MAB ReviewedBe Still, My Heart: The Connection Between Menopause and Heart Palpitations
Heart palpitations—fluttering, racing, or skipped beats—affect up to 75% of women in perimenopause and menopause. They’re often linked to hormonal changes, stress, or anxiety, not heart disease. Tracking symptoms and consulting with a healthcare provider can help identify causes and guide treatment, ranging from lifestyle adjustments to hormone therapy.
Written by Caitlyn Tivy, DPT, OCS
Reviewed by Dr. Emily Lau
Director, Women’s Heart Health Program
Menopause and heart palpitations are more connected than many people realize. For perimenopausal women and postmenopausal women, heart flutters are surprisingly common.
While they’re often benign, menopausal palpitations can be scary. They might make you wonder about your heart health—a worry you don’t need while you’re dealing with other menopause symptoms.
Here’s what we know about the link between palpitation and menopause: what palpitations mean, who’s more likely to experience them, and what treatment options might help address them.
What are heart palpitations?
Heart palpitations are sensations of missed, exaggerated, or fluttering heartbeats . Some people describe them as a racing heart, heart flutters, or the feeling that their heart has skipped a beat.
Palpitations may come and go, and they often appear alongside other menopause symptoms such as vasomotor symptoms (hot flashes and night sweats) . Importantly, palpitations are symptoms, not a disease or condition .
Heart palpitations can indicate various underlying conditions, including arrhythmias. Arrhythmias are irregular heart rhythms that range from neutral to life-threatening.
This is why palpitations deserve your attention. That said, don’t panic! Not all palpitations are dangerous .
If you’re experiencing heart palpitations, start by talking to your healthcare provider. They can help you understand the underlying cause and its impact on your overall health.
What’s the connection between menopause and heart palpitations?
Menopausal heart palpitations are common symptoms during the transition. A 2021 study in the journal Menopause reviewed the medical records of almost 400 post- and perimenopausal women between the ages of 40 and 59 and found that:
33% reported mild palpitations
30% reported moderate palpitations
11% reported severe palpitations
Only about a quarter (26%) reported that they did not notice heart palpitations during this phase of life. While they don’t get as much publicity as other menopausal symptoms such as night sweats or mood disturbances, heart palpitations are clearly quite common during the menopause transition.
What causes menopausal heart palpitations?
The short answer: we don’t really know. The risk of cardiovascular disease increases during and after the menopause transition, and declining estrogen levels likely contribute to this increased risk .
However, menopausal palpitations are a symptom, rather than a disease. It’s unclear if they are driven by the same mechanisms as heart disease.
While heart palpitations can affect anyone going through the menopause transition, some people may be more likely than others to experience them. Here’s what we know:
The aforementioned 2021 study of almost 400 women found that those who reported more menopause heart palpitations tended to have :
Higher blood pressure (specifically, the top number for systolic blood pressure was higher)
Lower physical activity levels
Higher scores for bothersome hot flashes and night sweats
Higher levels of anxiety and depression
A 2022 review of over 80 studies found additional associations between certain menopausal symptoms, such as poor sleep and lower quality of life, and the likelihood of experiencing irregular heartbeats . Race and ethnicity also appeared to affect how women experience irregular heartbeats, but the specifics vary a lot from country to country .
Keep in mind: these are associations, not established causes. Just because you’re sleeping poorly or feeling more anxious, you’re not guaranteed to experience menopausal palpitations. This research shows us links between certain symptoms, but it doesn’t prove that one symptom causes another.
Do heart palpitations during menopause indicate heart disease?
This is a common concern surrounding menopause and heart palpitations. However, recent research offers some reassurance for those worried about heart disease or other forms of cardiovascular disease.
In a 2022 analysis of data from the SWAN study (Study of Women’s Health Across the Nation), researchers identified three typical symptom trajectories among menopausal women :
About 16% of participants had a high probability of palpitations in perimenopause and early postmenopause
About 34% had a moderate probability of palpitations in perimenopause and early postmenopause
The remaining 50% had consistently low probability of palpitations throughout the whole menopause transition
Women in the high probability group shared some characteristics that differentiated them from the other two groups. They were more likely to :
Have started the menopause transition early
Have had more pregnancies
Report more intense hot flashes and night sweats
Experience more difficulty sleeping
Rate their perceived stress higher
Have high blood pressure
Here’s the good news: none of these trajectories were associated with later development of cardiovascular disease or signs of underlying heart disease such as arterial stiffness .
Menopause heart palpitations can feel scary: you might be worried that they are signs of undetected heart disease or an increased risk of future cardiac events.
Remember: Your first, best step is to talk with your healthcare provider about any new symptoms you’re experiencing. They can help you determine if you need additional testing.
What treatment options can help heart palpitations?
A 2021 systematic review of 37 studies examined how several treatment options impacted palpitations and menopause .
The findings were mixed, but here's a summary of what they found:
Hormone therapy (formerly called hormone replacement therapy with estradiol) showed some benefit in reducing the frequency or severity of heart palpitations. However, results were inconsistent across studies, and the doses and treatment durations varied widely.
Some studies have investigated how palpitations responded to beta blockers, medications that can help manage high blood pressure. Depending on the underlying cause of palpitations, beta blockers may help… or they might not. This is why it’s critical to speak with your healthcare provider if you’re experiencing menopausal palpitations.
Other studies reviewed the impact of cognitive behavioral therapy (CBT), ear acupressure, and isoflavones, plant-based chemicals that mimic estrogen. None of these options had convincing effects on heart palpitations.
All this might give you the impression that nothing can help with menopausal palpitations, but remember: big review studies don’t always capture individual experiences. Some people find relief from treatments that don’t stand out in large clinical studies.
Hormone therapy may help some people with symptoms of irregular heartbeats or a racing heart. However, some people with risk factors such as a history of blood clots, previous history of heart attack or stroke, or certain types of breast cancer may not be good candidates for hormone therapy . Talk with your healthcare provider to determine if it’s an appropriate choice for you.
How symptom tracking can help
Hormonal changes and symptoms vary widely during the menopause transition: no two people have identical experiences. To understand your unique patterns, it can help to track when you notice heart palpitations and what else is happening at the same time.
You might start to see connections: palpitations that cluster with hot flashes or periods of increased stress. Tools like smartwatch-enabled tracking systems can help you identify what’s going on and support better conversations with your healthcare provider.
Questions to ask your provider
Menopausal heart palpitations can feel difficult to explain or address, but you don’t have to brush them aside. Here are a few conversation starters to help you bring up palpitations at your next medical appointment.
I’ve noticed my heart racing or skipping a beat now and then. This is a new symptom for me: could it be related to perimenopause or something else entirely?
I’ve been using an app to track when I notice my heart fluttering or skipping beats. Can I share those data with you to see if we can find any patterns?
The heart palpitations I’ve been experiencing are really bothersome. What do you suggest as an approach to address them?
DISCLAIMER
This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.
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