A heart that suddenly pounds, races or seems to skip is one of the more alarming things perimenopause produces.
It is common. It is also a symptom where "it is probably just hormones" is not good enough, because several other causes are straightforward to exclude.
What women describe
- A sudden pounding, often in the chest or up in the throat
- A racing heart at rest, with no exertion
- A sensation of skipped or extra beats
- Waking at night with the heart hammering
- Palpitations arriving with or just before a hot flush
- Accompanying anxiety — sometimes as the cause, often as the result
The night-time pattern is reported constantly. Lying still in the dark makes your own heartbeat far more noticeable, and night sweats bring a genuine rise in heart rate.
Why perimenopause produces them
Vasomotor events. A hot flush is the body responding as though it is overheating — blood vessels dilate, sweating starts, and heart rate rises. Palpitations are frequently part of that same event rather than something separate.
Hormonal effects on the cardiovascular system. The hormones that fluctuate through perimenopause have effects on heart rate and vascular tone.
Disrupted sleep. Poor sleep raises resting heart rate and lowers the threshold at which you notice it.
Anxiety. A genuine two-way street. Anxiety produces palpitations; palpitations produce anxiety. Many women describe a loop where noticing the heartbeat generates fear which worsens the heartbeat.
Stimulants. Caffeine and alcohol both provoke palpitations, and tolerance to both often shifts in this decade.
What must be excluded
This is the part that matters, and the reason to actually see someone.
Thyroid problems. An overactive thyroid causes palpitations, heat intolerance, sweating, anxiety and weight change — a near-perfect overlap with perimenopause. A simple blood test separates them.
Iron deficiency and anaemia. Low iron makes the heart work harder and is extremely common in women with heavier perimenopausal periods. Ask for ferritin, not just a full blood count.
Heart rhythm disturbances. Atrial fibrillation becomes more common with age. It is important to identify because of stroke risk, and it is often intermittent — which is why an ECG on a good day can miss it and a monitor worn over days may be suggested.
Medications and supplements. Some, including over-the-counter decongestants and thyroid preparations, provoke palpitations.
What helps
Get assessed first. Everything below is more comfortable once you know what you are dealing with.
Track them. When, how long, what you were doing, where you were in your cycle, what you had eaten or drunk. Patterns emerge quickly.
Reduce caffeine, particularly after mid-afternoon. Its half-life lengthens with age.
Reduce alcohol. A well-recognised trigger, and it fragments sleep, which makes everything worse.
Protect sleep. See sleep problems.
Slow breathing at onset. Six seconds in, six out, for a couple of minutes. It will not stop a rhythm disturbance, but it interrupts the anxiety loop that amplifies benign palpitations.
Keep exercising. Regular aerobic exercise lowers resting heart rate over time. If exertion brings on palpitations, get assessed before continuing.
What to discuss with a doctor
Be specific. How often, how long they last, whether they are regular or irregular, what brings them on, whether anything else happens with them.
Ask for thyroid function, full blood count and ferritin as a minimum. Ask whether an ECG is worthwhile, and whether a monitor over several days would help if episodes are intermittent.
Mention every supplement and over-the-counter product you take.