" is suspected. Treatment depends on the actual rhythm.

Will cutting down on caffeine help?

If caffeine is a regular trigger for attacks, cutting down on the amount makes sense.

Caffeine, nicotine, alcohol, and some stimulants are among the common triggers of palpitations.[44]

A simple individual experiment can be helpful: reduce caffeine for a few weeks and see if the frequency of symptoms changes.

However, there is no universal ban on coffee for all women going through menopause.

If the attacks do not change or become more severe, continuing to look for only the food trigger is no longer enough.

Can hot flash treatment help?

If palpitations occur primarily in conjunction with severe vasomotor symptoms, treating the hot flashes themselves may reduce the overall symptom burden. However, the evidence for treating palpitations specifically is significantly weaker than the evidence for treating hot flashes.

A systematic review of 37 studies examining the treatment of menopausal palpitations found mostly small studies and moderate- or low-quality evidence. The authors were unable to recommend any method as a well-proven, specific treatment for palpitations; some hormonal options, including estradiol, had positive results, but only with caution. [45]

This is a fundamental nuance.

Menopausal hormone therapy has been well studied as a treatment for certain menopausal symptoms, particularly vasomotor symptoms, but palpitations themselves do not yet have the same evidence base as an independent indication.

Will hormone therapy help?

It may reduce heart rate in some women, especially if the symptom is part of a general complex of vasomotor manifestations, but such an effect cannot be guaranteed.

The European Society of Endocrinology recommends an individual approach to menopausal hormone therapy and the choice of treatment based on the totality of symptoms, medical history and risk factors, rather than one isolated sensation. [46]

A systematic review of palpitations shows that the available research is too limited to recommend hormonal therapy as an established treatment for palpitations.[47]

So the logic is:

"I'm 50 years old, my heart is racing – I need to start estrogen."

Not safe.

First, it is necessary to understand whether the symptom really corresponds to vasomotor syndrome and whether there is an independent cardiac, endocrine or other cause.

And if hormonal therapy has already been prescribed

If palpitations appear after starting a new medication or changing your treatment regimen, the temporal relationship should be discussed with your prescribing physician.

You should not stop or change the dose of a hormonal drug on your own based on this symptom alone, especially if the therapy is prescribed for specific medical indications.

The European Society of Endocrinology recommends that after initiation of menopausal hormone therapy, the effect, tolerability and progression of symptoms should be assessed and, if there is an insufficient response or side effects, the dose or form of therapy should be reconsidered. [48]

But if your heart palpitations are accompanied by dangerous symptoms, you don't need to wait for a scheduled visit.

Is it necessary to treat the heart if the examination is normal?

If examination, electrocardiogram, and, if necessary, monitoring do not reveal a clinically significant arrhythmia or structural heart disease, treatment depends on the remaining suspected mechanism.

Sometimes, explaining the benign nature of individual extrasystoles, adjusting the pacemaker, and observing is sufficient. In other cases, the palpitations are closely associated with anxiety, panic symptoms, or severe hot flashes, and treatment is directed at these. [49]

The mere fact that a symptom is felt very strongly doesn't mean the person is "making it up." A normal sinus rhythm can indeed be subjectively extremely unpleasant.

But it is precisely normal registration during a habitual symptom that allows us to move much more confidently from the search for dangerous arrhythmia to other mechanisms.

What the first study with long-term rhythm recording in such women showed

In 2025, a small but interesting Menopause Racing Heart Pilot Study was published, specifically designed to study the heartbeat of middle-aged women.

Fifteen women with palpitations and fifteen without wore an electrocardiographic patch for 14 to 28 days. They simultaneously reported episodes of palpitations and vasomotor symptoms.[50]

The study showed two sides of the problem at once.

On the one hand, subjective palpitations often occurred against the background of normal sinus rhythm, especially at night.

On the other hand, in women with complaints, the researchers found some objective rhythm differences, including longer episodes of atrial tachycardia.

Due to the extremely small sample size, it cannot be concluded that menopausal palpitations typically represent atrial tachycardia. The authors explicitly consider the results preliminary and require a larger study. [51]

But the work demonstrates the clinical principle very well:

The symptom should neither be automatically assumed to be a benign hormonal phenomenon, nor should it be automatically assumed to be an arrhythmia. The rhythm must be recorded.

Is palpitations during menopause dangerous for the heart?

The mere presence of palpitations does not mean that cardiovascular disease is developing.

In a large SWAN, women with different heart rate trajectories did not differ in the measured measures of subclinical atherosclerosis or arterial stiffness after accounting for confounding factors.[52]

This is an important argument against the claim that every menopausal heartbeat means “wear and tear on the heart.”

But the study did not test every possible arrhythmia and does not allow us to say that the symptom is always safe.

Furthermore, the menopausal transition occurs at an age when cardiometabolic risk gradually becomes more significant. Recent reviews emphasize the need to use midlife as an opportunity to assess blood pressure, lipids, diabetes, and other cardiovascular risk factors. [53]

That is, heart rate and long-term cardiovascular risk are related but not identical issues.

What is often misunderstood

"Palpitations during menopause are always due to hormones." No. Menopause can indeed be accompanied by palpitations, but arrhythmia, thyroid disease, anemia, medications, stimulants, and other causes must also be considered. [54]

"If the pulse isn't very high, then everything is fine." Not necessarily. Some arrhythmias manifest as irregularities or extrasystoles without a persistent, pronounced tachycardia, and the subjective sensation generally poorly reflects the exact rhythm. [55]

"If your heart is pounding, it's definitely tachycardia." No. A 2025 study found that women could experience palpitations even during normal sinus rhythm. [56]

"If the electrocardiogram in the office is normal, there is definitely no arrhythmia." No. The attack may end before the test; if symptoms persist, outpatient electrocardiographic monitoring is used. [57]

"Hormone therapy has been shown to treat palpitations." The evidence is still insufficient. A systematic review could not recommend any method as a clearly proven specific treatment for menopausal palpitations. [58]

"It's just anxiety." Anxiety may be involved, but potential cardiac and other medical causes cannot be ruled out just because a person is going through a stressful period.[59]

Practical algorithm

If palpitations occur for the first time during perimenopause, it's best to start by characterizing them rather than self-treating. Note whether they occur with hot flashes, how long they last, whether they are associated with coffee, alcohol, exercise, or waking up at night, and whether there are any additional symptoms.

If attacks recur, it's worth consulting your family doctor or primary care physician. A basic evaluation typically includes a medical history, physical examination, and a 12-lead electrocardiogram (ECG). Depending on the situation, the doctor may order a complete blood count, thyroid function, electrolytes, and other tests. [60]

If the routine ECG is normal but symptoms persist, a useful next step is often ambulatory rhythm recording, the duration of which is chosen based on the frequency of episodes.[61]

If an arrhythmia is detected, the specific rhythm disorder is treated. If the rhythm is normal during the symptom and no heart disease is detected, vasomotor symptoms, anxiety, sleep, and triggers can be more effectively addressed.

If the attack is accompanied by chest pain, severe shortness of breath, fainting, or near fainting, there is no need to go through all these stages in sequence - an urgent medical assessment is required. [62]

Key points from experts

Janet S. Carpenter, PhD, RN, FAAN, is a Distinguished Professor at Dean Indiana University School of Nursing and a researcher of menopausal symptoms. Carpenter's university profile specifically lists palpitations as one of her research interests. [63]

Her group's research emphasizes that women describe menopausal palpitations very differently and often fail to report them to their doctors at all. Later work with long-term electrocardiographic monitoring showed why this complaint requires further study: the same subjective sensation can accompany both sinus and altered rhythms. [64]

Chrisandra L. Shufelt, MD, MS, FACP - Professor of Medicine, Chair, Division of General Internal Medicine, Mayo Clinic; researcher of hormones and women's cardiovascular health. Her official Mayo Clinic profile describes research on the interactions of reproductive hormones, menopause, and the cardiovascular system. [65]

In a special interview about palpitations and menopause, Shufelt emphasizes a practical principle: the menopausal transition may indeed be one cause of palpitations, but it should not be automatically attributed to every episode; sleep, stress, caffeine, dehydration, thyroid disease, and cardiac causes must be considered. [66]

Mary Ann Lumsden is Hon Professor of Medical Education and Gynaecology, University of Glasgow, and lead author of the European Society of Endocrinology Clinical Practice Guideline 2025. Her position and leadership role are confirmed by the publication of the guideline. [67]

In its guidelines, the international working group includes palpitations in the spectrum of possible menopausal symptoms, but at the same time recommends a holistic assessment of the midlife woman, rather than an approach in which every individual symptom is automatically attributed to estrogen deficiency.[68]

Frequently Asked Questions

Is heart palpitations normal during menopause?

It does occur during perimenopause and menopause, but "normal" should not mean "never need to be examined." Recurring or new attacks should be discussed with a doctor. [69]

Why does the heart start beating during high tide?

Hot flashes may be accompanied by temporary changes in vasomotor and autonomic regulation, sweating, anxiety, and a sensation of rapid heartbeat. The precise mechanism of palpitations remains unclear.[70]

Can there be a heartbeat without a rush?

Yes. In studies, palpitations have also been observed outside of vasomotor episodes. Therefore, the absence of fever does not exclude either a menopausal connection or other causes. [71]

Why do I feel my heartbeat more often at night?

At night, there are fewer external stimuli, so cardiac sensations may become more noticeable; furthermore, attacks may coincide with nocturnal hot flashes and awakenings. In a pilot monitoring study, many subjective nocturnal episodes occurred in sinus rhythm. [72]

Are palpitations and tachycardia the same thing?

No. Tachycardia means an objectively accelerated heart rate, and palpitations are the sensation of the heart beating. This is possible even with a normal heart rate and sinus rhythm. [73]

How do you know if these are extrasystoles?

It's impossible to be sure by feel. "Skipping," "somersaults," and isolated strong beats may correspond to extrasystoles, but an electrocardiographic recording confirms this. [74]

Can menopause cause true arrhythmia?

The menopausal transition is associated with palpitations and changes in cardiovascular physiology, but evidence is insufficient to attribute any episode of arrhythmia directly to the hormonal transition. Confirmed arrhythmia is assessed and treated as an independent condition. [75]

Why is the thyroid gland checked when the heartbeat is detected?

Because excess thyroid hormones can cause rapid pulse and palpitations, and symptoms may partially overlap with menopausal symptoms. [76]

Why is a complete blood count needed?

It helps to identify anemia, one of the possible causes of palpitations, which is especially relevant in cases of severe uterine bleeding. [77]

Does a normal electrocardiogram rule out arrhythmia?

No, if the attacks are episodic. If necessary, an ambulatory monitor is used to record the rhythm directly during the symptom. [78]

Is it worth buying a watch with an electrocardiogram?

They may help maintain a record during an episode, particularly if atrial fibrillation is suspected, but are not a substitute for medical evaluation and have been less well studied for many other arrhythmias.[79]

Will hormone therapy help stop heart palpitations?

In some women, the symptom may decrease, especially when combined with vasomotor symptoms, but evidence is insufficient to guarantee an effect. Initiating menopausal hormone therapy solely for palpitations without assessing the underlying cause should not be done. [80]

When is palpitations dangerous?

Particularly alarming is the combination with chest pain or pressure, severe shortness of breath, fainting, or severe dizziness. In such a situation, emergency assistance is required. [81]

Which doctor should I contact?

A family doctor or primary care physician is usually a good starting point. If you suspect an arrhythmia, an abnormal electrocardiogram, heart disease, or significant symptoms, a cardiologist may be needed.

Main

Palpitations are indeed part of the spectrum of perimenopause and menopause symptoms, especially when they occur along with hot flashes, sleep disturbances, and other vasomotor manifestations. However, this is a symptom, not a diagnosis. A strong palpitation can occur with normal sinus rhythm, as well as with extrasystoles or true arrhythmia. [82]

Therefore, the main practical question is not "has estrogen decreased enough to cause tachycardia?" but "what was the rhythm at the time of the attack and is there another cause?" Recurrent palpitations are usually assessed by history, examination, electrocardiogram, and, if necessary, long-term monitoring; anemia, thyroid function, and electrolytes are checked as clinically indicated. [83]

Data on specific treatment for menopausal palpitations are limited. Hormonal therapy may reduce some symptoms in appropriate women, but it is not a proven universal antiarrhythmic treatment. The development of chest pain, severe shortness of breath, fainting, or pre-syncope elevates the condition from a menopausal symptom to one requiring urgent evaluation. [84]