- Often linked with
- Hot flashes, anxiety and poor sleep
- First test
- Electrocardiogram (ECG)
- Common non-hormonal causes
- Caffeine, alcohol, thyroid, anemia, medications
- Call 911 if
- Chest pain, fainting, breathlessness or unusual sweating
What palpitations feel like
People describe palpitations as a thumping in the chest, a flutter, a brief pause followed by a hard beat, or a run of fast beats. They may last a few seconds or several minutes, and they are often most noticeable at night when you are lying still.
Rapid or pounding heartbeat is listed among menopause symptoms by MedlinePlus, and palpitations often happen during a hot flash or as you wake from a night sweat. Even so, the feeling itself does not tell you the cause. Harmless extra beats and important rhythm problems can feel similar, which is why testing matters.
Hormonal links
Estrogen influences the nervous system that controls heart rate and blood vessel tone. During perimenopause, hot flashes come with a surge of fight-or-flight activity that can raise heart rate. Night sweats and fragmented sleep, along with anxiety that often rises in the transition, keep the system on edge.
After menopause, the risk of heart disease rises over time, partly because of changes in cholesterol, blood pressure and body composition. That is another reason not to dismiss new heart symptoms as just hormones.
Other causes to rule out
MedlinePlus lists a range of causes, many of which are common in midlife:
- Caffeine, nicotine, alcohol, decongestants, diet pills and stimulant supplements
- Anxiety, stress and panic attacks
- An overactive thyroid, or taking too much thyroid hormone
- Anemia, often from heavy perimenopausal bleeding
- Low potassium or magnesium, dehydration and fever
- Medicines for asthma, blood pressure or heart conditions
- Obstructive sleep apnea, especially when palpitations happen at night
- Heart rhythm disorders such as atrial fibrillation, or heart valve disease
When to see a doctor urgently
Call 911 if palpitations come with chest pain or pressure, fainting or near-fainting, shortness of breath, unusual sweating, or dizziness. These can signal a dangerous rhythm or a heart attack, and women are more likely than men to also have nausea or unusual tiredness during a heart attack.
Contact a clinician promptly for any of the following:
- Palpitations for the first time, or a clear change in your usual pattern
- Frequent extra beats or runs of fast beats
- A resting pulse over 100 without exercise, fever or anxiety
- Palpitations with weight loss, heat intolerance or tremor
- Known heart disease or strong risk factors such as high blood pressure or diabetes
What testing can help
An electrocardiogram (ECG) is usually the first test, ideally done during symptoms. Because palpitations often come and go, a wearable Holter monitor for 24 hours or a longer event monitor may be needed to capture an episode. An echocardiogram can check the heart's structure and valves.
Blood tests help find contributors: thyroid function, a complete blood count and ferritin, and electrolytes including potassium and magnesium. Hormone levels do not explain palpitations. If palpitations happen mostly at night with snoring or daytime sleepiness, sleep apnea screening is worthwhile.
Treatment options in general terms
Treatment depends on what testing shows. Many people improve by cutting back on caffeine, alcohol and nicotine, treating anemia or thyroid problems, and reviewing medications and supplements. Rhythm problems such as atrial fibrillation are managed by a primary care clinician or cardiologist and may need medication to control heart rate, blood thinners to prevent stroke, or procedures.
When palpitations are clearly tied to hot flashes and the heart checks out, treating vasomotor symptoms may reduce episodes. Options include hormone therapy for suitable candidates, which requires an individual discussion of risks such as blood clots and stroke, and non-hormonal medicines. Anxiety-related palpitations respond to therapy, breathing techniques and, when needed, medication.
Simple steps while you wait for testing
Learn to take your pulse at the wrist or use a validated home blood pressure monitor or wearable that records heart rhythm. Writing down the time, your pulse rate, whether it felt regular, how long the episode lasted and what you were doing gives your clinician useful clues.
In the meantime, cut back on caffeine, alcohol and nicotine, check supplement labels for stimulants, and stay well hydrated. Slow breathing can calm palpitations driven by anxiety or a hot flash. None of these replace an ECG for new symptoms.
How HealifyMD can help
Once palpitations have been evaluated in person with an ECG, a HealifyMD clinician can help with the menopause side of the picture: reviewing hot flashes, sleep and mood, ordering labs such as thyroid function, blood count and ferritin, and discussing treatment options. We do not perform ECGs or heart monitoring, and we will send you to in-person care first if you have red-flag symptoms.
Common questions
Can menopause cause heart palpitations?
Yes. A racing or pounding heart often accompanies hot flashes, anxiety and poor sleep during the transition, but other causes need to be ruled out.
Why does my heart race at night?
Night sweats, waking from a hot flash, sleep apnea, alcohol and lying still in a quiet room can all make palpitations more noticeable at night.
Are menopause palpitations dangerous?
Most are harmless, but some rhythm problems are not. An ECG and basic blood tests are the way to tell the difference.
Should I see a cardiologist?
Start with your primary care clinician for an ECG and blood work. A cardiologist is usually involved if tests show a rhythm or structural problem or symptoms persist.
What blood tests help with palpitations?
Thyroid function, a complete blood count, ferritin and electrolytes such as potassium and magnesium are common starting points.
Do palpitations go away after menopause?
Palpitations tied to hot flashes often ease as vasomotor symptoms settle, but new palpitations at any age should be checked.
Can caffeine make palpitations worse?
Yes. Caffeine, nicotine, alcohol and stimulant supplements are common triggers, and cutting back is a simple first step.
Sources
We cite government agencies, professional societies and peer-reviewed research. See our editorial policy.
- Heart palpitationsMedlinePlus (U.S. National Library of Medicine)
- Menopause (Medical Encyclopedia)MedlinePlus (U.S. National Library of Medicine)
- About heart attack symptoms, risk, and recoveryCenters for Disease Control and Prevention
- Hyperthyroidism (Overactive Thyroid)National Institute of Diabetes and Digestive and Kidney Diseases
- Iron-deficiency anemiaNational Heart, Lung, and Blood Institute
- AnxietyMedlinePlus (U.S. National Library of Medicine)