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Heart palpitations

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Heart palpitations

During the menopause transition, women may start to experience heart palpitations.

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    The science

    Palpitations make your heart feel like it’s racing — as if you just ran a marathon or got off a roller coaster. It’s not uncommon to feel like your heartbeat is irregular, too.

    While heart palpitations can happen at any time during the menopausal transition (perimenopause → postmenopause), they’re typically associated with hot flashes and night sweats, two of the most common vasomotor symptoms.

    Although the causes of hot flashes aren’t yet fully understood, evidence points to hormone fluctuations.

    When estrogen levels drop, the hypothalamus (which acts as our body’s thermostat) becomes more sensitive to slight changes in body temperature. Thinking it’s overheated, the hypothalamus starts working to cool the body by shunting blood away from the core to your skin, which kick-starts a chain of events that causes flushing, sweating, and an internal sensation of heat despite the fact that our body temperature isn’t actually rising. Our blood vessels at our skin’s surface dilate, which can cause our blood pressure to drop, and our body is left with no other choice but to increase our heart rate in order to maintain an adequate output. And that increased heart rate is what feels like a palpitation.

    Outside of hot flashes, decreased ovarian estrogen production is also independently associated with an increased heart rate (sinus tachycardia) and increased frequency of non-threatening irregularities with the rate or rhythm of the heartbeat.

    Although the case for estrogen is a strong one, it’s definitely not the only trigger. Other factors that can cause or exacerbate heart palpitations include:

    • Stress
    • Intense exercise
    • Caffeine
    • Nicotine
    • Anxiety
    • Alcohol
    • Fever
    • Severe anemia (likely due to heavy bleeding that causes iron deficiency)
    • Low blood sugar or blood pressure
    • Certain heart conditions or heart rhythm abnormalities
    • Hyperthyroidism (overactive thyroid)
    • Certain medications (Albuterol, asthma inhalers, certain cough/cold meds, thyroid meds, etc.)

    In the moment, when you feel your heart rapidly beating, it’s hard to differentiate between a “normal” palpitation and a time-to-see-your-doctor palpitation. We totally get it. But if it…

    • Lasts more than a couple of minutes
    • Is associated with chest pain
    • Lasts LONGER than your hot flash
    • Causes you to faint

    …then best to call your doctor ASAP.

    A note on heart health for women

    Heart attacks often present differently in women than men, meaning many times, women don’t feel the classic chest + left arm pain. Instead, women may have shortness of breath, nausea/vomiting, and back or jaw pain.

    If you experience any of the below, call 9-1-1 and get to a hospital right away:

    • Pressure, fullness, squeezing or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back
    • Pain/discomfort in one or both arms, the back, neck, jaw or stomach
    • Shortness of breath with or without chest discomfort
    • Breaking out in a cold sweat, nausea/vomiting or lightheadedness

    For more information on women’s heart health, visit the American Heart Association.

    READ MORE: A Guide To Heart Health Screenings During Menopause

    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.



    Although it sounds counterintuitive (because exercise = racing heart), aerobic activity is necessary for good cardiovascular health. The American Heart Association (AHA) recommends:

    • 150 minutes/week of moderate-intensity aerobic activity like walking OR 75 minutes/week of vigorous aerobic activity like jogging (or a combo of both spread throughout the week)
    • 2 days/week of moderate-high intensity muscle-strengthening activity via resistance/weights

    It’s also important to monitor just how much time we spend sitting.

    Unfortunately, a morning workout doesn’t compensate for being sedentary for the remainder of the day.

    Even light-intensity activity (walking to get the mail, going downstairs to go to the bathroom, investing in a standing desk) can offset some of the risks of being stationary so much of the day.

    Nutrition & Diet

    To reduce the chances of heart palpitations, it’s important to limit dietary triggers — we’re lookin’ at you, caffeine and alcohol.

    If your palpitations are associated with hot flashes, consider incorporating foods such as soy, flaxseed, and legumes while avoiding spicy foods. You can read more about the science behind why these ingredients help (or hurt) hot flashes in our full guide.

    Holistic Practices

    The following integrative, holistic therapies can be effective in managing and mitigating the symptoms of hot flashes, which is why we’re recommending them here for heart palpitations as well.

    Mindfulness-based stress management

    While many alternative therapies haven’t been clinically studied, the impact of mindfulness-based yoga on stress and anxiety has — and the results are promising. Since stress has been identified as a hot flash trigger, it’s worth giving something like meditation or yoga a whirl — while recognizing, of course, that it takes time to cultivate a practice and begin reaping the benefits (this isn’t a “quick fix”)

    Paced breathing exercises

    The North American Menopause Society recommends paced respiration (slow deep breathing sustained for a specific period of time) as a behavioral treatment for hot flashes. To start, try for five minutes twice per day, with a target rate of 6-8 breaths per minute. If that works, try to get up to 15-minute sessions. It might feel a bit odd and unnatural at first, but stick with it, and it will become second nature.

    Cognitive Behavioral Therapy (CBT)

    CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries — that may be triggering or exacerbating hot flashes. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and a mindset to improve the hot flash experience (vs the hot flash itself). It’s ideal for those looking to address underlying causes while working towards long-term management.

    Acupuncture & Acupressure

    Acupuncture is when extremely thin needles are inserted into the skin at strategic points (don’t worry — it doesn’t hurt!) and acupressure is when gentle pressure is used to stimulate certain points on your body. Both techniques have been studied in reducing hot flash severity and decreasing frequency (in addition to promoting sleep and reducing anxiety). A 2016 study, which compared an acupuncture group with a control group, found that hot flash frequency declined by 36% over six months with the acupuncture group, compared to just 6% with the control (no acupuncture).

    When it comes to night sweats, it’s important to keep your bedroom cool. Right around bedtime, our body temperature drops 1-2 degrees, which signals to our internal clock that it’s time to hit the hay. In doctor-speak, this is what’s called “thermoregulation.” We recommend keeping your bedroom at a cool 60 – 67°F and, if that’s not enough, trying the following:

    • Cooling sheets made with bamboo, which effectively wicks moisture (read: sweat) from your skin
    • Cooling mattress pad or blanket, or a heated blanket for your bed partner (look into one with dual controls if you want to accommodate a bed partner)
    • Cooling system for your bed that uses circulating water to maintain a consistent, cool temperature (e.g., this hydro-powered one from ChiliSleep)
    • A fan! Simple, low-cost, and effective


    Fortunately, most palpitations are benign and do not require any therapy. Sometimes, however, they may be prolonged or associated with different conditions requiring medications or other treatments. So, if your palpitations are severe or persistent, we would recommend that you get evaluated.


    So can HRT reduce palpitations? Although hormone therapy will not reduce palpitations from certain causes, IF your palpitations are associated with hot flashes, HRT can definitely be an effective treatment by reducing the frequency of those heat waves!

    Still have questions? We’re answering them in our full HRT guide or just ask us directly ([email protected]).


    Cardiac medications (e.g., beta-blockers like propranolol) can be used, but only under the advice of your primary care provider or cardiologist in the context of a separately diagnosed or underlying cardiac condition.

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


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