Heart Palpitations
A fluttering, racing, or skipping heartbeat — usually hormonal, but always worth checking.
What it feels like
A sudden awareness of your heartbeat — fluttering, skipping, racing, or pounding — often at rest, at night, or immediately after a hot flash. The sensation can be frightening, particularly if you have never experienced it before. Most perimenopausal palpitations are brief, benign, and directly linked to hormonal fluctuation.
Why it happens
Oestrogen has a direct effect on the cardiovascular system — it keeps blood vessels flexible, regulates the autonomic nervous system (which governs heart rate), and has a stabilising effect on cardiac rhythm. As oestrogen fluctuates unpredictably during perimenopause, the autonomic nervous system becomes less stable — producing temporary changes in heart rate and rhythm. Hot flashes often directly trigger palpitations: the rapid vasodilation of a flash causes a sudden cardiovascular response. Anxiety, which is itself driven by hormonal change, further sensitises the nervous system to heartbeat sensations — making palpitations feel more alarming than they are.
Our free 3-minute symptom check is designed for Indian women.
What helps
- If palpitations are frequent, prolonged, accompanied by chest pain, breathlessness, or dizziness — see a doctor promptly. Call 112 in an emergency.
- Reduce caffeine — coffee, tea, and energy drinks can trigger and worsen palpitations
- Reduce alcohol — it directly affects heart rate and rhythm
- Treating hot flashes (HRT, lifestyle measures) often reduces associated palpitations significantly
- An ECG is a simple, quick test that rules out cardiac causes and gives peace of mind
Frequently asked questions
Are heart palpitations during perimenopause dangerous?
In most cases, perimenopausal palpitations are benign and directly caused by oestrogen fluctuation. However, any new-onset palpitations in your 40s are worth a one-time ECG to establish a baseline and rule out an arrhythmia — this is a quick, non-invasive test available at most Indian diagnostic centres. Palpitations that are frequent, prolonged (lasting more than a few minutes), or accompanied by chest pain, breathlessness, dizziness, or fainting should be evaluated promptly.
When should I go to hospital for palpitations?
Go to hospital immediately (or call 112) if you experience: palpitations with chest pain or pressure, palpitations with breathlessness, feeling faint or actually fainting, palpitations that last more than 10–15 minutes and do not resolve, or any palpitations that feel different from your usual ones.
Can HRT help with palpitations?
Yes — by stabilising oestrogen levels, HRT reduces the hormonal fluctuation that drives palpitations. Women on HRT often report significant reduction in palpitations. However, palpitations should be evaluated by a doctor before attributing them entirely to perimenopause, to rule out cardiac causes.
What tests should I ask for if I have palpitations?
An ECG (electrocardiogram) is the first-line test — it is quick, non-invasive, and available at most clinics and diagnostic centres in India. If palpitations are frequent, a 24-hour Holter monitor (a portable ECG worn for a day) captures what happens during an actual episode. Your doctor should also check thyroid function and iron levels, as both thyroid disease and anaemia cause palpitations.