Perimenopause Heart Palpitations: What's Happening and When to Pay Attention
You're lying in bed and suddenly you feel it. Your heart is racing, pounding, fluttering in a way that doesn't make sense. You weren't exercising. You weren't anxious. You were just lying there, and now your heart is doing something it's never done before.
Or maybe it happens during the day. A sudden awareness of your heartbeat, a skipped beat, a sensation like your heart is flip-flopping in your chest. It passes, but it leaves you shaken. You start paying attention to your heart in a way you never had to before, and that attention itself becomes another source of anxiety.
Heart palpitations during perimenopause are common and usually harmless. But they're also frightening, especially the first few times they happen. And because heart disease is the leading cause of death in women, it makes sense to take any heart symptom seriously.
This article will help you understand what's happening, when to be concerned, and what actually helps.
What Are Heart Palpitations?
Heart palpitations are the sensation of feeling your heartbeat. Normally, you don't notice your heart beating. When you do, that's a palpitation.
Palpitations can feel like:
Your heart is racing or beating too fast
Your heart is pounding or beating too hard
Your heart is skipping beats or beating irregularly
A fluttering sensation in your chest
A flip-flopping feeling, like your heart turned over
Most palpitations are brief, lasting seconds to minutes. They can happen at rest or during activity. Many women notice them most at night, when they're lying quietly and there's nothing else to distract from the sensation.
Why Palpitations Happen During Perimenopause
There are several reasons heart palpitations become more common during this transition.
Hormonal Fluctuations
Estrogen affects your cardiovascular system in ways you probably never thought about. It influences how your blood vessels dilate, how your heart muscle contracts, and how your autonomic nervous system regulates your heart rate.
During perimenopause, estrogen fluctuates dramatically, sometimes spiking, sometimes dropping. These fluctuations can trigger palpitations directly. Many women notice that palpitations correlate with certain points in their cycle, or with particular hormonal shifts.
Nervous System Reactivity
This is often the bigger factor. Your autonomic nervous system controls your heart rate, and during perimenopause, that system often becomes more reactive. If you've been running on stress for years, your nervous system may already be primed to overreact. The hormonal shifts of perimenopause can amplify this.
Many women with palpitations are in a state of chronic nervous system activation. Their baseline is elevated. Their stress response triggers more easily. And the heart, which is directly regulated by the autonomic nervous system, reflects this dysregulation.
Hot Flashes and Night Sweats
Palpitations often accompany hot flashes. The same cascade that causes flushing and sweating also increases heart rate. If you're waking at night with a pounding heart, it may be part of a night sweat you're not fully aware of.
Caffeine and Stimulants
Caffeine directly stimulates the heart and can trigger palpitations, especially in higher doses. Many women who never had issues with caffeine find that perimenopause changes their sensitivity. The coffee that was fine for twenty years now triggers a racing heart.
Blood Sugar Instability
When blood sugar drops, your body releases adrenaline to bring it back up. That adrenaline surge can cause palpitations. If you're skipping meals, eating irregularly, or consuming a lot of refined carbohydrates and sugar, you may be triggering palpitations through blood sugar swings.
Sleep Deprivation
Poor sleep increases nervous system reactivity and can contribute to palpitations. Many women in perimenopause are chronically sleep-deprived, and this compounds everything else.
Anxiety
Anxiety and palpitations feed each other. Anxiety can trigger palpitations, and palpitations can trigger anxiety. For women who've never experienced either, this cycle can be disorienting. You're not sure which came first, or how to break the pattern.
When to See a Doctor
While most perimenopause palpitations are harmless, some symptoms warrant medical evaluation. Please see a healthcare provider if you experience:
Palpitations that last for extended periods or happen very frequently
Chest pain or pressure along with palpitations
Shortness of breath or difficulty breathing
Dizziness, lightheadedness, or fainting
Palpitations during physical exertion
A personal or family history of heart disease
Palpitations that are significantly impacting your quality of life
A basic cardiac workup can rule out structural issues or rhythm abnormalities. For most women, everything comes back normal, which is reassuring. But that reassurance is worth getting, especially if your symptoms are frequent or distressing.
What Actually Helps
Once you've ruled out cardiac issues, the focus shifts to addressing what's driving the palpitations.
Regulate Your Nervous System
This is the foundation. If your nervous system is chronically activated, your heart will reflect that. Calming your nervous system can significantly reduce palpitation frequency.
Slow breathing with extended exhales directly activates the parasympathetic nervous system and slows heart rate. When you feel palpitations starting, try breathing in for four counts and out for six or eight. This isn't just a coping strategy. It's a direct physiological intervention.
Regular practices that calm the nervous system, whether that's meditation, gentle yoga, time in nature, or simply building pauses into your day, can change your baseline over time. You become less reactive, and palpitations become less frequent.
Reduce or Eliminate Caffeine
This is often the most direct intervention. Try eliminating caffeine completely for two weeks and see what happens to your palpitations. Many women find this alone makes a significant difference.
If you can't imagine giving up coffee entirely, try reducing to one cup in the morning and see if that helps. Pay attention to other sources of caffeine too: tea, chocolate, some medications.
Stabilize Blood Sugar
Eat regular meals with adequate protein and fat. Don't skip meals. Reduce refined carbohydrates and sugar. If your palpitations tend to happen at predictable times, like mid-afternoon or the middle of the night, blood sugar may be a factor.
Address Sleep
Improving sleep reduces nervous system reactivity and often decreases palpitations. This might mean addressing night sweats, creating better sleep conditions, or working on the factors that are disrupting your rest.
Reduce Alcohol
Alcohol can trigger palpitations directly and disrupts sleep, which contributes indirectly. Many women notice that palpitations are worse on nights they've had alcohol.
Manage Hot Flashes
If your palpitations are connected to hot flashes, addressing the hot flashes often helps the palpitations too. The interventions overlap: nervous system regulation, avoiding triggers, supporting your body through this transition.
Move Your Body Gently
Regular, moderate exercise supports cardiovascular health and nervous system regulation. But be thoughtful about intensity. Very intense exercise can trigger palpitations in some women. Walking, swimming, and moderate strength training are usually well-tolerated.
What This Looks Like in Practice
A woman came to us at 48, terrified by her heart. For three months, she'd been having palpitations almost daily. Sometimes her heart would race for no reason. Sometimes it felt like it was skipping beats. She'd been to the emergency room twice, certain something was seriously wrong. Both times, her workup was normal.
Her cardiologist had done a full evaluation: EKG, echocardiogram, Holter monitor. Everything was fine. He told her it was probably hormonal and stress-related, and suggested she find ways to relax.
That advice frustrated her. She didn't know how to "relax" when her heart was doing things it had never done before. The palpitations themselves were creating anxiety, and the anxiety seemed to be making the palpitations worse.
When we talked, the pattern was familiar. She was drinking four cups of coffee a day. She was sleeping poorly, waking most nights with her heart pounding. She was under significant stress at work and had been for years. She was skipping lunch most days, then eating heavily in the evening. Her nervous system had been in overdrive for a long time, and the hormonal shifts of perimenopause had pushed it past what it could handle.
We started with the most direct interventions. She cut caffeine completely, which was hard but she was motivated enough by her symptoms to do it. She started eating lunch. She began a simple breathing practice twice a day, and used slow breathing when she felt palpitations starting.
The first two weeks were difficult. She was tired without the caffeine, and the palpitations didn't disappear immediately. But by week three, she noticed they were less frequent. By week six, they had decreased significantly. She was still having occasional palpitations, but they no longer frightened her. She understood what was happening and had tools to respond.
The deeper work was about her nervous system. She had been running on adrenaline for years, and her body was telling her it couldn't continue. The palpitations were a symptom, but they were also a message. Her heart was asking her to pay attention to how she'd been living.
What she told me: "I kept thinking something was wrong with my heart. But my heart was fine. It was trying to tell me something was wrong with my life."
Your Next Step
If you're experiencing heart palpitations during perimenopause, please don't ignore them, but also don't assume the worst. Get checked out if you haven't been. And if everything comes back normal, know that you have significant influence over this symptom.
Palpitations respond to nervous system regulation, lifestyle changes, and addressing the underlying patterns that are keeping your body in a reactive state. You don't have to live in fear of your own heart.
This is the heart of our Embody & Heal path. Our Embodied Perimenopause Coaching program focuses on nervous system healing and lifestyle medicine. We help women understand what their symptoms are actually communicating and make the changes that bring real relief.
Contact us at 212.432.1110 or info@fafwellness.com.