A fluttering heart or a sudden racing sensation can feel alarming. For many women in perimenopause and menopause, palpitations are a recognised symptom, yet they are not talked about as much as hot flushes or brain fog. This lack of awareness and context can make them much more frightening when they happen.

What are palpitations?

Palpitations are an increased awareness of your heartbeat. You might notice your heart beating harder, faster or irregularly. Some women describe a fluttering sensation. Others say it feels like their heart is pounding or briefly skipping. These episodes can last seconds or minutes and they may arrive on their own or alongside hot flushes, night sweats, dizziness or breathlessness.

They are more common than many women realise. Palpitations account for 16% of GP visits among women and are the second most common reason for referral to cardiology. Even so, many women do not know they can be part of perimenopause and menopause.

Why do palpitations happen?

Hormones play an important role in how your heart and blood vessels function. Estradiol, progesterone and testosterone all affect the electrical pathways through which the heart beats. When hormone levels fluctuate and fall, the heart can become more sensitive and more easily stimulated. Some evidence suggests the heart can beat 8 to 16 times more per minute when hormone levels are lower. That helps explain why palpitations can appear out of nowhere, even in women who have never experienced them before.

Palpitations can also be connected with anxiety. A hormonal cause produces palpitations, palpitations provoke anxiety, and anxiety makes those palpitations worse. Understanding the underlying hormone connection can interrupt that cycle.

Are they dangerous?

In most cases, palpitations linked to hormone change are harmless. Even so, they deserve assessment. A healthcare professional should be able to rule out other causes and give you a clearer picture of what is happening.

Seek advice promptly if palpitations last several minutes or if they come with chest pain or shortness of breath. Watch and respond if they’re becoming more frequent or are not improving after a few months of hormone treatment. New cardiac symptoms always warrant proper evaluation – the hormonal context does not remove the need for that.

What helps?

Addressing the underlying hormone changes is usually the most effective approach. The right type and dose of hormone treatment can ease palpitations alongside other symptoms. Managing stress, staying well hydrated, limiting alcohol and caffeine, and eating regularly to avoid blood sugar spikes can also reduce episodes. Longer term, regular exercise, maintaining a healthy weight and not smoking all support cardiovascular health. Evidence aösp suggests that women who take hormone treatment have a lower future risk of heart disease.

What to do next

Palpitations are a real and recognised part of perimenopause and menopause and you do not have to simply monitor them in silence. If they are affecting your confidence, sleep or daily life, speak to a healthcare professional. The right treatment should always look at the full picture. That includes your sleep, your overall wellbeing, your heart and your hormones.