Last checked September 2026 against 11 sources · Editorial policy
Heart palpitations in perimenopause
Perimenopause heart palpitations feel like a racing, pounding, fluttering or skipping heartbeat. In SWAN, which followed 3,276 women, 15.9% had a high probability of palpitations through perimenopause and early postmenopause, 34.3% a moderate one, and 49.8% rarely had them. Those patterns weren't linked with artery plaque or stiffness. Palpitations with chest pain, breathlessness or fainting need 911 (999 in the UK).
A racing, fluttering or pounding heart is common in perimenopause and often harmless. What causes it, how to calm it, and warning signs that need a doctor.
Perimenopause heart palpitations: expectation vs reality
What people often expect
“Palpitations mean something is wrong with your heart”
What the evidence shows
In SWAN, 15.9% of women had a high chance of palpitations through perimenopause and early postmenopause, easing later, and another 34.3% a moderate chance. Their palpitations weren't related to artery stiffness or plaque, the early signs of heart disease. The NHS describes palpitations as common and not usually a sign of anything serious, and lists menopause among the causes.
Why perimenopause causes heart palpitations
Heart palpitations often come with hot flashes
Palpitations often track with hot flashes. During a flash, the heart speeds up as your body sheds heat, and the NHS lists palpitations as part of a hot flash. In SWAN, women with the most palpitations also had more hot flashes and night sweats at the start of the study. If your heart races mostly during or just before a wave of heat, the palpitations are very likely part of the flash itself.
Stress, poor sleep and low mood add to a racing heart
The SWAN women with a high probability of palpitations had more perceived stress, more depressive symptoms, more sleep problems and poorer overall health at baseline. Hormone shifts may make the nervous system more reactive, so the same coffee or bad night that felt fine in your thirties can leave your heart flip-flopping in midlife. The sensation is real even when tests show a normal rhythm.
What palpitations feel like
Palpitations are when your heartbeat becomes more noticeable. You may feel it in your chest, neck or throat, as racing, pounding, thumping or fluttering, or as an irregular beat with skipped or extra beats, which doctors call ectopic beats. They can last seconds, minutes or longer. Most women with perimenopause palpitations describe short bursts, often at night or during a hot flash.
Everyday triggers for heart palpitations
Everyday triggers still matter. The NHS lists strenuous exercise, lack of sleep, stress and anxiety, medicines, alcohol, caffeine, nicotine and recreational drugs as common causes. Iron deficiency anemia, an overactive thyroid and heart rhythm problems can also cause them. In perimenopause, heavy periods make anemia more likely, and it's one of the easiest causes to test for and fix. Cutting caffeine and alcohol for two weeks is a simple test of whether they are part of your pattern.
Chest tightness and shortness of breath in perimenopause
Anxiety and palpitations can make your chest feel tight or your breathing feel fast, and anxiety often rises in perimenopause. But chest pain or tightness should never be assumed to be hormonal. Heart attack symptoms in women can include chest pain that feels tight, heavy or like indigestion, pain spreading to the arms, neck, jaw or back, sweating, nausea and breathlessness. If you have these, call 911 first and ask questions later.
Do palpitations go away after menopause?
In SWAN, the palpitations that rose in perimenopause and early postmenopause diminished in late postmenopause, for both the high- and moderate-probability groups. So for most women they're a phase of the transition rather than a permanent change. That matches the course of hot flashes, which usually ease over the years after the final period. If palpitations start for the first time years after menopause, get them checked rather than assuming they are hormonal.
How common are heart palpitations in perimenopause?
From the studies on this page
had a high probability of palpitations through the transition
15.9%
had a moderate probability. The remaining 49.8% rarely had them
34.3%
0 links
Put together, about half of women in SWAN had palpitations at a moderate or high rate during the transition, making them one of the more common symptoms of perimenopause.
Palpitations that aren't perimenopause
Palpitations in perimenopause are usually harmless, but a few treatable conditions cause the same fluttering or racing heart. Simple tests tell them apart.
Iron deficiency anemia
Check →Palpitations with tiredness, breathlessness, pale skin and heavy periods.
Test: Full blood count and ferritin
Overactive thyroid
Check →A racing heart at rest, weight loss, shaky hands, feeling hot, anxious and restless.
Test: TSH blood test
Heart rhythm problem
Palpitations lasting more than a few minutes, getting more frequent, or with a heart condition in you or your family.
Test: ECG
Anxiety or panic
Check →Racing heart with worry, a tight chest, breathing fast, tingling fingers.
Test: Doctor or talk therapy
Caffeine, alcohol or a medicine
Palpitations after coffee, energy drinks, alcohol or a new medicine, including some decongestants and inhalers.
Test: Medicine review; cut back and see
How to calm perimenopause heart palpitations
Cut the triggers of heart palpitations
First stepThe NHS advises cutting back on caffeine and alcohol, stopping smoking, and finding ways to manage stress, since avoiding triggers helps if palpitations aren't caused by a health condition. Keep a simple log of when palpitations hit: time of day, after coffee, during a hot flash, after poor sleep. It helps you and your doctor see the pattern.
Treat the hot flashes behind the palpitations
If this is the causeWhen palpitations cluster around hot flashes or night sweats, treating the flashes often eases both. HRT cuts hot flash frequency by about 75%. Non-hormonal options, such as fezolinetant, SSRIs, SNRIs and gabapentin, work too when HRT isn't suitable. NICE advises offering HRT for hot flashes, and CBT is another option for both flashes and the anxiety that can come with them.
Related guide →Estradiol for menopause palpitations
Limited evidenceA systematic review of 37 studies found mostly low- to moderate-quality evidence. No therapy could be fully recommended for palpitations alone, but some hormonal agents such as estradiol showed positive signals and can be considered with caution. Beta blockers such as atenolol, supplements like isoflavones and sage, CBT and acupressure lacked solid proof in that review.
Related guide →Better sleep and stress care
First stepPoor sleep and stress were linked with more palpitations in SWAN. Regular sleep times, a cool bedroom if night sweats wake you, and relaxation or talk therapy for anxiety all lower the load on your nervous system. CBT helps with anxiety and sleep problems. Try to keep the same wake-up time every day, even after a bad night.
Related guide →Get the simple tests done
First stepIf palpitations keep coming back, a doctor may offer an ECG, which records the heart's electrical signals, and blood tests for anemia and thyroid problems. Most results are normal, which is reassuring in itself. If something is found, such as a rhythm problem, you may be referred to a cardiologist.
When heart palpitations need a doctor
Urgent: Palpitations now with chest pain, breathlessness or feeling faint
Call 911 (999 in the UK) or go to the ER. Don't drive yourself.
Urgent: Chest pain spreading to the arm, jaw, neck or back, or with sweating and nausea
Call 911 (999 in the UK). This could be a heart attack.
Palpitations keep coming back, are more frequent or last more than a few minutes
See a doctor. You may be offered an ECG.
You have a heart condition or heart problems run in the family
See a doctor, even if the palpitations are mild.
Heart palpitations in menopause: questions women ask
Can perimenopause cause heart palpitations?
Yes. The NHS lists palpitations among menopause symptoms, and in SWAN about half of women had them at a moderate or high rate during the transition. They often come with hot flashes, stress and poor sleep.
Are menopause heart palpitations dangerous?
Usually not. In SWAN they weren't linked with early signs of heart disease, such as artery plaque or stiffness. Palpitations with chest pain, breathlessness or fainting are an emergency, and ones that keep coming back deserve an ECG.
Do palpitations go away after menopause?
They usually ease. In SWAN, palpitations were most likely in perimenopause and early postmenopause and diminished later. Treating hot flashes and cutting caffeine and alcohol can help in the meantime. If they start for the first time after menopause, see a doctor.
Can low estrogen cause heart palpitations?
It seems to contribute. Palpitations peak in perimenopause and early postmenopause, when estrogen swings and falls, and they cluster with hot flashes, which are driven by falling estrogen. A review found estradiol had some positive evidence for reducing palpitations, though the studies were small.
Why does my heart flutter in perimenopause?
Fluttering usually means extra or skipped beats, which are common and usually harmless. In perimenopause, hot flashes, stress, poor sleep, caffeine and alcohol make them more noticeable. See a doctor if they keep coming back or last more than a few minutes.
Is chest tightness a perimenopause symptom?
Anxiety and palpitations can feel like a tight chest, but chest pain or tightness needs urgent checking. Call 911 (999 in the UK) if it comes with breathlessness, fainting, sweating, or pain spreading to your arm, jaw or back.
Can perimenopause cause shortness of breath?
Not directly, but anxiety, palpitations during hot flashes and iron deficiency from heavy periods can all make you feel short of breath. Breathlessness with chest pain or fainting is an emergency. New breathlessness on exertion needs a doctor and a blood count.
Does perimenopause change your resting heart rate?
Your heart rate rises briefly during each hot flash, and anxiety and poor sleep can push it up too. A fast heartbeat at rest all the time isn't typical of perimenopause and should be checked for an overactive thyroid, anemia or a rhythm problem.
Sources
- Carpenter JS, Cortés YI, Tisdale JE, et al. Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease. Menopause. 2023;30(1):18-27.
- NHS. Heart palpitations.
- National 911 Program. 911.gov.
- NHS. Symptoms of menopause and perimenopause.
- NHS. High blood pressure.
- NHS. Tiredness and fatigue.
- Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- NICE. Menopause: identification and management (NG23). Updated 2024.
- Sheng Y, Carpenter JS, Elomba CD, et al. Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric. 2022;25(2):128-140.
- NHS. Things you can do to help menopause and perimenopause symptoms.
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