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A racing, pounding or fluttering heart is common in perimenopause, often with hot flashes. Learn the usual causes, which checks you may need and warning signs.
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.
They may last a few seconds or several minutes, and often happen at rest, at night, or during a hot flash.
| Possible cause | Clues |
|---|---|
| Overactive thyroid | Palpitations with weight loss, tremor, heat intolerance, anxiety or insomnia |
| Anemia | Heavy periods, tiredness, breathlessness, pale skin |
| Caffeine, alcohol, nicotine | Palpitations after drinks or smoking |
| Medicines | Decongestants, some asthma inhalers, thyroid medicine, stimulants |
| Heart rhythm problems (arrhythmias) | Irregular rhythm, a very fast rate, dizziness or fainting |
| Other heart conditions | Chest pain, breathlessness or swollen ankles |
| Dehydration or low blood sugar | After exercise, illness or skipped meals |
| Panic attacks | Sudden fear with a racing heart, breathlessness and tingling |
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.
A clinician will usually:
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.
Treatment depends on the cause:
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.
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.
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.
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.
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
See your first menopause appointment.
Hot flashes · Anxiety · Sleep problems · Heavy bleeding
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.
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.
If palpitations come with hot flashes, treating hot flashes with hormone therapy may help. Palpitations from other causes need their own treatment.
Palpitations with chest pain, fainting, severe breathlessness or dizziness need emergency care.
Yes. Iron-deficiency anemia, often from heavy periods, can cause a fast heartbeat along with tiredness and breathlessness. A blood test can check.
Cutting back is often worthwhile, as caffeine is a common trigger. Try reducing gradually to avoid withdrawal headaches.
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
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