Is perimenopause causing your heart palpitations?
Written and edited by the Peryla team. Last reviewed August 2026. Educational information, not medical advice.
Often, yes. It's common to notice heart palpitations, a racing, pounding, or fluttering feeling in your chest, as your body moves through perimenopause. They can start early in the transition and, for some women, continue into early postmenopause.
Most of the time these are harmless and tied to hormonal shifts rather than heart disease. But because palpitations can occasionally signal something that does need treatment, it's worth mentioning to your doctor rather than assuming it's hormonal by default.
Why perimenopause causes heart palpitations
Estrogen has effects on the cardiovascular system beyond reproduction, including influence on heart rate and blood vessel function. As estrogen fluctuates in perimenopause, it can affect the autonomic nervous system, which governs the automatic parts of heart rhythm, making some women more prone to noticing their own heartbeat as a flutter, skip, or pounding sensation.
Palpitations also frequently show up alongside hot flashes, since both can be triggered by the same surges in adrenaline that accompany a vasomotor event. Anxiety, which is itself more common in perimenopause, can amplify the sensation even when the heart rhythm itself is normal.
How common it is
Palpitations are one of the more frequently reported, if less talked about, perimenopause symptoms. They're generally described as common and usually not dangerous, though the sensation, pounding, flip-flopping, or a feeling of missed beats, can be alarming the first time it happens.
What helps
Because palpitations sit at the intersection of hormones and heart health, it's worth approaching from both angles.
- Cutting back on caffeine and alcohol, both common triggers.
- Managing stress and anxiety, since adrenaline surges can trigger or worsen the sensation.
- Treating hot flashes if they're the trigger, whether through lifestyle changes, hormone therapy, or non-hormonal options like fezolinetant.
- A baseline cardiac check (EKG, sometimes a Holter monitor) if palpitations are new, frequent, or you have any cardiac risk factors, just to rule out an arrhythmia.
When to see a doctor
- Palpitations with chest pain, shortness of breath, dizziness, or fainting, which need prompt evaluation.
- A racing heart that doesn't settle within a few minutes, or that's paired with an irregular rather than fast rhythm.
- Any new palpitations if you have a personal or family history of heart disease.
Frequently asked questions
- Are heart palpitations in perimenopause dangerous?
- Usually not. Most perimenopause-related palpitations are harmless and linked to hormonal and nervous-system shifts. That said, a doctor should rule out an underlying heart rhythm issue, especially if the episodes are new, frequent, or come with other symptoms.
- What causes a racing heart in perimenopause?
- Fluctuating estrogen can affect the autonomic nervous system and how it regulates heart rate, and palpitations often cluster with hot flashes and anxiety, both of which trigger the same adrenaline response.
- When should I see a doctor for palpitations?
- See a doctor if palpitations come with chest pain, breathlessness, dizziness, or fainting, if they're frequent or prolonged, or if you have any personal or family cardiac history. An EKG can usually settle whether it's rhythm-related.