Ever felt that sudden flutter or racing heartbeat and wondered, “What’s going on with my heart right now?” 

You’re probably experiencing heart palpitations. 

These unexpected sensations can be unsettling, leaving you searching for answers. This topic is particularly important for women in their 30s, 40s, and 50s, as hormonal changes during perimenopause and menopause can contribute to these symptoms. Understanding the causes and implications of heart palpitations can help alleviate anxiety and guide you toward appropriate care.

In this post I’ll dive deeper into understanding heart palpitations and their connection with anxiety, perimenopause, and menopause.

What Are Heart Palpitations?

Heart palpitations are feelings of having rapid, fluttering, or pounding heartbeats. You might feel like your heart is:

• Skipping beats
• Beating too fast (tachycardia)
• Pounding or fluttering
• Flip-flopping in your chest

These sensations can be felt in your chest, throat, or neck and may occur during activity or at rest.

Are Heart Palpitations Normal?

Occasional heart palpitations are common and often harmless. They can result from stress, anxiety, caffeine, nicotine, or physical exertion. However, frequent or severe palpitations may indicate an underlying medical condition, such as:

• Arrhythmia: Irregular heartbeats like atrial fibrillation or tachycardia.
• Thyroid Disorders: Hyperthyroidism can increase heart rate.
• Hormonal Changes: Fluctuations during menopause or menstruation.
• Anemia: Low red blood cell count can make the heart work harder.

If you’re experiencing palpitations regularly, it’s important to consult a healthcare professional for a proper evaluation.

Why Heart Palpitations Happen

Heart palpitations occur when there is an irregularity in the heart’s rhythm or rate, or when you become more aware of your heartbeat. Palpitations can be brief or last for longer periods. Often, palpitations are harmless, but they may sometimes indicate an underlying medical condition that needs attention.

Potential Causes of Heart Palpitations

1. Lifestyle Factors
• Stress or Anxiety: Emotional distress or panic attacks can trigger heart palpitations due to increased adrenaline in the body.
• Caffeine: High consumption of coffee, tea, or energy drinks can lead to increased heart rate and palpitations.
• Alcohol: Alcohol, especially when consumed in large amounts, can disrupt heart rhythms.
• Nicotine: Smoking or using nicotine products can cause irregular heartbeats.
• Exercise: Intense physical activity can make you more aware of your heartbeat, though it’s usually temporary.
2. Medications and Stimulants
• Cold and Cough Medications: Some over-the-counter medications contain stimulants like pseudoephedrine that can trigger palpitations.
• Diet Pills: Weight loss medications often contain stimulants that may affect the heart.
• Asthma Inhalers: Medications like albuterol used in asthma inhalers can sometimes cause palpitations.
• Thyroid Medications: Medications that affect thyroid hormone levels may cause irregular heart rhythms.
3. Medical Conditions
• Arrhythmia: Irregular heartbeats like atrial fibrillation, tachycardia, or bradycardia can cause noticeable palpitations.
• Thyroid Issues: Hyperthyroidism (overactive thyroid) can increase the heart rate and cause palpitations.
• Electrolyte Imbalances: Potassium, magnesium, calcium, and sodium imbalances can impact heart function.
• Low Blood Sugar: Hypoglycemia can increase adrenaline levels, leading to palpitations.
• Heart Conditions: Structural heart problems, such as mitral valve prolapse, heart failure, or coronary artery disease, can cause palpitations.
• Anemia: Low red blood cell levels can make the heart work harder, leading to palpitations.
• Fever: Increased body temperature raises the heart rate, potentially causing palpitations.
4. Hormonal Changes
• Menopause: Hormonal fluctuations during menopause can lead to palpitations, especially during hot flashes.
• Pregnancy: Increased blood volume and hormonal changes during pregnancy can cause palpitations.
• Menstruation: Hormonal shifts during the menstrual cycle can sometimes cause irregular heartbeats.

Hormonal changes can have a profound effect on heart function, especially in individuals going through stages like menopause, perimenopause, and menstruation.

Heart Palpitations but Normal ECG

Many individuals experience palpitations but have normal results on diagnostic tests like ECGs (electrocardiograms). This can be frustrating and lead to feelings of being dismissed by healthcare providers.

Why Do Palpitations Occur Despite Normal ECGs?

• Transient Events: Palpitations may not occur during the brief period of an ECG test.
• Non-Cardiac Causes: Hormonal changes, anxiety, or electrolyte imbalances might not show up on an ECG.
• Holter Monitors: Longer monitoring periods (24-48 hours) can sometimes capture irregularities missed in standard ECGs.

Heart Palpitations for Months

For some individuals, palpitations are not fleeting but persist for months, significantly impacting quality of life.

• Anxiety and Depression: Ongoing palpitations can lead to increased anxiety, depression, and stress.
• Sleep Disturbances: Nighttime palpitations disrupt sleep, leading to fatigue and irritability.
• Social Withdrawal: Fear of experiencing palpitations in public can lead to avoidance of social situations.

Anxiety and Heart Palpitations

Can Anxiety Cause Heart Palpitations?

Yes, anxiety is a common cause of heart palpitations. When you’re anxious or stressed, your body activates the “fight or flight” response, releasing stress hormones like adrenaline and cortisol.

Anxiety Heart Palpitations

The sensation of palpitations can, in turn, increase anxiety, creating a feedback loop that’s hard to break.

Physiological Connection Between Anxiety and Heart Rate Increases

• Sympathetic Nervous System Activation: Anxiety triggers the sympathetic nervous system, increasing heart rate and blood pressure.
• Hyperventilation: Rapid breathing can lead to imbalances in oxygen and carbon dioxide levels, affecting heart rhythm.
• Muscle Tension: Stress can cause muscle tightness, including in the chest, making palpitations more noticeable.

Heart Palpitations at Night

Why Do Palpitations Often Occur at Night or When Lying Down?

Many people report experiencing heart palpitations at night, especially when lying down. Several factors contribute to this phenomenon:

1. Increased Awareness: At night, the environment is quieter, and there are fewer distractions. This heightened awareness can make you more attuned to your heartbeat.
2. Postural Changes: Lying down can alter blood flow dynamics and increase pressure in the chest, making palpitations more noticeable.
3. Vagal Tone: The vagus nerve, which influences heart rate, can be stimulated when lying down, potentially triggering palpitations.
4. Digestive Processes: Eating a heavy meal before bedtime can cause the heart to work harder during digestion, leading to palpitations.

Heart Racing at Night Due to Anxiety

Anxiety can heighten at night when the mind is less occupied. The worry of upcoming events or dwelling on stressors can activate the body’s stress response, releasing adrenaline and causing the heart to race.

Anxiety Heart Racing When Trying to Sleep

This can create a cycle where the fear of palpitations makes it harder to relax, further exacerbating the symptoms. Mindfulness techniques and relaxation exercises before bed can help break this cycle.

Waking Up with Heart Racing Shortly After Falling Asleep

This can be caused by:

• Nocturnal Panic Attacks: Sudden episodes of intense fear during sleep.
• Sleep Apnea: Breathing interruptions during sleep can cause the heart to race upon awakening.
• Hormonal Surges: Fluctuations in stress hormones like cortisol can affect heart rate.

A study by Carpenter et al. (2022) found that women distressed by palpitations had lower morning cortisol levels, suggesting a blunted stress hormone response might be linked to palpitations.

Hormonal Changes and Heart Palpitations

By 2025, it’s estimated that 1.1 billion women globally will be navigating the challenges of menopause. Symptoms like hot flashes and night sweats are commonly discussed, but heart palpitations, which often accompany these other symptoms, receive far less attention. Yet, they significantly impact the quality of life and warrant a deeper understanding.

1. Menopause Menopause is the stage in life when menstruation permanently ceases, typically around the age of 45-55. During menopause, the ovaries reduce their production of estrogen and progesterone, hormones that regulate many systems in the body, including the cardiovascular system.
• Estrogen’s Role: Estrogen is believed to have a protective effect on the heart. It helps keep blood vessels flexible, allowing them to relax and contract efficiently. When estrogen levels drop during menopause, it can lead to changes in blood pressure and heart function, increasing the likelihood of palpitations.
• Hot Flashes and Palpitations: Many women experience hot flashes during menopause, which are often accompanied by palpitations. A hot flash can cause a sudden increase in heart rate, making the heart feel like it’s pounding or fluttering. These episodes are typically short-lived but can be uncomfortable.
• Vasomotor Symptoms: Vasomotor symptoms, such as night sweats and hot flashes, are linked to autonomic nervous system changes during menopause, which can lead to palpitations. Women who experience more severe hot flashes may be more likely to report heart palpitations.
2. Perimenopause Perimenopause is the transition phase leading up to menopause, usually beginning in the 40s but sometimes earlier. During this time, estrogen and progesterone levels fluctuate widely, which can trigger symptoms such as palpitations.
• Hormonal Fluctuations: In perimenopause, hormone levels can rise and fall unpredictably. These fluctuations may affect the autonomic nervous system, which controls involuntary functions like heart rate, contributing to palpitations. This is especially true when hormone levels spike or drop rapidly.
• Increased Sensitivity: Many women in perimenopause report becoming more sensitive to stimulants like caffeine or alcohol, which can exacerbate palpitations. The body’s response to stress may also change during this time, leading to more frequent episodes of heart palpitations.
• Progesterone’s Impact: Low levels of progesterone during perimenopause can affect the heart’s electrical system, potentially leading to more noticeable heartbeats. Progesterone has a calming effect on the body, so its reduction can contribute to anxiety and increased awareness of heart rhythm irregularities.
3. Menstruation Even during the reproductive years, many women experience hormonal shifts during their menstrual cycle that can cause palpitations. The changes are most noticeable in the days leading up to and during menstruation, particularly for women with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).
• Luteal Phase: During the luteal phase (the time between ovulation and menstruation), progesterone levels rise, and estrogen drops. This hormonal shift can cause fluid retention, bloating, and changes in blood pressure, potentially leading to heart palpitations. Women may also feel more sensitive to stress and stimulants, which could further trigger palpitations.
• Drop in Hormones Before Menstruation: Just before menstruation, both estrogen and progesterone levels fall sharply, which can lead to increased anxiety, irritability, and sometimes palpitations. These symptoms are often linked to premenstrual syndrome (PMS).
• Iron Levels and Anemia: Heavy menstrual bleeding can lead to iron deficiency or anemia, both of which can cause palpitations. When the body is low on iron, the heart has to work harder to pump oxygenated blood, which can result in noticeable irregular heartbeats.

Additional Considerations

• Hormone Replacement Therapy (HRT): For women undergoing menopause or perimenopause, hormone replacement therapy is sometimes used to alleviate symptoms. However, starting or changing HRT can sometimes temporarily increase the risk of palpitations as the body adjusts to new hormone levels.
• Stress and Emotional Changes: The hormonal changes in all these stages can also contribute to mood swings, anxiety, and stress, which further increases the risk of palpitations. Emotional stress is one of the most common non-cardiac causes of palpitations.
• Other Factors: Weight changes, diet, exercise levels, and overall health may change as women age or go through these hormonal transitions, and these factors can either mitigate or exacerbate heart palpitations.

In summary, heart palpitations can be a common symptom during menopause, perimenopause, and menstruation due to fluctuations in estrogen and progesterone levels. These hormonal changes affect the cardiovascular system and the autonomic nervous system, often leading to irregular heartbeats, especially during times of stress or emotional shifts.

Insights from Research

In a comprehensive review by Carpenter and colleagues in 2021, researchers undertook the first systematic examination of how prevalent palpitations are among women at different stages of menopause—from pre to post. They delved into existing data to paint a clearer picture of this phenomenon.

The prevalence rates they uncovered were telling:

• Premenopausal women: 3.7% to 40.2%
• Perimenopausal women: 20.1% to 40.2%
• Postmenopausal women: 15.7% to 54.1%

These numbers suggest palpitations are more common as women transition through menopause, with factors such as hormonal fluctuations playing a significant role.

• One of the critical insights from the review is that palpitations are often a secondary focus in studies, which means they don’t receive the concentrated attention needed to develop specific interventions. This lack of focused research has led to variations in how palpitations are assessed and understood across different studies and populations.
• The review also highlighted that the experience of palpitations varies widely across different cultural and geographical contexts, which complicates drawing broad conclusions but underscores the global relevance of this issue.

The study points out a significant need for standardized assessment methods for palpitations. Tools like the Menopause Rating Scale and the Kupperman Index are helpful but vary in terms of wording and recall periods. A unified approach could greatly enhance our understanding and management of palpitations.

Another enlightening piece of research was conducted by Carpenter and team in 2022, exploring the correlates of palpitations during menopause.

In this scoping review on heart palpitations in peri- and post-menopausal women, several factors were identified as “likely correlates,” meaning they are potentially linked to palpitations based on available research:

1. Race/Ethnicity: The research found that women from different racial and ethnic backgrounds reported varying experiences of palpitations during menopause. This is not surprising, as studies have shown that many menopausal symptoms, like hot flashes or sleep issues, also differ across racial and ethnic groups. For example, Black women were found to report more frequent vasomotor symptoms (like hot flashes) than White women, while Hispanic women reported more memory problems. These findings suggest that heart palpitations may be experienced differently depending on a woman’s racial or ethnic background.
2. Physical Activity: Lower levels of physical activity were found to be linked to a higher likelihood of experiencing palpitations. However, other measures of physical health, such as body weight (BMI), fitness levels, and balance, did not show the same clear connection. This suggests that staying physically active could play an important role in reducing palpitations during menopause, although further research is needed to understand why other indicators of physical health were not as strongly related.
3. Vasomotor Symptoms (VMS): Vasomotor symptoms (like hot flashes and night sweats) are common during menopause, and the review found a connection between these symptoms and palpitations. It’s possible that the discomfort and stress caused by hot flashes may lead to palpitations, or both symptoms may share an underlying cause. Some researchers even consider palpitations a part of the experience of hot flashes.
4. Sleep Problems: Sleep disturbances, such as trouble falling asleep or staying asleep, were also linked to palpitations. Since menopause is often associated with disrupted sleep, this connection may reflect the general impact of sleep deprivation or poor sleep quality on heart health. Lack of sleep can stress the body and increase the likelihood of experiencing palpitations, though more studies are needed to understand exactly how these issues interact.
5. Quality of Life (QOL): The review found that palpitations were connected to lower quality of life for menopausal women. This is not surprising, as many menopausal symptoms, like hot flashes and sleep issues, can significantly impact daily functioning and well-being. The connection between palpitations and QOL was seen across different aspects of life, such as physical health, sleep, and even work life. Women who experience frequent palpitations may find it more challenging to maintain a good quality of life, which highlights the importance of addressing these symptoms in healthcare.

Another study from Carpenter et al., published in 2021 in Menopause, represents yet another important contribution from this group. It delves into the relationship between heart palpitations and cortisol in peri- and postmenopausal women, further exploring how hormonal fluctuations during this stage can impact physiological stress responses.

Cortisol, often referred to as the “stress hormone,” plays a critical role in managing stress responses in the body. The study specifically investigated whether women experiencing distress from heart palpitations—such as sensations of the heart racing or pounding—exhibited different cortisol patterns throughout the day compared to those not reporting such distress.

The research team collected saliva samples from 293 women at four different times over the course of two days, allowing them to measure cortisol levels at different points of the diurnal cycle. The women participating in the study also provided details on whether they had experienced palpitations that caused them distress within the last two weeks, in addition to information about their age, any menopause symptoms they were experiencing (like hot flashes), their medication use, and other relevant factors such as levels of depression, stress, and sleep quality.

The analysis revealed a significant difference in morning cortisol levels between the two groups:

• Women who reported distress from palpitations showed notably lower cortisol levels in the morning than those who did not report distress.
• This difference remained significant even after accounting for other potential influencing factors, such as overall stress levels, symptoms of menopause, and mental health conditions like depression.

The findings of this study suggest a potentially blunted cortisol response in women who experience distress from palpitations. Typically, cortisol levels peak in the morning to help energize and prepare the body for the day ahead; however, lower morning cortisol levels in these women might indicate a disrupted or diminished stress response system. This disruption could be a key factor in why these palpitations feel more intense or more distressing.

As we look at this data and the daily impact on women’s lives, it’s clear that heart palpitations are not just a bothersome symptom but a significant health concern that intersects with the monumental life transition of menopause. These findings not only encourage a more empathetic and informed approach in medical practices but also remind us of the urgent need for more targeted research.

To all women experiencing these symptoms: you’re not alone, and your experiences are valid. It’s crucial to speak openly with healthcare providers about your symptoms to tailor a management plan that considers all aspects of your health—physical, hormonal, and emotional.

Conclusion

Understanding heart palpitations involves recognizing the interplay of physiological and psychological factors, especially in women experiencing hormonal changes during perimenopause and menopause. Acknowledging the significant prevalence of palpitations and their impact on quality of life is crucial for both individuals and healthcare providers.

Healthcare professionals should:

• Consider Hormonal Influences: Recognize the role of menopause and hormonal fluctuations in palpitations.
• Provide Comprehensive Evaluations: Go beyond standard tests to consider all potential causes.
• Validate Patient Experiences: Listen to and acknowledge symptoms to provide appropriate care.

For those experiencing palpitations, understanding the potential causes can alleviate anxiety and guide you toward seeking appropriate help.

Remedies and Treatments

You can try the following remedies and treatments for heart palpitations:

• Medical Treatments: Exploring hormone replacement therapy (HRT) and its efficacy.
• Lifestyle Interventions: Stress management techniques, mindfulness, and exercise.
• Mind-Body Techniques: Practices like MBSR and their impact on palpitations.

References

1. Carpenter, J. S., Sheng, Y., Elomba, C., Alwine, J., Yue, M., Pike, C., Chen, C., & Tisdale, J. (2021). A Systematic Review of Palpitations Prevalence by Menopausal Status. Current Obstetrics and Gynecology Reports, 1-7. https://doi.org/10.1007/s13669-020-00302-z.
2. Carpenter, J. S., Tisdale, J. E., Larson, J., Sheng, Y., Chen, C. X., Ah, D., Kovacic, T., Reed, S. D., Thurston, R. C., & Guthrie, K. A. (2022). Correlates of palpitations during menopause: A scoping review. Women’s Health, 18. https://doi.org/10.1177/17455057221112267.
3. Carpenter, J., Tisdale, J., Larson, J., Sheng, Y., Chen, C., Ah, D., Kovacs, R., Reed, S., Thurston, R., & Guthrie, K. (2021). MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women. Menopause, 29, 144 – 150. https://doi.org/10.1097/GME.0000000000001897.
4. Sheng, Y., Carpenter, J., Elomba, C., Alwine, J., Yue, M., Chen, C., & Tisdale, J. (2021). Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric, 25, 128 – 140. https://doi.org/10.1080/13697137.2021.1948006.