A sudden flutter in your chest. A heartbeat that pounds or races for no clear reason. A feeling that your heart has skipped a beat. These are the sensations you might notice when palpitations first show up in perimenopause. They can feel alarming ,but palpitations are usually a harmless part of perimenopause and menopause, tied closely to the hormonal changes happening at this stage of life.2
Why palpitations show up in perimenopause
A heart that beats faster, harder, or more irregularly than usual, even when you are resting, often traces back to your hormones. During perimenopause, oestrogen rises and falls unpredictably before settling lower. Oestrogen helps regulate how your heart and blood vessels work, so when its levels shift, the part of your nervous system that controls your heart rate can become unsettled. That is when your heartbeat can start to feel off.1
You may notice palpitations turning up alongside hot flushes and night sweats. Sometimes a flutter and a flush arrive together. Sometimes palpitations come more often when your sleep is broken. These symptoms cluster because they share the same hormonal swings, the kind that drive hot flushes and night sweats (often called vasomotor symptoms).3
When palpitations are hormonal and when to get checked
Palpitations that are brief, occasional, and settle on their own are most likely down to the hormonal shifts of perimenopause. They do not usually point to a heart problem. It is still worth speaking to your GP if you feel worried, if palpitations last a long time, if they are coming more often or feeling more intense, or if you have a personal or family history of heart problems. Your GP can check your heart rhythm, rule out other causes like low iron or thyroid changes, and give you a clear picture of what is going on.4
What helps with perimenopausal palpitations
A few everyday changes can ease how often palpitations come and how strong they feel. They work best alongside any medical care, and they do not replace a conversation with your GP if you have concerns.
- Easing stress with breathing exercises, gentle movement, or rest.
- Cutting back on caffeine and alcohol, which can trigger palpitations.
- Keeping your fluids up and eating regular meals to keep your blood sugar steady.
- Moving gently and regularly, which supports your heart health over time.6
How HRT can help
Hormone Replacement Therapy (HRT) can be an effective treatment for palpitations in perimenopause. By steadying your hormone levels, it can ease palpitations along with other symptoms. Whether HRT suits you depends on your health and medical history. That is a conversation to have with your GP or a specialist, who can weigh up the benefits and considerations with you.7
How this changes after menopause
The palpitations here belong to perimenopause, the stretch of time when your hormones swing up and down. After menopause, when oestrogen settles at a steadily lower level, the pattern of heart-related symptoms can change. If you are further along in the transition, or past menopause, the things shaping your heart health will be different and are worth talking through separately with your GP.