Perimenopause heart palpitations: why your heart races, and when to get help

You're sitting still, or lying in bed, and suddenly your heart is thumping. It might race, flutter, or seem to skip a beat and then catch up with a thud. It's frightening, and it's very hard not to fear the worst.

Perimenopause heart palpitations are common. The NHS says palpitations can sometimes be a sign you're going through the menopause, and most of the time they're harmless. But your heart matters, so it's important to know which signs need help straight away, and to get new palpitations checked rather than assume they're hormonal.

These signs come from the NHS, the British Heart Foundation and the NHS advice on chest pain. If your palpitations have stopped but you're worried, the NHS says to ask your GP surgery for an urgent appointment or call 111.

What do perimenopause heart palpitations feel like?

The NHS describes palpitations as your heartbeat suddenly becoming more noticeable. It can feel like your heart is:

• racing or beating very fast
• pounding or thumping
• fluttering
• skipping a beat, or adding an extra one

You may feel it in your chest, neck or throat. It can last seconds, minutes or sometimes longer.

That "skipped beat" feeling is often caused by ectopic beats, which are early or extra heartbeats. The British Heart Foundation says most people have them at some point, especially at times of hormonal change such as menopause, and they're usually harmless.

Are heart palpitations a symptom of perimenopause?

Yes. The NHS lists a faster, slower or more noticeable heartbeat among the symptoms of menopause and perimenopause. The British Heart Foundation says a racing heart or palpitations are common symptoms of the menopause for many women.

A US study followed more than 3,200 women through the menopause transition. About half fell into groups with a moderate or high chance of palpitations during perimenopause and the first years after periods stopped, and these faded later on. The palpitations weren't linked to early signs of artery disease once other factors were taken into account. But they were measured by questionnaire, not heart tests, so the study couldn't rule out rhythm problems (Carpenter and others, 2023).

Why does menopause cause palpitations?

The British Heart Foundation says more research is needed to understand exactly why. Several things seem to play a part.

Changing hormones. The BHF lists hormonal changes in menopause as one cause of palpitations.

Hot flushes. The NHS says hot flushes can cause palpitations or anxiety. A flush can bring a pounding heart along with the heat.

Anxiety and the worry loop. Stress, anxiety and panic attacks can all cause palpitations. Then the racing heart itself feels alarming, which brings more anxiety. The NHS describes how a racing heartbeat, chest pain, sweating and hot flushes can all be part of a panic attack. Our guide to menopause anxiety explains more.

Poor sleep. Lack of sleep is a common trigger for ectopic beats, according to the BHF.

Caffeine, alcohol and smoking. All three can set off palpitations, and the BHF says cutting down may help with both palpitations and hot flushes.

Can perimenopause cause chest pain or shortness of breath?

The British Heart Foundation says aches and pains, including in the chest area, are among the menopause symptoms many women worry about. Breathlessness can also come with anxiety and panic.

But chest pain and breathlessness also have serious causes, so never assume they're "just the menopause". The NHS says to call 999 or go to A&E if you're struggling to breathe, your chest feels tight or heavy, or your lips or skin are turning pale, blue or grey. If breathlessness is new and you're not sure why, see a GP.

It's also worth knowing that heart risk changes at this stage of life. The BHF explains that oestrogen helps control cholesterol. As oestrogen falls, fat can build up in the arteries, which raises the risk of coronary heart disease, heart attack and stroke. If your menopause came before 45, your risk is higher.

The BHF lists the most common heart attack signs as:

• chest pain or discomfort that comes on suddenly and doesn't go away, which may feel like pressure, squeezing, heaviness, indigestion or burning
• pain that spreads to the arms, neck, jaw, back or stomach
• feeling sick, sweaty, light-headed or short of breath

If you have these, call 999.

What else can cause palpitations?

The NHS and the BHF list many causes besides menopause:

Common and usually harmless	Need checking by a doctor
Caffeine, alcohol, smoking or vaping	An overactive thyroid
Stress, anxiety and panic attacks	Anaemia (low iron)
Hard exercise	Heart rhythm problems (arrhythmia)
Lack of sleep	Heart valve disease and other heart conditions
Spicy or rich food	Side effects of some medicines

Iron deficiency anaemia is worth knowing about in perimenopause, because heavy periods are a very common cause. It can bring tiredness, breathlessness and palpitations.

If you think a medicine might be causing palpitations, check the leaflet and talk to your GP or pharmacist. Don't stop or change any prescribed medicine on your own.

What can help with menopause palpitations?

If your GP has checked you and there's no heart problem, the BHF suggests avoiding the things that set your palpitations off:

• Cut down on caffeine. Try swapping some cups for decaf.
• Drink less alcohol, and stay within 14 units a week.
• Stop smoking, if you smoke.
• Keep a symptom diary, so you can spot your own triggers.
• Find ways to manage stress. The BHF suggests breathing exercises, yoga and mindfulness for stress and anxiety.
• Keep active. The BHF says being more active can help with anxiety, low mood and heart health.

When palpitations start, try to sit down and breathe slowly. If you've already been checked, it can help to remember what the BHF says: palpitations are usually harmless, and often feel more serious than they are.

What your GP can do

Your GP will ask about your symptoms, how often they happen and how long they last. Writing this down beforehand helps.

• An ECG. This quick, painless test checks your heart's rhythm. If needed, you may wear a monitor for longer, or have a heart scan, to look for rhythm problems.
• Blood tests, for example to check for anaemia or a thyroid problem.
• A referral to a heart specialist if anything needs a closer look.

A GP and menopause specialist writing for the Menopause Charity notes that women with menopause palpitations have often had heart scans and 24-hour heart recordings, and these are most usually normal. That can be very reassuring, but it's still right to get checked.

If your palpitations come with other menopause symptoms, it's worth asking about:

• HRT. NICE's menopause guideline (NG23) says doctors should offer HRT for hot flushes and night sweats.
• CBT. The BHF says CBT has been shown to help with heart palpitations, hot flushes and night sweats. NICE says menopause-specific CBT can be considered for hot flushes and night sweats.

Where relaxation fits in

When your heart suddenly races, a jolt of fear is natural, and that fear can keep the feeling going. Once your GP has checked you over, some women like to practise a calming routine for those moments. Our hypnosis for menopause anxiety, Calm the Anxious Mind, is a recording to help you feel calmer when your heart starts racing. It includes slow breathing with a longer out-breath, and a cue you can practise: feet flat on the floor, a hand on your stomach, a long breath out, and the word "settle". It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.

You may also find these pages useful: perimenopause panic attacks, menopause dizziness and what a hot flush feels like.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms