Your heart suddenly flutters, skips, or pounds while you are sitting on the couch. It is frightening, and it is also one of the more common perimenopause complaints. Palpitations are reported by a notable share of women in the menopause transition, but they should still be checked, because other causes can look the same.
Why perimenopause can cause them
Estrogen influences the autonomic nervous system, which controls heart rate. As estrogen fluctuates, heart rhythm can feel less steady. Hot flashes and night sweats also trigger sudden heart rate rises. Poor sleep, anxiety, and stress add to it.
Other common triggers
- Caffeine and alcohol. - Skipped meals and low blood sugar. - Dehydration or low electrolytes. - Iron deficiency anemia, especially with heavy periods. - Thyroid problems. An overactive thyroid can cause a fast or irregular heartbeat, and thyroid disease is common in midlife. - Some decongestants, supplements, and medications. - Panic attacks, which can feel like a heart problem.
What to do in the moment
Sit down, breathe slowly (in for four, out for six to eight), and drink water. Some people find that bearing down gently, as if having a bowel movement, or splashing cold water on the face helps, but ask your clinician before trying vagal maneuvers if you have heart disease.
What to track
Note the time, how long it lasted, what you ate or drank, your sleep, and your stress. Many smartwatches and phones record pulse, which can be useful to show your clinician.
Ask for an evaluation
A clinician may check your heart rhythm with an ECG, possibly a heart monitor, and labs including thyroid (TSH, free T4, free T3), a complete blood count, ferritin, electrolytes, and blood sugar. Since perimenopause is also a time when cardiovascular risk rises, it is worth having your blood pressure and cholesterol checked.
Daily habits that may reduce episodes
- Limit caffeine and alcohol. - Eat regular meals with protein. - Hydrate and include magnesium- and potassium-rich foods like leafy greens and bananas. - Strength train and walk. - Practice five minutes of slow breathing daily.
When to get urgent help
Call emergency services for palpitations with chest pain or pressure, fainting, severe shortness of breath, pain spreading to the arm or jaw, or a very fast heartbeat that does not settle. Do not wait for these.
The bottom line
Perimenopause can cause palpitations, but get them checked, especially if they are frequent or new. For more support, try the free Purposeful Hormone Reset.