Heart Palpitations

By Sophora Editorial  ·  Evidence reviewed  ·  Published July 2026  ·  Last reviewed July 2026

It happens while you are sitting still. Watching television, lying in bed, standing at the sink. A flutter, a hard thud, a sense that your heart skipped and then caught up with a jolt.

Sometimes it races for a few seconds. Sometimes it feels like it stops entirely before restarting. Your first thought is rarely calm.

Your first thought is usually: is something wrong with my heart. You are in your 40s, and this is the first time you have ever felt this.

Heart palpitations are commonly reported around the menopause transition and can be alarming when they arrive without an explanation.

Reviews have found reported prevalence ranging from about 20 to 40 percent in perimenopause and roughly 16 to 54 percent after menopause, although studies use different definitions and methods.

Hormonal change may contribute, but palpitations have many possible causes. This article explains what is known, what may help, and which symptoms need prompt medical attention.

Someone important to you needs this too.

WhatsAppiMessageCopy LinkEmail

Why perimenopause causes heart palpitations

Researchers are still working out why palpitations become more noticeable for some women during the menopause transition.

Estrogen affects cardiovascular and autonomic function, and changing hormone levels may influence heart-rate regulation and the way heartbeats are perceived.

The evidence does not support a simple story in which fluctuating estrogen directly makes the heart’s electrical signals unstable.

The autonomic nervous system helps regulate functions you do not consciously control, including heart rate and blood pressure. Its sympathetic branch prepares the body for action; its parasympathetic branch supports recovery.

Research suggests autonomic regulation can change across the menopause transition, but the direction, size and clinical significance of those changes vary.

A strong coffee, alcohol, poor sleep, stress, dehydration, fever and some medicines can also make palpitations more noticeable. Sometimes the explanation is as ordinary as caffeine arriving before breakfast and behaving as though it owns the building.

Palpitations are also associated with worse vasomotor symptoms and worse sleep in observational research.

Research has found that palpitations are reported more often by women who also have frequent hot flashes, night sweats or poor sleep. These symptoms often appear together, although researchers cannot yet say that one directly causes the other.

A hot flash can temporarily raise heart rate, and waking suddenly from sleep can make a pounding or racing heartbeat especially noticeable. These associations do not prove that every palpitation is caused by hormones, progesterone decline, adrenaline or cortisol.

That distinction is important because palpitations can also occur with arrhythmias, thyroid disease, anaemia, pregnancy, low blood sugar, dehydration, medicines and stimulants, among other causes. The sensation tells you that you are noticing your heartbeat; it does not identify the cause by itself.

Someone important to you needs this too.

WhatsAppiMessageCopy LinkEmail

When palpitations need medical evaluation

Many palpitations are harmless, but the sensation alone cannot tell you whether the cause is menopausal, cardiac or something else. Recurrent, worsening or prolonged episodes deserve medical assessment, especially when there is a history of heart disease or a family history of heart problems.

Beyond those emergency signs, arrange a routine appointment if episodes keep returning, are becoming more frequent, last longer than a few minutes, or you have a heart condition or family history of heart problems. Assessment may include an ECG and, depending on the history, blood tests or longer heart-rhythm monitoring. Thyroid disease, anaemia, medicines and stimulants are among the non-cardiac possibilities a clinician may consider. Being in your 40s does not make a hormonal explanation automatically the most likely one.

What actually helps

Start with food and drink triggers you can actually test

There is no special menopause diet proven to stop palpitations. The useful food-and-drink approach is more individual: notice whether caffeine, alcohol or large amounts of energy drinks reliably precede episodes, then reduce or remove the suspected trigger and see whether the episodes change. Stay adequately hydrated, especially in hot weather or during illness. If palpitations occur with fasting, shakiness or other symptoms, discuss that with a clinician rather than trying to diagnose blood-sugar problems from the sensation alone.

Support sleep and reduce avoidable stimulation

Poor sleep and worse vasomotor symptoms are associated with palpitations during the menopause transition.

Protecting sleep, moderating alcohol, reviewing stimulant use and treating disruptive hot flashes may reduce some of the conditions in which palpitations become more noticeable. If you snore loudly, wake gasping or have severe daytime sleepiness, ask whether sleep apnoea needs assessment.

Use slow breathing for calm, not as an arrhythmia treatment

Slow, comfortable breathing can reduce distress while an episode passes, particularly when fear is amplifying the sensation.

Avoid claims that a breathing count can reliably stop a palpitation or correct an abnormal rhythm. If an episode is sustained, severe or accompanied by warning symptoms, breathing exercises are not a substitute for medical care.

Treat the cause when one is found

Treatment depends on what the assessment shows. An arrhythmia, thyroid disorder, anaemia, medication effect or another cause needs its own management. Beta-blockers are used for some rhythm disorders and symptom situations, but they are not a routine menopause treatment and should not be presented as the automatic next step after lifestyle changes.

Where HRT fits

HRT may improve palpitations for some women, particularly when they occur alongside other menopause symptoms that respond to treatment.

The evidence specifically for treating palpitations is limited and mixed; a systematic review found that some hormonal treatments showed benefit, but the evidence was not strong enough to recommend any treatment solely for menopausal palpitations.

HRT should therefore be considered for established menopause indications after individual assessment, not as a treatment that “stabilises the underlying heart rhythm.”

“The flutter in your chest is frightening precisely because your heart is not something you want to guess about. Getting it checked once, and understanding the mechanism after, replaces fear with clarity.”

Questions you are probably asking

Is it normal to get heart palpitations in perimenopause?

Palpitations are commonly reported during the menopause transition, but prevalence estimates vary widely because studies define and measure them differently.

Reviews report roughly 20 to 40 percent in perimenopause and about 16 to 54 percent after menopause. Hormonal and autonomic changes may contribute, but the mechanism is not fully established and other causes remain possible. Recurrent, worsening or prolonged episodes deserve assessment.

Why do my palpitations happen mostly at night?

Nighttime palpitations are commonly reported in perimenopause, often triggered by hot flashes, heightened autonomic activity from sleep disruption, or undiagnosed sleep apnoea, which itself increases during this transition. If you regularly wake with a racing heart, mentioning this specifically to a doctor is worthwhile, as a sleep evaluation may be indicated alongside the standard cardiac workup.

How do I know if my palpitations are hormonal or something more serious?

You cannot know for certain without medical evaluation, because hormonal palpitations can feel identical to those caused by an arrhythmia or another cardiac condition.

What distinguishes a benign presentation is the absence of chest pain, fainting, or breathlessness. Episodes are brief, self-resolving, and clearly connected to known triggers like hot flashes or caffeine. Even with a reassuring picture, a first-time evaluation with an ECG and blood tests provides the certainty that guessing cannot.

Will palpitations stop after menopause?

There is no reliable timetable. Some women report fewer palpitations later, while others continue to experience them.

Because palpitations have several possible causes and the research on their course across menopause is limited, persistence should not automatically be blamed on hormones or assumed to disappear once periods stop.

Can anxiety cause the same feeling as hormonal palpitations?

Yes. Anxiety and panic can cause a racing, pounding or fluttering heartbeat, and feeling a palpitation can itself provoke anxiety.

The sensations can overlap with those from other causes, so symptoms should not be dismissed as “just anxiety” without considering the wider clinical picture. A clinician can use the history, examination and appropriate testing to decide what needs investigation.

In summary

A palpitation can be frightening without being dangerous, but the sensation alone cannot tell you the cause. Clear information, sensible assessment and treatment directed at the actual cause are more useful than either panic or dismissal.

Last reviewed: July 2026  ·  Review due: October 2026  ·  For education only. This is neither therapy nor medical advice. For your own use and understanding only.  ·  mysophora.com