Heart palpitations in menopause: causes and what actually helps

Name: Heart palpitations in menopause: causes and what actually helps
Creator: MenoWoman

Palpitations, a sense that your heart is racing, pounding or skipping, are common in perimenopause and after menopause. They are usually harmless, but they should be checked by a doctor, and research on treatment is limited.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

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Call emergency services if palpitations come with chest pain, fainting, severe breathlessness or severe dizziness. See a doctor if they last long, keep coming back, get worse, or you have heart disease.^2,3

What it is and how common it is

Palpitations are feeling your own heartbeat. It may seem fast, fluttering, pounding or irregular.² Some women feel them during a hot flash, others at random times.

A 2021 review found palpitations in 20% to 40% of perimenopausal women and 16% to 54% of postmenopausal women.¹ The review included only five studies, so these numbers are rough.¹ Roughly one in five or more women in midlife may be affected.¹

Why it happens in menopause

Hormone changes in menopause are a recognized cause of palpitations.^2,3 Researchers think a fast drop in estrogen, not just a low level, may be the trigger. This idea has not been tested well for palpitations.¹

Researchers also note that studies measure palpitations in different ways. That makes it hard to compare results or know how strong the link with menopause is.¹

Palpitations sometimes come with hot flashes.¹ Stress, anxiety and poor sleep, which are common in midlife, can also set them off.²

What else can cause it

Often no cause is found.² But palpitations can also come from:

Caffeine, alcohol, nicotine, recreational drugs and some cold medicines.^2,3
An overactive thyroid.^2,3
Anemia (low iron or low red blood cells).³
Fever, intense exercise, stress or panic attacks.²
Heart rhythm problems such as an arrhythmia, or other heart conditions.^2,3

Because heart disease becomes more common after menopause, it is wise to get palpitations checked. A doctor will usually start with an ECG, a quick painless test of your heart rhythm. Longer heart monitoring may follow.³

Treatment options

Treatment depends on the cause. If tests are normal and menopause seems to be the cause, evidence on what helps is thin.⁴

A 2021 review looked at 37 studies of menopause treatments and palpitations. Most studies were small or not well designed.⁴ Estrogen-based hormone therapy showed some positive results.⁴ No therapy could be fully recommended.⁴

If palpitations come with frequent hot flashes, treating the hot flashes may be a sensible place to start. Discuss the options with your doctor.

Everyday measures

These steps are low risk and may reduce episodes:³

Cut back on caffeine and alcohol.
Stop smoking or vaping.
Find ways to manage stress.
Keep a diary of when palpitations happen and what you were doing. Share it with your doctor.

A diary can help show whether palpitations line up with hot flashes, drinks or your menstrual cycle.

Note how long each episode lasts and whether the beat felt fast, slow or irregular. This detail helps your doctor decide which tests you need.³

What helps: options rated

Option	Evidence	What the research shows
Getting checked (ECG and blood tests)	Some evidence	Not a treatment, but the recommended first step. An ECG and sometimes longer monitoring rule out heart rhythm problems.³
Hormone therapy (HRT)	Some evidence	A systematic review found some positive evidence for estradiol, but most studies were small or lower quality.⁴ HRT is mainly prescribed for other symptoms, such as hot flashes.⁵
Cutting caffeine, alcohol and nicotine	Some evidence	Advised by the British Heart Foundation as common triggers.³ Rated some because it has not been tested in trials of menopausal palpitations.
Symptom diary	Some evidence	Recommended to spot triggers and patterns.³ It helps diagnosis rather than treating palpitations.
CBT and stress management	Weak evidence	The one review of menopausal palpitations did not find enough evidence to recommend a cognitive-behavioral approach.⁴
Popular supplements (isoflavones, sage, rhubarb extract)	Weak evidence	The review did not recommend these for palpitations because of weak evidence.⁴

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.