Menopause and heart issues: palpitations, blood pressure changes, and more

There are a lot of things you’d expect to get your heart racing: rollercoasters, exercise, a scary movie. But you should also add menopause to that list. Heart palpitations, flutters, racing or pounding heartbeat, and occasional shortness of breath are all typical symptoms of perimenopause and menopause. If you experience these symptoms know that most palpitations are typically harmless, and a clinician can help you rule out other causes. 

If you’re experiencing perimenopause heart flutters or menopausal heart palpitations, this guide can help you understand your symptoms. We’ll cover common triggers, tips to help you manage, and warning signs that your symptoms are a sign of something more serious.

Heart palpitations are often described as the awareness of an abnormal heartbeat, rapid pulse, or irregular beating of the heart that can last a few seconds or minutes. People also tend to refer to them as rapid heart fluttering, skipping, or a pounding sensation occurring in the chest or neck.

During the menopause transition, fluctuating hormones may cause your heartbeat to feel more pronounced and sometimes coincide with vasomotor symptoms like hot flashes. 

How hormonal changes can affect heart rhythm

Heart palpitations, heart pounding, racing, and flutters can all occur due to fluctuating levels of estrogen during menopause. While the exact mechanisms are not fully understood, it likely involves multiple factors including changes in the autonomic nervous system and changes in temperature regulation. Low levels of estrogen can also cause hot flashes, mood swings, stress, and anxiety, which can all cause heart palpitations as well.

Besides the estrogen levels, there are other factors that can trigger heart palpitations, chest pain, or shortness of breath. These factors can make your heart feel like it’s fluttering, pounding, or skipping, even if there’s no underlying diagnosed heart condition. Examples include:

• Stress

• Poor sleep

• Caffeine

• Alcohol

• Dehydration

• Illness

• Some over-the-counter and prescription medicines 

While heart palpitations and other symptoms can be harmless and a typical symptom of perimenopause, there are some circumstances where they should be taken seriously as a sign of a life-threatening condition. Anyone experiencing the following symptoms should seek urgent medical evaluation:

• Chest pain

• Fainting

• Severe shortness of breath

• Severe lightheadedness or dizziness

• Neurologic symptoms

• Persistent palpitations

A clinician will be able to conduct a review of your symptoms, medical history, and medications to decide if further testing is required.

And if you keep having heart palpitations, mild chest discomfort, or new but non-severe breathlessness, make an appointment with a medical professional to find out what’s going on.

Research shows that blood pressure and other cardiovascular risk factors may become heightened during and after menopause. Estrogen provides protection against heart disease in women, so as estrogen levels begin to decline, risk of cardiovascular disease (CVD) and high blood pressure can increase. Because of this, it’s vital that women keep an eye on their health during this time.

Knowing your numbers — your blood pressure, cholesterol, blood sugar — and reviewing them with your clinician can help manage your well-being and allow you to come up with strategies that support long-term heart health.

Lifestyle changes for a healthier heart

Healthier habits can support heart health, including:

• Regular movement 

• Balanced eating patterns low in saturated fat

• Good-quality sleep 

• Stress management

• Avoiding smoking 

These foundations can be especially valuable during menopause, when changes in sleep, metabolism, and stress can make blood pressure more variable.

Experiencing heart palpitations and flutters during menopause can cause worry and concern for women. However, finding ways to manage symptoms for such palpitations can help. Your clinician will be able to advise you on the right management strategies. They may suggest:

• Identifying your triggers and finding ways to reduce them

• Paced breathing

• Relaxation techniques

• Hydration

• Reviewing any stimulants you’re taking

Behavioral strategies and trigger management

Keeping a simple symptom and trigger log can help you and your clinician spot patterns and come up with ways to manage your heart palpitations. This involves jotting down when symptoms like heart flutters occur, what’s happening at the time, how you’re feeling and any possible triggers such as caffeine, alcohol, or stress.

If you’re experiencing hot flashes as well as heart palpitations, you could try pairing cooling and calming strategies to help with both. This can include using a fan, dressing in layers, and lowering the room temperature while pacing your breathing or doing a brief grounding exercise. 

Treatment pathways to discuss with a clinician

Your clinician will be able to help you address triggers by performing additional evaluations and reviewing medicines that might be contributing to any palpitations. They may also consider other therapies that provide relief—this can include hormone replacement therapy (HRT), particularly if palpitations are occurring alongside other perimenopausal or menopausal symptoms. During consultations, it’s important to work together to weigh the benefits, risks, and personal preferences tied to each option. Regular follow-up can help ensure that your approach is adjusted as your symptoms evolve over time.

Many women going through menopause report that heart palpitations are more noticeable at night. According to research, this is partly because menopause usually affects sleep and is often associated with an increase in insomnia symptoms.

Hot flashes and night sweats can also disrupt sleep quality. And the quiet and stillness of the night can make heartbeat sensations stand out more than they do during the day. Over time, repeated sleep disruption can leave you more alert or sensitive to bodily sensations, especially when lying in bed at night. It can also amplify your awareness and sensitivity to a racing heart or irregular heartbeat.

Sleep hygiene and when to screen for sleep apnea

Taking simple steps to improve your sleep hygiene can help to make nights more comfortable and help you potentially get a better night’s sleep. This can include:

• Reducing noise

• Minimizing light 

• Keeping the bedroom cool 

• Creating a calming wind-down routine

• Maintaining a consistent sleep schedule 

• Replacing mattress and pillows if possible

• Reducing screen time near bedtime

Sleep disruption during menopause can have many causes, and sometimes these can overlap with other sleep conditions like sleep apnea. If you experience frequent awakenings, loud snoring, or daytime sleepiness, it may be worth asking your clinician whether sleep apnea screening is needed.

Not all heart palpitations during menopause are caused by hormonal changes. While many people experience sensations like fluttering, racing, or occasional perimenopause chest pain during menopause, it’s important to remember that these symptoms can also be associated with other health conditions.

For example, thyroid conditions, anemia, anxiety, and certain heart rhythm issues can all cause similar heart sensations. You should discuss your symptoms with your clinician so that they can help you rule out any other causes and give you the best support and treatment. 

What your clinician might look for

When evaluating menopausal heart palpitations, your clinician will typically review your medical history. This can include a family history assessment, discussion of the onset, frequency, and triggers of your palpitations, as well as any related symptoms such as shortness of breath. They may also explore lifestyle factors, sleep patterns, stress levels, and any other health conditions that could contribute to your symptoms. 

Your healthcare professional may perform a physical exam to examine your overall cardiovascular and general health. Additionally, they might order selective tests if your symptoms present particular risk factors. This process helps to distinguish typical menopause-related heart palpitations from other conditions and helps them provide you with a tailored plan for managing the flutters and pounding.

If you’re currently going through perimenopause, you may find comfort in knowing that heart palpitations and other sensations like fluttering or pounding are common experiences for many women. Hormonal shifts, sleep disturbances, stress, and hot flashes can all contribute to menopausal heart palpitations, and for most people, these are usually harmless and manageable with support from a clinician. Furthermore, self-help strategies such as relaxation techniques, sleep management, and paying attention to triggers can help with management.

At the same time, not all heart palpitations are related to menopause. If you’ve noticed any new, severe, and persistent symptoms that are accompanied by chest discomfort, dizziness, or shortness of breath, be sure to consult a clinician to rule out other health conditions.