Heart palpitations and menopause: what you need to know

Understand the triggers and how to get help

50% of women experience palpitations during the menopause
Fluctuating oestrogen levels can cause symptoms
Although they can feel alarming, in most cases palpitations are harmless

An increasing awareness of your heart beating – whether it feels faster than usual or irregular – is a common symptom of the perimenopause and menopause [1]. However, many women aren’t aware of this symptom until it happens to them, so it can feel scary. Palpitations in women account for 16% of GP visits and they are the second most common reason for referrals to cardiology [2].

Understanding what’s happening to your heart, and how the menopause has an impact, can help you decide what action to take.

What are palpitations?

Most people will usually go about their day without noticing their heart beating. But if you get a feeling that your heart is beating more intensely than usual, or irregularly, these sensations are called ‘palpitations’. Some women describe it as a fluttering, for others it can feel like their heart is racing.

Heart palpitations can last for a few seconds or a few minutes. They can coincide with a hot flush or night sweat, a dizzy spell, feeling breathless, or they can happen on their own.

How are palpitations linked to the menopause?

The hormone oestrogen helps to protect your heart. During the perimenopause and menopause, levels of oestrogen change or decline, which can affect the pathways in your heart through which electrical impulses travel. Lower oestrogen levels can overstimulate your heart – it can beat 8-16 times more per minute.

What impact can palpitations have?

When you first feel your heart flutter, pound or beat in an unusual way, it’s natural to feel concerned, particularly if you have a history of heart problems.

In her podcast, balance founder, GP and Menopause Specialist Dr Louise Newson, spoke to author Emma Kennedy about her palpitations. Emma says: ‘I thought I was through the menopause but then the palpitations started, coupled with anxiety, which I had never had in my life before. The heart palpitations were something beyond anything that I could comprehend and I thought I was dying – at one point I was carted off in the back of an ambulance as they thought I was having a heart attack.’

Many women aren’t aware that palpitations can be linked to menopause. In a Newson Health survey on menopausal symptoms, almost three quarters of respondents experienced surprising or unexpected symptoms, with heart palpitations being quoted as an unexpected symptom by 25% of respondents [3].

Alongside the worry, palpitations can be associated with sleep problems and reduced quality of life [2]. Stress and mood fluctuations, also common during the menopause, can in turn contribute to heart palpitations.

Should I seek help?

While palpitations can feel alarming, in most cases they are usually harmless. Still, it is worth seeing a healthcare professional to rule out any other cause. Also seek help if your palpitations:

Last for several minutes
Are accompanied by shortness of breath or chest pain
Get worse over time or become more frequent
If they do not improve within three months of starting HRT.

How can I manage my palpitations?

HRT helps to relieve many symptoms caused by the menopause, including heart palpitations. Oestrogen moderates stimulation of the heart and there is evidence that if HRT is taken in the early years of menopause, it can protect your heart health [4].

RELATED: Menopause and your heart

Emma Kennedy told the Dr Louise Newson Podcast that tests determined there was nothing wrong with her heart, but she still felt awful because of the palpitations. She has a familial link to breast cancer but with her GP evaluated the risks – Emma doesn’t drink, is a healthy weight, eats well – and was prescribed a small amount oestrogen and progesterone. ‘The heart palpitations stopped in 48 hours and they haven’t come back,’ Emma says. ‘It’s like a miracle.’

Lifestyle factors can also affect palpitations. Try to reduce your stress levels – some women find practising mindfulness helpful, while others find yoga or breathing exercises useful. Sleep has a positive impact on stress so make sure you have healthy sleeping habits.

Drink plenty of water to keep hydrated and avoid alcohol and caffeine, which can trigger palpitations. Avoid sugary and high-carb foods – these can cause your blood sugar to spike, which can lead to palpitations – and eat at regular intervals.

Maintaining a healthy body weight will help to protect your heart, as will quitting smoking and taking regular exercise.

References

1. Carpenter J.S., Sheng Y., Elomba C., et al. (2021), ‘A systematic review of palpitations prevalence by menopausal status’, Curr Obstet Gynecol Rep; 10: 7–13. DOI: 10.1007/s13669-020-00302-z

2. Carpenter J.S., Sheng Y., Pike C., et al. (2022). ‘Correlates of palpitations during menopause: A scoping review’. Women’s Health. doi:10.1177/17455057221112267

3. Newson, L. (2023) ‘Distressing, debilitating and embarrassing: surprising symptoms and the need for holistic approach to menopause care’

4. Taylor J.E., Baig M.S., Helmy T., Gersh F.L. (2021), ‘Controversies regarding postmenopausal hormone replacement therapy for primary cardiovascular disease prevention in women’, Cardiol Rev, Nov-Dec 01;29(6): pp.296-304. doi:10.1097/CRD.0000000000000353