You are lying in bed when your heart suddenly pounds. Or it starts fluttering in the middle of the day while you are sitting still. These episodes can feel frightening. Palpitations are reported during perimenopause and menopause, but a fast or unusual heartbeat is not automatically caused by hormones. New, recurring or troublesome symptoms deserve a medical assessment.

What are heart palpitations during menopause?

Palpitations mean that you become unusually aware of your heartbeat. It may feel fast, forceful, fluttering or irregular; you may notice a skipped or extra beat. This describes a sensation, not a diagnosis. Only a recording, such as an electrocardiogram or ECG, can show whether the rhythm itself has changed.

Around menopause, palpitations may occur alongside hot flushes, night sweats, disrupted sleep or inner restlessness. The timing makes a hormonal contribution plausible, but it does not prove one. It is sensible to consider the menopause transition while also checking for other causes.

Why can your heart suddenly race?

The precise link between hormonal change and palpitations is not yet clear. Fluctuating oestrogen levels may influence the autonomic nervous system, which helps regulate heart rate, blood pressure and temperature. Research also finds associations with more severe vasomotor symptoms and poorer sleep. These are clues, not a single cause-and-effect explanation.

Common triggers include stress, anxiety, lack of sleep, strenuous exercise, fever, dehydration, caffeine, alcohol and nicotine. Some medicines, including certain decongestants and inhalers, may also provoke palpitations. Medical causes worth checking include iron deficiency or anaemia, especially with heavy bleeding, an overactive thyroid, electrolyte problems and heart rhythm disorders.

What can palpitations feel like?

Experiences vary. You may notice:

• a fast, pounding or forceful heartbeat
• fluttering, skipped beats or extra beats
• a sudden start at rest or during a hot flush
• restlessness, anxiety, light-headedness or chest discomfort

What can help in the moment?

If there are no warning signs, four simple steps can help you gather useful information:

• Stop what you are doing. Sit or lie somewhere safe, and do not keep driving if you feel dizzy.
• Breathe steadily, making your out-breath a little longer than your in-breath. This may settle the alarm response but does not replace assessment.
• Note the start time, duration, possible trigger, whether the rhythm felt regular and any other symptoms. Check your pulse only if you can do so calmly.
• If your watch records an ECG, save it for your GP. Do not stop medicines or start supplements without professional advice.

What may help over time?

Keep a brief diary for one or two weeks. Record the time, duration, pulse or rhythm sensation, hot flushes, sleep, stress, drinks and medicines. This may reveal patterns without making you monitor every heartbeat.

Staying hydrated, eating regularly, protecting sleep and temporarily reducing caffeine, alcohol and nicotine may help identify personal triggers. Discuss recurrent episodes with your GP or a cardiology clinician. Depending on your history, assessment may include your pulse and blood pressure, an ECG or ambulatory monitor, and targeted blood tests. A single hormone test does not usually explain palpitations in perimenopause.

When should you seek medical help?

Call 999 or 112 if the palpitations do not settle and you have chest pain or pressure, severe shortness of breath, fainting or near-fainting, marked dizziness, cold sweats, or sudden neurological signs such as weakness, numbness or difficulty speaking. Do not wait for the symptoms to pass and do not drive yourself.

Arrange a prompt appointment if episodes are new, becoming more frequent, last more than a few minutes, feel clearly irregular or interfere with daily life. This is particularly important if you have known heart disease, a concerning family history or a repeatedly high resting pulse without an obvious reason. Anxiety can amplify palpitations, but that should never be used to dismiss your symptoms as ‘just anxiety’.

What does the research say?

A 2022 systematic review examined 37 studies of treatments for menopausal palpitations. The studies varied widely, were often small and usually measured palpitations as a secondary outcome. No treatment could therefore be recommended without reservation. A few hormonal treatments showed cautious positive signals, but the evidence did not support a one-size-fits-all recommendation.

In practical terms, hormone replacement therapy is not automatically a treatment for palpitations. If you also have troublesome menopausal symptoms, it can be discussed through an individual assessment of benefits and risks. Herbal products, magnesium and other supplements should not be tried at random before the cause, dose and possible interactions have been considered.

Further reading and sources

• The Women Circle: heart diseases are not men’s diseases
• NHS: heart palpitations, causes and when to get help
• PMC systematic review: treatments for menopausal palpitations

Your step for this week

Create a note with five fields: time, duration, pulse or rhythm sensation, possible trigger and accompanying symptoms. Complete it after every episode for seven days. Act immediately on warning signs and take the note to an appointment. It will give your clinician a clearer picture than memory alone.

You do not have to ignore palpitations or manage them alone: careful tracking and timely assessment bring clarity.