Perimenopause heart palpitations: why your heart races at night, and when to worry

You are lying in bed, finally drifting off, and your heart suddenly thumps, flutters or takes off at a gallop. Maybe a hot flash rolls in right behind it. If you are in your 40s or early 50s, you are far from alone, and there is a real reason it happens. There is also a short list of signs that mean you should not wait it out. Let us walk through both.

Yes, palpitations are a menopause symptom

The NHS lists palpitations, described as "a faster, slower or more noticeable heartbeat," among the physical symptoms of menopause, and its general palpitations page notes they can be a sign you are going through the menopause. Cleveland Clinic also names menopause as one of the life stages when palpitations commonly show up.

How common are they? A systematic review of studies by menopausal stage found palpitations reported by 20.1 to 40.2% of perimenopausal women and 15.7 to 54.1% of postmenopausal women. The numbers vary a lot between studies, but three of the five studies that compared stages found palpitations were significantly more common in perimenopause and after surgical menopause than before or after a natural transition.

Why your heart races, especially at night

Researchers have not pinned down one cause, and the evidence is thinner than we would like. A 2022 scoping review of what travels with menopausal palpitations found the most likely companions were:

• Hot flashes and night sweats. Worse vasomotor symptoms were one of the likely correlates. If your heart pounds just before or during a flash, that pattern fits.
• Poor sleep. Broken sleep showed up as a likely correlate too, which may be part of why night is when many of us notice it most. A quiet room also makes every beat easier to feel.
• Less physical activity and lower quality of life were also linked.

The same review found that evidence on anxiety and stress was too thin to draw conclusions, even though general sources list stress and anxiety as common triggers. If 3 a.m. wake-ups are part of your picture, our guide to waking at 3am in perimenopause goes deeper on sleep.

Everyday triggers worth checking

MedlinePlus, the NHS and Cleveland Clinic all point to the same usual suspects: caffeine, alcohol, nicotine, stress, lack of sleep, strenuous exercise, fever, dehydration, and some medicines, including decongestants such as pseudoephedrine and diet pills. Check the leaflet for anything new you are taking.

Look-alikes your clinician will want to rule out

Perimenopause is a common reason for palpitations, but it is not the only one, and several others are easy to test for.

That anemia row matters more than people think. MedlinePlus lists a racing or pounding heartbeat among the early symptoms of iron deficiency anemia, and heavy or long periods are a leading cause. Perimenopause can bring exactly those periods. See our guide to heavy periods in perimenopause if that sounds familiar.

What a check-up usually involves

MedlinePlus says that if you have never had palpitations before, you should see your provider. Most people do not need the emergency room for this. Expect questions about what the beats feel like (skipped, fast, slow, regular or irregular), when they start and stop, and your caffeine, alcohol and medicine use. An ECG is common. If a rhythm problem is suspected, you may be offered a Holter monitor that records your heart for 24 hours or longer, or an echocardiogram.

One study of midlife women found many struggled to describe their palpitations until they were prompted, and half of them had never mentioned them to a provider at all. So write it down before your visit: time of day, how long it lasted, what you were doing, and whether a hot flash came with it. A pulse reading during an episode helps too. Our menopause appointment guide has a simple prep checklist.

Why this is a good moment to think about your heart

Most palpitations are harmless, as MedlinePlus puts it. But the American Heart Association calls the menopause transition "a time of accelerating" cardiovascular risk, with total cholesterol, LDL and related markers rising around the final period. A palpitations visit is a natural chance to ask about your blood pressure, cholesterol and blood sugar too.

What helps day to day

• Trim the triggers. Try cutting back on caffeine and alcohol for a few weeks and see whether episodes change. Do not smoke.
• Calm the system. MedlinePlus suggests deep breathing, relaxation exercises, yoga, meditation or tai chi, and regular exercise.
• Treat the hot flashes. Since palpitations and vasomotor symptoms tend to travel together, easing flashes may help. Options range from hormone therapy to non-hormone treatments; your clinician can help you weigh them.
• Once you have been checked, try not to monitor every beat, but do report any sudden change in your pattern.

When to call your clinician

Call 911 right away if palpitations will not stop, or if they come with any of these:

• Chest pain or pressure, or pain spreading to your neck, jaw, arm or upper back
• Shortness of breath or trouble breathing
• Fainting, nearly fainting, dizziness or lightheadedness
• Unusual sweating that is not a typical hot flash

Do not drive yourself. Contact your clinician promptly if palpitations are new or different, keep coming back or are happening more often, last more than a few minutes, or if your resting pulse is over 100. MedlinePlus also flags frequent extra beats (more than 6 a minute, or in groups of 3 or more). Get seen sooner if you have heart disease, risk factors for it, or a family history of heart problems.

Questions to ask your clinician

1. Could my palpitations be linked to perimenopause, and what else should we rule out?
2. Should I have an ECG, a Holter monitor, or blood tests for thyroid and anemia?
3. Could any of my medicines or supplements be a trigger?
4. If my hot flashes are treated, might the palpitations ease too?
5. What are my blood pressure, cholesterol and blood sugar, and should we be tracking them more closely now?
6. Which symptoms mean I should go straight to the ER?

Questions

Can perimenopause cause heart palpitations?

Yes. The NHS lists palpitations as a menopause symptom, and several studies find they are more common in perimenopause than before it. They often come with hot flashes and poor sleep. New palpitations still deserve one check to rule out thyroid problems, anemia and rhythm problems.

Why does my heart race at night in perimenopause?

Night sweats and broken sleep are both linked to palpitations in menopause research, and a quiet bedroom makes every beat easier to notice. Caffeine or alcohol later in the day can add to it. If it happens often, keep a log and bring it to your clinician.

Are menopause palpitations dangerous?

Most palpitations are harmless. Call 911 if a racing heart comes with chest pain, shortness of breath, fainting or dizziness, or will not stop. See your clinician for new, frequent or longer-lasting palpitations.

What tests check for palpitations?

Usually a history and an ECG, plus blood tests for thyroid and anemia. If a rhythm problem is suspected, you may wear a Holter monitor for a day or longer, or have an echocardiogram.

Can hormone therapy help palpitations?

Research on palpitations specifically is limited. Because palpitations tend to travel with hot flashes and poor sleep, treating those may help. Ask your clinician whether hormone or non-hormone options fit your health history.

Keep reading

• Menopause joint pain: why your joints ache in perimenopause, and what helps
• Menopause hair loss: why your hair is thinning, and what actually helps
• Heavy periods in perimenopause: flooding, clots, and when to worry
• Perimenopause brain fog: why your memory feels off, and what helps
• Vaginal dryness in menopause: what it is, why it gets worse, and what actually works
• Low libido in menopause: why your sex drive disappeared, and what can help

Education and personal experience, not medical advice. Talk with your own clinician before making health decisions.