Heart Palpitations in Menopause: Causes and Red Flags

Palpitations, a racing, pounding, fluttering or skipped heartbeat, are common in perimenopause and menopause. They often come with hot flashes. Most are harmless, but palpitations can also be caused by heart rhythm problems, an overactive thyroid, anemia or caffeine. The NHS advises contacting a doctor if you have palpitations. Palpitations with chest pain, fainting or breathlessness need emergency care.

What do palpitations feel like?

• A racing or pounding heartbeat
• Fluttering in the chest
• A "skipped" or extra beat, sometimes followed by a thump
• Feeling your heartbeat in your neck or throat
• An irregular or uneven rhythm

They may last a few seconds or several minutes, and often happen at rest, at night, or during a hot flash.

Why does menopause cause palpitations?

• Hot flashes. The NHS explains that hot flashes can make you sweat, feel dizzy, and cause palpitations or anxiety. During a flash, blood vessels widen and the heart speeds up to help release heat. See hot flashes and night sweats.
• Hormone changes. Estrogen affects the heart and blood vessels, and fluctuating levels may make the heart more sensitive to triggers.
• Anxiety. Anxiety causes a faster heartbeat, and noticing palpitations can make anxiety worse. See anxiety.
• Poor sleep and stress, which raise adrenaline levels. See sleep problems.

What else can cause palpitations?

Mayo Clinic notes that an overactive thyroid can cause hot flashes, palpitations, anxiety and insomnia that may be mistaken for menopause, and that cardiovascular conditions can resemble menopause symptoms. Heavy periods can cause anemia, which may lead to a fast heartbeat. See heavy bleeding and perimenopause or something else.

What will a clinician assess?

A clinician will usually:

• Ask what the palpitations feel like, how long they last, what triggers them, and whether you feel dizzy, breathless or faint
• Check your pulse and blood pressure, and listen to your heart
• Arrange an ECG (electrocardiogram), a quick recording of your heart’s electrical activity
• Suggest blood tests, such as a blood count, thyroid function and sometimes electrolytes
• Offer longer monitoring with a portable heart monitor if palpitations come and go

Tapping out the rhythm of your palpitations, or noting your pulse during an episode, can help. Some smartwatches can record a heart rhythm tracing, and it’s worth showing that to your clinician.

What treatments help?

Treatment depends on the cause:

• If palpitations come with hot flashes: treating hot flashes can help. Hormone therapy is the most effective treatment, and NICE recommends considering menopause-specific CBT. Non-hormonal medicines such as fezolinetant are available in some countries.
• If anxiety is involved: CBT, relaxation techniques and treatment for anxiety.
• If there’s an underlying condition: treating an overactive thyroid, anemia or a heart rhythm problem.
• If triggers are involved: cutting back on caffeine, alcohol and nicotine.

Practical steps that may help

• Reduce caffeine, including coffee, tea, energy drinks and cola.
• Limit alcohol and stop smoking.
• Stay hydrated and eat regularly.
• Try slow breathing during an episode: in for four counts, out for six.
• Improve sleep, and manage stress.
• Keep a palpitations diary, noting time, duration, what you were doing, and any hot flash, caffeine or alcohol. Our private Symptom Explorer can help.

Palpitations and your long-term heart health

Heart disease is the leading cause of death in women, and risk rises after menopause. Research from the SWAN study has also linked frequent or persistent hot flashes with higher later cardiovascular risk. Even if your palpitations turn out to be harmless, it’s a good time to check your blood pressure, cholesterol and blood sugar. See heart health after menopause.

What happens during an ECG?

An electrocardiogram (ECG) is a quick, painless test. Small sticky pads are placed on your chest, arms and legs to record your heart’s electrical activity for a few seconds. It can show heart rhythm problems, but only if they happen during the recording. That’s why a portable monitor, worn for a day or more, is sometimes used for palpitations that come and go.

Using a smartwatch or phone app

Some smartwatches can record a single-lead ECG or flag an irregular rhythm. They can be a useful way to capture an episode to show your clinician. But they can miss problems or give false alarms, so they don’t replace a proper assessment. If your device alerts you and you feel unwell, seek medical advice.

The palpitations and anxiety loop

Noticing your heartbeat can make you anxious, and anxiety speeds up your heart, which can make palpitations feel worse. Knowing what’s happening, slow breathing, and reassurance after a proper check can break the cycle. CBT can help if the worry persists. See anxiety.

When should you get help?

The NHS advises contacting your GP if you have symptoms like a fast heartbeat (palpitations).

Call emergency services immediately if palpitations come with:

• Chest pain, pressure or tightness
• Severe breathlessness
• Fainting, or feeling like you’re about to faint
• Sudden weakness, numbness, facial drooping or difficulty speaking

See a clinician promptly if:

• Palpitations are frequent, last a long time, or feel very fast or irregular
• You feel dizzy or light-headed with them
• They happen during exercise
• You have a family history of heart rhythm problems or sudden cardiac death
• You also have heavy periods, weight loss or tremor

Questions to ask at your appointment

1. Could my palpitations be linked to hot flashes or menopause?
2. Should I have an ECG or wear a heart monitor?
3. Should my thyroid and iron levels be checked?
4. Could any of my medicines or drinks be contributing?
5. What is my overall heart disease risk?

See your first menopause appointment.

Related symptoms

Hot flashes · Anxiety · Sleep problems · Heavy bleeding

Frequently asked questions

Are heart palpitations normal during menopause?

They’re common and often harmless, especially with hot flashes. The NHS still advises contacting your GP if you have them, so other causes can be ruled out.

Why do I get palpitations at night during perimenopause?

Night sweats, lying still and quiet, and anxiety at night can all make palpitations more noticeable. Tell your clinician if they wake you or feel irregular.

Can HRT help palpitations?

If palpitations come with hot flashes, treating hot flashes with hormone therapy may help. Palpitations from other causes need their own treatment.

When are palpitations dangerous?

Palpitations with chest pain, fainting, severe breathlessness or dizziness need emergency care.

Can low iron cause palpitations?

Yes. Iron-deficiency anemia, often from heavy periods, can cause a fast heartbeat along with tiredness and breathlessness. A blood test can check.

Should I stop caffeine if I have palpitations?

Cutting back is often worthwhile, as caffeine is a common trigger. Try reducing gradually to avoid withdrawal headaches.

References

1. NHS: Symptoms of menopause and perimenopause (palpitations; contact your GP)
2. Mayo Clinic Press: Menopause symptoms? It could be a copycat
3. ACOG: Heavy menstrual bleeding (anemia)
4. NICE guideline NG23: Menopause, identification and management (2024 update)
5. El Khoudary SR et al. Menopause transition and cardiovascular disease risk: AHA scientific statement, 2020
6. Thurston RC et al. Vasomotor symptoms and cardiovascular events in SWAN. Journal of the American Heart Association
7. GlobalRPH: Perimenopause vs thyroid vs mood: sorting symptom overlap

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.