A fluttering in your chest, a sudden pounding heartbeat, or a racing feeling in your throat. These are palpitations, and they often turn up during menopause. They do not always settle once your periods have ended. In the years after menopause, when your oestrogen stays low rather than rising and falling, you might keep noticing this sensation, or feel it for the first time. Knowing what is happening in your body, what helps, and when to act gives you a clearer way forward.1
Why low oestrogen can affect your heart rate after menopause
When your heartbeat suddenly feels louder or faster, oestrogen is often part of the picture. It helps steady both the nervous system that controls your heart rate and the heart's own electrical signals. When your levels fall and stay low after menopause, that steadying influence drops too, and your heartbeat can feel more noticeable or come more often. Whether it shows up as a flutter, a thud, or a brief racing, it is a physical response to that lasting hormonal shift.2
When palpitations are hormonal and when they need a closer look
Palpitations are common and usually nothing to worry about. Now and then, though, they can point to something else, like an overactive thyroid, iron deficiency anaemia, or a heart rhythm problem (an arrhythmia). These all share the same fluttering or racing feeling, so a GP appointment is the way to get the right checks done.3
Your GP might suggest an electrocardiogram (an ECG, which records your heart's electrical signals). It helps rule out anything underlying before putting palpitations down to menopause. It is a routine test, painless and quick, and a straightforward way to get some clarity.4
What helps with palpitations in menopause
Everyday changes that can help
A few everyday things can make palpitations more likely, so easing off them often helps. Cutting back on caffeine and alcohol can settle how often they happen, and drinking less may take the edge off hot flushes too. If you smoke, stopping helps, since it can make palpitations worse. Finding ways to manage stress, whatever works for you, also supports a steadier heart rate.7
Non-hormonal options
If palpitations come with a wave of anxiety, Cognitive Behavioural Therapy (CBT, a talking therapy that works on thought patterns) can help with that side of things. Relaxation practices like meditation and yoga may help too. If symptoms are really getting in the way of daily life, your GP can talk through whether medication makes sense. That is a conversation to have with a clinician, rather than something to try on your own.8
Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) helps with many menopausal symptoms, and because it works on the hormonal shift underneath, it can ease palpitations too. There is also evidence that starting HRT within 10 years of menopause and before the age of 60 can lower the risk of developing coronary heart disease. Whether HRT is right for you comes down to your own health history, and it is a decision to make together with your GP or a specialist.9
If you already have cardiovascular disease, the decision needs more care. Where HRT is needed for symptoms, the preferred approach is a low-dose, transdermal form of oestrogen (absorbed through the skin rather than swallowed) combined with a specific type of progesterone. This is a decision to make with a specialist, with the right support behind you.10