Perimenopause Heart Palpitations: Causes, Triggers and When to Worry

Last updated October 10, 2026. Educational information, not medical advice: see our Medical Disclaimer.

A sudden flutter, a pounding beat as you lie down at night, or a moment where your heart seems to skip: perimenopause heart palpitations can be unsettling, especially when they appear out of nowhere in your 40s. The NHS lists a faster, slower or more noticeable heartbeat among the symptoms of perimenopause and menopause (NHS), and says palpitations can sometimes be a sign you’re going through the menopause (NHS).

This guide explains why hormone changes can affect your heartbeat, what research shows about how common palpitations are around menopause, which other causes are worth checking, what helps, and the warning signs that mean you should get help straight away. If you’re still working out whether you’re in perimenopause, our perimenopause symptoms checklist is a good place to start.

In this article:

• Can Perimenopause Cause Heart Palpitations?
• What Palpitations Feel Like
• At Night, Lying Down, After Eating or Before Your Period
• Other Causes and Triggers
• How to Ease Perimenopause Palpitations
• Tests Your Doctor May Suggest
• When to Get Help
• Perimenopause Palpitations FAQ
• Your Next Step

Can Perimenopause Cause Heart Palpitations?

Yes. Mayo Clinic lists hormone changes associated with menstruation, pregnancy or menopause among the common causes of palpitations, alongside stress, exercise, stimulants and fever. It also notes that palpitations are usually harmless, and that often no specific cause is found (Mayo Clinic).

The best long-term data come from the Study of Women’s Health Across the Nation (SWAN), which followed 3,276 women through the menopause transition. Researchers found three patterns:

• 15.9% had a high chance of palpitations from perimenopause into early postmenopause, easing in later postmenopause.
• 34.3% had a moderate chance over the same years, also easing later.
• 49.8% had a consistently low chance.

Women in the high group were more likely to have started perimenopause early and to report hot flashes, poorer overall health, more depressive symptoms, higher stress, more sleep problems and higher blood pressure. Reassuringly, palpitation patterns were not linked to atherosclerosis or artery stiffness measured later (Carpenter et al., Menopause, 2023).

The link with hot flashes is worth noticing. Mayo Clinic describes a rapid heartbeat as part of a hot flash (Mayo Clinic), and our guide on how to stop hot flashes covers the treatments with the best evidence.

What Palpitations Feel Like

Palpitations can make your heart feel like it’s racing, pounding, fluttering, flip-flopping or skipping beats. You may feel them in your chest, throat or neck, at rest or during activity, and they can last seconds, minutes or longer (NHS; Mayo Clinic).

Most palpitations are brief. What matters is how often they happen, how long they last and whether anything else comes with them, which is covered in When to Get Help below.

At Night, Lying Down, After Eating or Before Your Period

Palpitations often follow a pattern. Spotting yours can point to the trigger.

At night

Night-time palpitations are usually just like daytime ones; you notice them more at night because you’re not busy or distracted (Cleveland Clinic). In perimenopause, night sweats can add to them. A small 2025 pilot study fitted 30 midlife women, 15 with palpitations and 15 without, with a heart-monitoring patch for 14 to 28 days. Half of the women with palpitations felt them on at least a third of nights, on nearly half of days, or at least once every 24 hours. Symptoms happened both during changes in heart rhythm and during a normal rhythm, and the normal-rhythm episodes seemed more common at night. Reporting palpitations was linked to having hot flashes and diabetes, not to anxiety. With only 30 women, the authors stress that a larger study is needed (Carpenter et al., Menopause, 2025).

When lying down

Your position can matter too. Cleveland Clinic notes that sleeping on your side may increase pressure in your body, which can cause palpitations. If they start as you turn onto one side, try changing position.

After eating or drinking

Spicy or rich foods can cause palpitations, and so can caffeinated drinks and alcohol. Dehydration is another possible trigger (Cleveland Clinic). If palpitations follow meals, note what you ate and drank.

Before or during your period

Mayo Clinic lists hormone changes linked to menstruation, as well as menopause, among the causes of palpitations (Mayo Clinic). If yours cluster around your period, note it in a diary. If your periods are also heavy, ask about low iron, which is covered below.

All day or every day

Palpitations that keep coming back, happen more often or last longer than a few minutes should be checked by a doctor, and palpitations that don’t go away need urgent care (NHS). Don’t assume constant palpitations are just hormones.

Other Causes and Triggers

Because perimenopause is such a busy time for your body, it’s easy to put every new symptom down to hormones. These causes can look the same and are worth thinking about:

• Stimulants and lifestyle. Caffeine, alcohol, nicotine, strenuous exercise and lack of sleep can all bring on palpitations (NHS). So can some cold and cough medicines containing pseudoephedrine, and energy drinks (Mayo Clinic).
• Stress, anxiety and panic. Strong emotions are one of the most common triggers. Our guide to perimenopause anxiety explains why anxiety often rises in these years and what helps.
• Low iron. Noticeable heartbeats are one of the main symptoms of iron deficiency anaemia, and heavy periods are a very common cause of it (NHS). If your periods have become heavier, see our guide to irregular periods in perimenopause.
• Thyroid problems. Too much or too little thyroid hormone can cause palpitations (Mayo Clinic). Our guide to hormonal imbalance symptoms explains how thyroid problems overlap with perimenopause.
• Medicines. Check the leaflet of anything you take (NHS).
• Heart conditions. Rarely, palpitations are a sign of an irregular heart rhythm (arrhythmia) or another heart problem, such as heart valve disease, which needs treatment (NHS).

Midlife is also when heart health deserves extra attention. The CDC says heart disease is the leading cause of death for women in the United States, and that after menopause women are at higher risk of coronary heart disease because of hormonal changes. In some women, palpitations can be among the first signs of heart disease (CDC). That’s not a reason to panic, but it is a reason not to dismiss new palpitations without a check.

How to Ease Perimenopause Palpitations

Unless a heart condition is behind them, palpitations rarely need treatment, Mayo Clinic says. The main approach is to find and avoid your triggers (Mayo Clinic).

Cut back on stimulants

Caffeine, nicotine, energy drinks and some cold medicines can make the heart beat too fast or irregularly. Avoiding triggers such as caffeine, alcohol and smoking can help if a health condition isn’t the cause (NHS). Try swapping afternoon coffee for decaf and see whether night-time palpitations ease.

Calm your stress response

Mayo Clinic suggests relaxation techniques such as meditation, yoga or deep breathing to reduce stress-related palpitations. If stress or anxiety is the trigger, Cleveland Clinic says calming activities such as a breathing-focused mindfulness exercise may help you control them (Cleveland Clinic).

Drink enough water

Dehydration can trigger palpitations (Cleveland Clinic), and night sweats and hot flashes make you lose more fluid than usual. Keep water by the bed.

Treat hot flashes and protect your sleep

Because palpitations track so closely with hot flashes and poor sleep in the research above, treating those may help. Lack of sleep is itself a trigger (NHS).

What about hormone therapy?

A 2022 systematic review looked at 37 studies of menopause treatments that measured palpitations. Most were small, and the authors concluded that no treatment can be fully recommended for palpitations yet. Only some hormonal treatments, such as estradiol, could be recommended with caution, based on some evidence that they reduce how often or how severely palpitations happen. The evidence for supplements such as isoflavones and sage, for cognitive behavioral therapy and for acupressure wasn’t strong enough to recommend them for palpitations (Sheng et al., Climacteric, 2022).

That also answers the “natural remedies” question: so far, no supplement has good evidence for menopause palpitations, so check with a doctor or pharmacist before trying one. If palpitations come with other troublesome menopause symptoms, it’s worth asking whether hormone therapy is an option for you. Our guide to perimenopause treatment options explains how the benefits and risks are weighed up.

Keep a palpitations diary

Note when each episode happens, how long it lasts, what it feels like and what you were doing, along with coffee, alcohol, sleep, hot flashes and where you are in your cycle. Your doctor is likely to ask whether palpitations come and go, start and stop suddenly, happen at the same time each day or with certain activities, and whether anything makes them better or worse (Mayo Clinic). A diary answers all of that.

Tests Your Doctor May Suggest

Your doctor will examine you, listen to your heart and ask about your medical and family history. If a heart rhythm problem is suspected, tests may include (Mayo Clinic):

• An electrocardiogram (ECG or EKG), a quick, painless test of your heart’s electrical activity using sticky patches on your chest.
• A Holter monitor, a portable ECG worn for a day or more to catch palpitations during normal life.
• An event recorder, worn for up to 30 days, where you press a button when symptoms happen.
• An echocardiogram, an ultrasound scan that shows your heart’s structure and blood flow.

Your doctor may also suggest blood tests to check your thyroid and iron levels, since both can cause palpitations. If needed, you may be referred to a heart specialist (cardiologist) for further tests (NHS).

When to Get Help

Call 911 or go to the emergency room if palpitations don’t go away, or if they come with chest pain or discomfort, fainting, severe shortness of breath or severe dizziness (NHS; Mayo Clinic). Don’t drive yourself. The CDC also lists pain in the jaw, neck, back, arms or shoulders, feeling weak or light-headed, and a cold sweat as possible heart attack symptoms (CDC).

Book a doctor’s appointment if you feel well but your palpitations (NHS):

• keep coming back or are happening more often
• last longer than a few minutes
• happen and you already have a heart condition
• happen and there’s a history of heart problems in your family

Mayo Clinic notes that palpitations which are infrequent and last only a few seconds usually don’t need to be checked. If you’re unsure, it’s always reasonable to ask.

Perimenopause Palpitations FAQ

Your Next Step

Start a two-week palpitations diary and bring it to your appointment, along with a list of your medicines and supplements and any family history of heart problems. Our free printable perimenopause symptom and cycle tracker has room for your cycle, sleep and hot flashes alongside it. Not sure your symptoms are perimenopause at all? Take our free perimenopause test.

About the author: Jessica Bordo writes Daily Health Cycle out of personal interest in women’s health, not as a clinician. Each article summarizes what sources such as the NHS, Mayo Clinic, the CDC and published research say, and links to them so you can check the claims yourself. No medical reviewer is listed for this article, so use it to prepare questions for your own clinician, not to replace their advice. Our editorial standards explain how we source and check articles.

This article is for general education and isn’t medical advice. See our full disclaimer and talk with a qualified clinician about your own care.

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