Menopause and Heart Palpitations

You may be sitting quietly and relaxing, or enjoying a fun activity when suddenly, out of nowhere, your heart starts to flutter or pound. These uncomfortable, and potentially disconcerting sensations are heart palpitations.

Heart palpitations have many causes and can affect people at any age. However, if you’re a woman in perimenopause or menopause, you may be surprised to learn that this natural transition is also considered to be a potential cause. If you’re experiencing heart palpitations, take a deep breath. Menopause and heart palpitations can go together and are often not considered serious. Read on to learn more about this connection and when you should contact your healthcare provider.

What Are Heart Palpitations?

A heart palpitation is a change in the heart’s natural rhythm. Palpitations occur when the heart suddenly speeds up, slows down, or beats erratically.

During a heart palpitation, it might feel like your heart is beating out of your chest. You may also feel like it’s skipping beats, flip-flopping, or racing.¹

Heart palpitations usually last for as little as several seconds, for up to a minute or two.² Even though they’re short-lived, these changes in heart rhythm can be disconcerting or downright scary, especially if you don’t know what is causing them.

In some instances, you may be able to identify the trigger. In others, the cause may be more elusive. Some common causes of heart palpitations include:³

• hormonal fluctuations (such as those experienced during the menopause transition)
• caffeine intake
• stimulants, such as nicotine
• medications that contain caffeine, stimulants, or decongestants, like pseudoephedrine
• exercise
• emotions that trigger the “fight or flight” response, like anxiety, fear, or stress

Less commonly, heart palpitations can have serious, underlying causes. Your healthcare provider may refer to this type of abnormal heartbeat as an arrhythmia.⁴ Arrhythmias are not caused by, or associated with, perimenopause, menopause, or hormonal fluctuations.

Arrhythmias may be caused by coronary artery disease, or by muscles that are damaged by a heart attack. They may also be caused by many underlying health conditions, including high blood pressure, obstructive sleep apnea, and diabetes.⁵ A heart arrhythmia may be mistaken for benign palpitations, which is why it's important to have an evaluation done for any new or concerning, heart-related symptoms.

What’s the Link Between Menopause and Heart Palpitations?

You may drink tons of coffee, exercise like crazy, or be under lots of stress. Any or all of these things may be why you have occasional heart palpitations. But if you’re in perimenopause or menopause, fluctuating or declining estrogen levels may also be playing a strong role.⁶

Estrogen is the female sex hormone that results from ovulation during the menstrual cycle. Estrogen starts to fluctuate significantly during perimenopause and decline during menopause. According to studies, heart palpitations in women are most common during times when estrogen levels are in flux. These include the luteal (second) phase of the menstrual cycle just after ovulation and prior to menses, pregnancy, and perimenopause.⁷ It’s also well known that estrogen is cardioprotective – meaning it plays a role in keeping cardiovascular tissue healthy⁸.

In addition to its effects on the female reproductive system, fluctuations in estrogen can impact other bodily systems, including the heart. Like many organs, the heart contains estrogen receptors which help maintain cell function.⁹ Each beat of your heart is jumpstarted by electrical signals from a cell group called the sinoatrial node (SA).¹⁰ Hormonal fluctuations in estrogen adversely affect the ability of the SA node to maintain balance and stability, and to function properly. Heart palpitations are a common result.¹¹

Up to 42% of perimenopausal women and 54% of postmenopausal women experience heart palpitations.¹² Some women get them during hot flashes. Others say they experience heart palpitations as an independent symptom, without hot flashes.¹³

When to Check-in with Your Healthcare Provider About Heart Palpitations During Menopause

In most instances, heart palpitations are not serious. However, if they’re accompanied by other symptoms, such as chest pain, dizziness, or trouble breathing, let your healthcare provider know. They can assess you for underlying causes which may be important to aiding in your diagnosis and treatment.

If your hormones are fluctuating or declining due to menopause, it may be challenging to eliminate heart palpitations completely. Self-care and modifying certain lifestyle habits can, however, help to diminish them:

• First up, assess your stress levels. Concerns about family, career, relationships, and world events can all converge into feelings of intense anxiety. You may not be able to broker world peace all on your own, but you can calm yourself down with yoga, meditation, or deep breathing or paced respiration.
• Take stock of your caffeine and stimulant intake. If necessary, consider reducing your dependence on cigarettes, alcohol, and caffeinated beverages.
• Talk to your healthcare provider about prescription and over-the-counter medications you use. Some may include stimulating ingredients that can impact the heart.

Lastly, keep in mind that heart palpitations, and other menopausal symptoms, don’t last forever. When your hormones are fully stabilized, these troublesome symptoms usually disappear. Regardless, if you’re experiencing heart palpitations, and it’s something new for you, or you have concerns, don’t hesitate to speak with your healthcare provider for advice.      

Resources

1. https://www.medicalnewstoday.com/articles/317700#what-are-heart-palpitations
2. https://www.medicalnewstoday.com/articles/317700#what-are-heart-palpitations
3. https://uihc.org/health-topics/heart-palpitations-frequently-asked-questions#:~:text=The%20startle%20effect%20releases%20substances,functioning%20of%20the%20nervous%20system.
4. https://my.clevelandclinic.org/health/diseases/21677-heart-palpitations-and-anxiety  
5. https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668#:~:text=Things%20that%20can%20cause%20an,structure%2C%20such%20as%20from%20cardiomyopathy
6. https://www.medicalnewstoday.com/articles/317700#what-are-heart-palpitations
7. https://pubmed.ncbi.nlm.nih.gov/9160219/#:~:text=Several%20noncardiac%20disorders%20may%20also,and%20during%20the%20perimenopausal%20period.
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655818/
9. https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.110.236687
10. https://www.templehealth.org/about/blog/all-about-heart-arrhythmias
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148331/
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289918/#:~:text=Many%20menopause%20symptom%20checklists%20include,postmenopausal%20women%20report%20having%20palpitations.
13. https://www.everydayhealth.com/menopause/menopausal-heart-palpitations-can-cause-distress-may-signal-serious-health-issue/