Understand this symptom
Heart palpitations in menopause
Written by
Uma Health
Medically verified by
Dr. William Declerck
Physician
Insight
The essentials
This symptom is caused by the hormonal shifts your body is going through. Understanding what's happening helps you better cope with what you're feeling.
The cause
The fluctuating and falling oestrogen of menopause affects your autonomic nervous system, the part that controls your heart rate without you thinking about it. That can make your heart feel faster, harder or irregular, often right around a hot flush or at night. Caffeine, alcohol, poor sleep and stress all play a part too.
What helps
Cutting back on caffeine and alcohol (especially later in the day), staying hydrated, protecting your sleep and breathing slowly through an episode. For most women, palpitations are harmless. If they keep coming back, or come with fainting, chest pain or breathlessness, have your heart rhythm checked.
Honest and transparent
The most frequently asked questions
It can be a fright to suddenly feel your heart pounding, but you are far from alone. Palpitations are among the commonly reported menopause symptoms and are often noticed alongside hot flushes and night sweats. In most cases they are harmless: you feel your heart, but there is nothing wrong with your heart.
An understandable worry, and the honest answer is usually reassuring. Isolated palpitations with no other symptoms are rarely dangerous, but if you are in any doubt, always contact your GP or the emergency services. Call for help straight away if they come with fainting or near-fainting, chest pain or pressure, or severe breathlessness. If they keep returning or last a long time, have your heart rhythm checked by your GP.
Frustrating, because they hit just as you are trying to wind down. At night the outside distractions fall away and you notice your body more sharply, and a hot flush or night sweat can push your heart rate up. See also night sweats and hot flashes. Caffeine or alcohol earlier in the day can still be at work by the evening.
A smart instinct to look wider, because menopause is not the only explanation. An overactive thyroid, anaemia, dehydration, too much caffeine and certain medications can all cause palpitations. A blood test at your GP can rule out many of these causes quickly.
Very recognisable, because a pounding heart feels threatening even when nothing serious is going on. Breathing slowly and calmly during an episode helps your heart rate settle. The anxiety itself can amplify the palpitations, which creates a loop. There is more on this on our anxiety page.
A logical question, and the answer is nuanced. Hormone therapy is not prescribed to treat palpitations on their own: the evidence for that is currently too limited. Indirectly, it can make a difference. With fewer hot flushes and night sweats and better sleep, many women notice fewer of the palpitations that came with them.
You are lying in bed and you can feel your heart thudding against your ribs. Or it skips, as if it stumbles for a beat. In the daytime it sometimes races for no reason you can name. For many women that is a fright: is this menopause, or is something wrong with my heart? Here is an answer: why palpitations show up now, when they are harmless and when it is worth getting them checked.
How women describe it
"My heart pounds right up into my throat."
"It feels like my heart skips a beat."
"Out of nowhere I'm racing, just sitting on the sofa."
"It hits me at night, and then the panic joins in."
Sound familiar? You are not alone. Palpitations are among the commonly reported menopause symptoms, and yet they are far less studied than hot flushes.1 A palpitation is not a disease in itself but a sensation: you become aware of your own heartbeat, faster, harder or irregular.
Why your heart races in menopause
Oestrogen does more than regulate your cycle. It also affects your autonomic nervous system, the part that runs your heart rate, breathing and stress responses without you thinking about it. When your oestrogen starts to fluctuate and fall in perimenopause, that system can respond more readily, and you feel your heart step up.1
Palpitations rarely travel alone. They are often reported in the same moments as hot flushes and night sweats, when your heart rate rises with them. That is why you tend to feel them more at night, or just as a flush comes on.
One thing to be honest about: this is younger science. Researchers know palpitations are common around menopause, but the exact route by which hormones affect your heart rhythm has not been fully worked out.1 That your symptom is real is separate from that uncertainty.
The anxiety loop
A pounding heart feels threatening, even when nothing physical is wrong. That fear tips your nervous system a little further into alarm, so your heart runs faster and the palpitations grow stronger. A loop forms: palpitations spark anxiety, and anxiety feeds the palpitations.
Breaking the loop starts with your breath. Breathe in slowly through your nose and out for longer, for a few minutes. That switches on the calming side of your nervous system and helps your heart rate settle. If tension and worry are playing a big role, read our page on anxiety in menopause too.
When to get it checked
This is the part that matters most. Most palpitations are harmless, but a few signals deserve prompt attention.
Call the emergency number (112 in Belgium) or go to A&E if your palpitations come with fainting or near-fainting, chest pain or pressure, or severe breathlessness. That combination always needs urgent assessment.
Make an appointment with your GP soon if the episodes come back often or last a long time, if your heartbeat is clearly irregular, if you already have heart disease, or if there is a family history of sudden death at a young age.
One more thing worth knowing at this age: atrial fibrillation, an irregular heart rhythm, becomes more common as you get older.2 Feel your pulse when your heart is racing: is it steady, or jumping around erratically? A smartwatch that records your rhythm, or a heart trace, can help capture an episode that has passed by the time you sit with the doctor. There is no need to fixate on it, but a recording gives your GP something concrete to look at.
A check-up is less than you might fear. Often a short ECG (heart trace) of a few minutes is enough, sometimes you go home with a Holter monitor: a small device that records your heart rhythm for one to several days while you go about your life. Your GP will usually also take some blood to check your thyroid and iron.
Could it be something other than menopause?
Menopause is a likely explanation, but not the only one. An overactive thyroid can send your heart racing. Anaemia, dehydration, plenty of caffeine or alcohol, nicotine and some medications do the same. So it is sensible to look at the whole picture, especially if the palpitations are new or clearly changing. A blood test at your GP rules out many of these causes quickly.
What you can do yourself
A pill for palpitations is usually not needed. A few changes take most women a long way.
Start by mapping your pattern. For a week or two, note when the palpitations come on, how long they last and what came before: coffee, alcohol, stress, a hot flush, a bad night. A thread often shows up fast.
Then tackle the most common triggers. Less caffeine and alcohol, especially in the second half of the day, because both can still be at work hours later. Drink enough, especially in the heat and with night sweats, because dehydration pushes your heart rate up. Protect your sleep with a cool room and a calmer evening. And build in real recovery time: a nervous system stuck in alarm for weeks does not settle on its own.
Does hormone therapy help?
Hormone therapy is not prescribed to treat palpitations on their own. The scientific evidence for that is currently too limited.3,4,5,6
Indirectly, it can make a difference. Treat your hot flushes and night sweats and the palpitations that came on in those moments often ease with them, and you sleep through better. If you are considering hormone therapy for other menopause symptoms, a care provider who knows menopause well can look at what is useful and safe in your specific situation.
Where to find help
Do the palpitations keep coming back, or are they leaving you anxious? You don't have to figure this out alone.
Your GP (huisarts) is a good first stop. They can do a heart trace, use a blood test to rule out other causes such as a thyroid problem or iron deficiency, and refer you to a cardiologist if needed. If menopause is clearly part of the picture, a gynaecologist or a hospital menopause clinic can take you further.
Want to talk directly to someone who works on menopause every day? On Uma you will find care providers who specialise in (peri)menopause. Your consultation takes place online, you discuss all your symptoms together, including the ones you hadn't yet connected, and you leave with a concrete plan. Uma is active mainly in Belgium, the Netherlands, Luxembourg and France, but any woman in Europe can consult a care provider on Uma. Prescriptions are valid across Europe.
Sources
- Sheng, Y., Carpenter, J.S., Elomba, C.D. et al. (2021). Review of menopausal palpitations measures. Women's Midlife Health, 7, 5.
- Liu, J., Jin, X., Chen, W. et al. (2023). Early menopause is associated with increased risk of heart failure and atrial fibrillation: A systematic review and meta-analysis. Maturitas.
- Rozenberg, S. et al. (2026). Guidelines Menopause. Belgian Menopause Society.
- National Institute for Health and Care Excellence (2024). Menopause: identification and management. NICE Guideline NG23.
- BCFI (2025). Hormone therapy during perimenopause: benefits and drawbacks.
- RIZIV/INAMI (2024). Consensus conference: The management of menopause.
The content on this page is intended for informational purposes and does not replace medical advice. Please consult a physician for a personal assessment.