Heart Palpitations and Menopause: Why Does Your Heart Race or Flutter?
Palpitations are commonly reported during perimenopause and menopause. They may feel like racing, pounding, fluttering, skipped beats or a suddenly more noticeable heartbeat.
Hormonal changes may contribute, particularly when palpitations occur alongside hot flashes, night sweats, sleep disturbance or anxiety. But not every palpitation during menopause is caused by menopause, so persistent or concerning symptoms deserve appropriate evaluation.
Can Menopause Cause Heart Palpitations?
- Yes, palpitations are commonly reported during the menopause transition.
- They may occur alongside hot flashes, night sweats, anxiety or sleep disturbance.
- Changing reproductive hormones may influence cardiovascular and autonomic function, but the exact mechanism behind menopausal palpitations is not completely understood.
- Palpitations may occur while the heart is in normal sinus rhythm or during an actual rhythm change.
- Menopause does not exclude other causes such as thyroid disease, anemia, caffeine, medicines, PACs, PVCs, SVT or atrial fibrillation.
- New, recurrent or worsening palpitations should not automatically be dismissed as “just hormones.”
- Palpitations with chest pain, fainting, severe breathlessness or severe dizziness require urgent medical attention.
Why Can Palpitations Become More Noticeable Around Menopause?
During perimenopause, estrogen and other reproductive hormones fluctuate before eventually settling at lower postmenopausal levels.
These hormonal changes occur alongside changes in body temperature regulation, sleep, mood, autonomic nervous-system activity and cardiovascular physiology.
Palpitations are frequently reported during this stage of life, but scientists have not established one simple mechanism explaining every menopause-related palpitation.
It is therefore too simplistic to say that low estrogen directly “overstimulates the heart.”
Menopause may contribute to the symptom pattern, but a racing or irregular heartbeat still needs to be interpreted in the context of the individual patient.
How Common Are Palpitations During Menopause?
Palpitations appear to be relatively common among women during the menopause transition, although estimates vary considerably between studies.
Research involving midlife women has reported palpitation symptoms in a substantial proportion of participants.
One analysis of menopause research noted that up to about 47% of menopausal women have reported palpitations.
However, prevalence estimates depend on how the symptom is defined and measured, so there is no single percentage that applies to every population.
More recent rhythm-monitoring research also suggests that reported palpitations can occur during both normal sinus rhythm and altered heart rhythms.
What Do Menopause Heart Palpitations Feel Like?
Racing
The heartbeat may suddenly feel faster than usual.
Pounding
Each heartbeat may seem unusually forceful or prominent.
Fluttering
Some women describe a fluttering or quivering sensation in the chest.
Skipped Beats
Premature beats can feel as though the heart pauses or misses a beat.
Strong Thump
A premature heartbeat may be followed by a stronger beat that is felt as a thump.
Irregular Heartbeat
Some women describe an uneven or irregular rhythm.
Persistent irregularity should not automatically be attributed to menopause.
See our cornerstone guide to heart palpitation symptoms for a more detailed explanation of racing, pounding, fluttering and skipped beats.
Is a Heart Rate of 200 BPM a Normal Menopause Symptom?
No.
Menopause-related palpitations should not be described as normally reaching 200 beats per minute.
A sustained heart rate around that level may occur with arrhythmias such as supraventricular tachycardia, depending on the person and circumstances, and deserves medical assessment.
Similarly, there is no useful rule that menopausal women normally have a certain number of “extra beats per minute.”
The actual rhythm should be recorded when necessary rather than assumed to be a hormonal effect.
Why Do Palpitations Sometimes Occur With Hot Flashes?
Some women notice a stronger or faster heartbeat during a hot flash.
Hot flashes involve changes in temperature regulation and autonomic nervous-system activity, which can be accompanied by sweating, flushing, anxiety and increased awareness of the heartbeat.
Research has found an association between palpitations and vasomotor symptoms in midlife women.
However, experiencing a hot flash at the same time as a palpitation does not prove that every heartbeat abnormality is caused by menopause.
Can Menopause Anxiety Make Palpitations Worse?
Anxiety can itself increase heart rate and heartbeat awareness.
Sleep disruption, night sweats and stress may also make the heartbeat more noticeable.
This can create a cycle in which a palpitation produces fear, the fear increases adrenaline, and the heartbeat becomes even more noticeable.
Read our dedicated guide to anxiety and heart palpitations if anxiety is a prominent part of your symptom pattern.
What Other Causes Should Be Considered?
Perimenopause and menopause occur during an age when several other causes of palpitations may also become relevant.
Thyroid Disease
Too much thyroid hormone can cause a rapid or irregular heartbeat, tremor, sweating and weight change.
Anemia
Iron-deficiency anemia can cause palpitations, fatigue, weakness, dizziness and shortness of breath.
This may be particularly relevant during perimenopause if menstrual bleeding is heavy.
PACs & PVCs
Premature beats can produce skipped beats, pauses, extra beats or strong thumps.
Atrial Fibrillation
AFib can produce a fast and irregular heartbeat, although some people experience few symptoms.
SVT
Supraventricular tachycardia can produce episodes of rapid heartbeat that may begin and stop suddenly.
Caffeine, Alcohol & Medicines
Stimulants, alcohol and certain medicines may contribute to symptoms in susceptible people.
See our guide to caffeine and heart palpitations .
For the broader differential diagnosis, see our cornerstone page on causes of heart palpitations .
Menopause Is Also an Important Time to Review Cardiovascular Risk
A woman’s cardiovascular risk changes around the menopause transition.
Blood pressure, cholesterol, body composition, blood glucose, smoking status, exercise and family history all deserve attention.
This does not mean menopause itself causes every cardiovascular problem.
Rather, midlife is an important opportunity to review cardiovascular prevention instead of assuming that new heart symptoms are simply part of getting older.
Do You Need Hormone Blood Tests to Diagnose Menopause?
In otherwise healthy women aged 45 or older with typical menopausal symptoms and menstrual changes, menopause or perimenopause can usually be identified clinically.
Routine hormone testing is therefore not required simply to confirm menopause in most women in this group.
This is different from ordering selected blood tests to investigate palpitations, such as thyroid testing or a blood count for anemia.
What Tests Are Needed for Palpitations During Menopause?
Not every woman with menopause-associated palpitations needs an extensive cardiac investigation. Testing should match the symptom pattern and risk factors.
Medical History
Your clinician may ask whether the heartbeat is fast, irregular, skipped or pounding, when episodes occur and how long they last.
Physical Examination
Pulse, blood pressure, heart examination and relevant signs of thyroid or other disease may provide useful clues.
ECG / EKG
An ECG records the electrical activity of the heart and may identify an arrhythmia when it occurs during the test.
Holter, Patch or Event Monitor
If palpitations come and go, longer ambulatory monitoring may help capture the heart rhythm during an actual episode.
Selected Blood Tests
Depending on the history, your clinician may consider a complete blood count, thyroid tests, electrolytes or other investigations.
Echocardiogram When Indicated
An echocardiogram may be appropriate when the history, examination or ECG raises concern about structural heart disease.
It is not automatically required for every menopausal palpitation.
Does Every Woman Need a Stress Echocardiogram?
No.
A stress test or stress echocardiogram is not routinely required simply because palpitations develop around menopause.
Exercise testing may be appropriate when symptoms occur with exertion or when a clinician needs to investigate suspected exercise-related or coronary disease.
The choice of test should be based on the patient’s symptoms, cardiovascular risk, examination and initial ECG findings.
What Can Help With Palpitations During Menopause?
Track the Pattern
Record when palpitations occur, how long they last, whether hot flashes occur, and what the heartbeat feels like.
Review Caffeine
If coffee, tea or energy drinks repeatedly trigger symptoms, reducing them may help.
There is no need for every woman to eliminate caffeine automatically.
Limit Excess Alcohol
Alcohol can affect heart rhythm and can also worsen sleep and hot flashes in some people.
Address Sleep
Improving sleep may reduce stress and make palpitations less intrusive.
Manage Anxiety & Stress
Relaxation, mindfulness and evidence-based psychological treatment may help when anxiety is an important contributor.
Stay Physically Active
Regular physical activity supports cardiovascular and overall health during and after menopause.
Does HRT Treat Menopause Heart Palpitations?
Hormone therapy is an established and highly effective treatment for bothersome menopausal vasomotor symptoms, particularly hot flashes and night sweats.
Some studies suggest that certain hormonal therapies, including estradiol, may reduce palpitation frequency or severity in some women.
However, the evidence specifically for treating palpitations remains limited.
A systematic review of treatments for menopausal palpitations concluded that no treatment could be strongly recommended specifically for palpitations, although some hormonal therapies showed possible benefit.
Therefore, HRT should not automatically be started solely because a woman reports palpitations.
The decision to use hormone therapy should consider the full menopausal symptom pattern, medical history, age, type of HRT and individual benefits and risks.
Are Beta-Blockers the Standard Treatment for Menopause Palpitations?
No.
Beta-blockers are prescription cardiovascular medicines used for specific clinical indications.
Whether a beta-blocker is appropriate depends on:
- The actual heart rhythm
- Heart rate
- Blood pressure
- Other heart conditions
- Other medications
They should not routinely be prescribed simply because palpitations occur during menopause.
What About Black Cohosh, Hawthorn, Motherwort or Flaxseed?
Herbal products should not be described as proven treatments for menopausal heart palpitations.
Black Cohosh
Black cohosh has been studied mainly for menopausal symptoms such as hot flashes.
Results have been inconsistent, and it has not been established as a treatment for heart palpitations.
Rare reports of serious liver injury have also occurred with products labelled as black cohosh.
Hawthorn
Hawthorn is marketed for cardiovascular health, but there is insufficient high-quality evidence that it treats abnormal heartbeats or menopausal palpitations.
Herbal products may also interact with medications.
Motherwort
Motherwort is promoted for anxiety and heart symptoms, but robust evidence supporting it as a treatment for menopausal palpitations is lacking.
Flaxseed
Flaxseed can be part of a healthy diet, but research has not established flaxseed as a specific treatment for heart palpitations.
Tell your healthcare professional about supplements you use, especially if you take prescription heart, blood-pressure or anticoagulant medication.
Menopause May Explain the Timing — But I Still Want to Know the Rhythm
When a woman in her 40s or 50s tells me that palpitations began around the same time as hot flashes, irregular periods or night sweats, menopause is certainly relevant.
But I do not want the word “menopause” to become a shortcut diagnosis.
I still ask: Is the heart racing? Is it irregular? Are there skipped beats? How long does the episode last? Does it happen during exercise?
I also consider thyroid disease, anemia, medications, caffeine, blood pressure and cardiovascular history.
Most importantly, dizziness, fainting, chest discomfort or significant breathlessness changes how urgently the symptom should be evaluated.
When Should You See a Doctor?
Arrange medical evaluation if palpitations:
- Are new or unexplained
- Keep returning
- Are becoming more frequent
- Last longer than before
- Feel very fast or clearly irregular
- Occur during exercise
- Occur even when no hot flash or menopausal symptom is present
- Are accompanied by significant weakness, dizziness or breathlessness
- Occur if you already have heart disease or a known arrhythmia
If dizziness accompanies the episodes, read dizziness and heart palpitations .
If palpitations are occurring repeatedly throughout the day, see our guide to constant heart palpitations .
Do Not Assume Serious Symptoms Are “Just Menopause”
Seek urgent or emergency medical care if palpitations occur with:
- Chest pain or significant chest pressure
- Fainting or loss of consciousness
- Severe shortness of breath
- Severe dizziness or near-fainting
- Sudden severe weakness or collapse
- A sustained very fast or severely irregular heartbeat with significant symptoms
- Other severe or rapidly worsening symptoms
Menopause is common, but women going through menopause can still develop heart disease or significant arrhythmias.
Menopause and Heart Palpitations: FAQs
Are heart palpitations common during menopause?
Yes. Palpitations are reported by many women during perimenopause and menopause.
Estimates vary between studies, and the symptom remains less well studied than hot flashes and other menopause symptoms.
What do menopause palpitations feel like?
They may feel like racing, pounding, fluttering, skipped beats or an unusually strong heartbeat.
Why do I get palpitations during hot flashes?
Hot flashes involve changes in temperature regulation and autonomic activity, and some women notice heartbeat changes during these episodes.
Research has found an association between vasomotor symptoms and palpitations.
Can menopause cause a heart rate of 200?
A sustained heart rate around 200 beats per minute should not automatically be considered a normal menopause symptom.
Very rapid sustained heart rates can occur with arrhythmias and deserve medical evaluation.
How long do menopause palpitations last?
There is no fixed duration.
Some women experience intermittent symptoms during the menopause transition, while others may have recurrent symptoms for longer.
Palpitations should not be assumed to disappear after a specific number of months.
Are menopause palpitations harmless?
Many episodes are not caused by dangerous heart disease.
However, it is not safe to say that all palpitations during menopause are harmless.
Rhythm disorders, thyroid disease, anemia and other causes may produce similar symptoms.
Can HRT stop heart palpitations?
Some studies suggest certain hormonal therapies may reduce palpitations in some women, but evidence is not strong enough to recommend HRT specifically as a universal treatment for palpitations.
HRT decisions should consider the woman’s overall menopausal symptoms, health history and individual benefits and risks.
Do I need thyroid testing?
Thyroid testing may be appropriate when symptoms suggest thyroid disease or when unexplained palpitations are being evaluated.
This is different from routinely measuring reproductive hormones to diagnose menopause in otherwise healthy women aged 45 or older with typical symptoms.
Can anxiety cause menopause palpitations?
Anxiety can increase heart rate and heartbeat awareness, and anxiety symptoms can occur during the menopause transition.
However, recurrent palpitations should not automatically be diagnosed as anxiety.
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Evidence Used for This Article
- The Menopause Society. Menopause Topics: Hormone Therapy .
- NICE. Menopause: Identification and Management . Updated 2026.
- Sheng Y, et al. Effect of Menopausal Symptom Treatment Options on Palpitations: A Systematic Review . Climacteric. 2022.
- Alzahrani M, et al. Palpitations in Midlife Women: The Menopause Racing Heart Pilot Study . 2025.
- Carpenter JS, et al. Menopausal Palpitation Distress in Midlife Women .
- American Heart Association. How Serious Are Heart Palpitations? Causes, Symptoms and When to Worry . February 2026.
- National Center for Complementary and Integrative Health. Black Cohosh: Usefulness and Safety .
- National Center for Complementary and Integrative Health. Hawthorn: Usefulness and Safety .