Menopause can cause a variety of uncomfortable symptoms. You’ve likely heard of or maybe even experienced hot flashes, night sweats, or mood swings, but did you know that heart palpitations are also common during this time? Here, Dr. Heather Hirsch, M.D. explains why heart palpitations occur during perimenopause and what you can do about them.*

Menopause and heart palpitations

Many women first experience heart palpitations when they enter perimenopause, the several-year span before menstruation fully stops. Heather Hirsch, M.D., a faculty member at Harvard Medical School and the clinical program director of the Menopause Clinic at Brigham and Women’s Hospital in Boston, Massachusetts, explains that the hormonal changes occurring during perimenopause can affect your pulse.

“Your heart is made up of four different chambers,” she says. “In the top of the heart, there is something called the node. The node is what causes the signal to go down to the bottom chamber [for] a nice, rhythmic contraction every time your heart beats.”

Estrogen, the main reproductive hormone in women, is involved in how this node fires. As estrogen levels decline during perimenopause, it can cause the node to fire irregularly, resulting in heart palpitations. 

How to manage heart palpitations during menopause

Menopausal heart palpitations are not usually dangerous, says Hirsch, but it’s a good idea to let your doctor know that they are occurring, and rule out an underlying medical condition. If the palpitations are indeed estrogen-related and there are no concerns, here are steps you can take to manage this symptom.

Educate yourself

The single most important thing you can do is to educate yourself. Sudden palpitations can be scary, and when you don’t know why they’re happening, they can trigger your fight or flight response and potentially make the palpitations worse. Knowing how common they are and why they’re occurring can help you stay calm when you feel them. 

Use relaxation techniques

When you have a heart palpitation, try to engage your parasympathetic nervous system, the collection of nerves that tell your body to relax and rest. Here are some techniques to try:

• Close your eyes, take a couple of deep breaths, and remind yourself that everything is okay. “Say a mantra,” Hirsch recommends. “This is normal. This is perimenopause. This is normal. This is perimenopause.”
• If you enjoy yoga, certain poses, such as child’s pose and downward facing dog can be helpful. Many of these poses can slow down your heartbeat and help you relax. (Head-down positions may not be recommended for people with glaucoma, so consult with your doctor before doing them.)
• Lower your shoulders and give yourself a neck massage while taking deep breaths. This can also help slow your heart rate.
• Avoid your known triggers, and be on the lookout for new ones. Many women find that caffeine, alcohol, and/or extremely vigorous exercise can trigger a heart palpitation.

Speak with your doctor about hormone therapy

Hormone replacement therapy has not been approved by the Food and Drug Administration (FDA) for treating heart palpitations. Hirsch explains, however, that since it can stabilize estrogen levels, it may mitigate your discomfort.

If you’re having other disruptive menopause-related symptoms, like hot flashes or night sweats, ask your doctor if hormone therapy might be an appropriate option for you.

*Heather Hirsch MD, MS, NCMP. (2022, February 28). Perimenopause can cause heart palpitations! [Video]. YouTube. Retrieved September 16, 2022, from https://www.youtube.com/watch?v=Jbxgr69k7OY