mature woman having heart issues touching her chest
A decline in the hormone estrogen can cause a harmlessly fluttery heart, but it never hurts to investigate any cardiac issue.
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Even though menopause is an inevitable fact of life for women, most aren’t aware of all the changes in their bodies, brains, and overall health that the transition will bring. Vasomotor symptoms, such as hot flashes, are widely recognized, but there are dozens of other menopausal symptoms that a woman can experience.
Not All Menopausal Symptoms Are the Same, in Terms of Risk or Discomfort
Although no menopause symptom can be considered unimportant, heart palpitations can be particularly concerning, as they can indicate a more serious underlying health issue. Menopausal palpitations are described as loud, racing, or skipped heartbeats, flip-flops, fluttering, or pounding that occurs with or without dizziness or light-headedness.
“Palpitations are not only quite common, but also underdiagnosed and understudied; when I’ve talked to some of my colleagues about heart palpitations, they’ve been a little bit shocked about what we still don’t know,” says Janet S. Carpenter, PhD, RN, a distinguished professor at Indiana University School of Nursing in Indianapolis who studies heart palpitations in women.
In January 2021, Dr. Carpenter and her team published a research review in Current Obstetrics and Gynecology Reports analyzing the prevalence of palpitations among women going through menopause. They found that as many as 54 percent of the studied women reported palpitations.
Menopause, Hormones, and Heart Disease Risk
When a woman is still having her menstrual period, estrogen and progesterone levels rise and fall during different times of the month, according to the Cleveland Clinic. When a woman enters perimenopause, the lead-up to menopause, there is a significant decrease in estrogen production.
“Estrogen plays a role in regulating the autonomic nervous system, which controls the heart rate and can affect the heart rhythm,” explains David Slotwiner, MD, the chief of cardiology at NewYork-Presbyterian Queens in New York City. “As estrogen levels decline, some women may experience irregular heartbeats or a sensation of their heart racing or fluttering, known as heart palpitations.”
Perimenopause can begin 8 to 10 years before menopause; during the last 1 to 2 years of this transition, the drop in estrogen accelerates and many women begin to experience menopausal symptoms.
Menopause is diagnosed in hindsight, after a woman has gone without a menstrual period for 12 consecutive months. Estrogen declines even further during this phase, and irregular heartbeats and palpitations can occur, according to research published in the journal Climacteric.
Although menopause doesn’t cause heart disease, the risk of heart disease goes up with the onset of menopause, according to the American Heart Association (AHA). One factor that may contribute is the decline in estrogen, which is believed to have benefits for the inner layer of the artery wall, helping to keep blood vessels flexible.
Could Midlife Heart Palpitations Be a Sign of a Serious Heart Condition in Women?
In many cases, palpitations in general aren’t cause for concern and will go away on their own, per Cleveland Clinic. But there are cases where someone with heart palpitations does have an underlying heart condition or discovers underlying heart disease that was previously undiagnosed, says Purvi Parwani, MD, a cardiologist at Loma Linda University International Heart Institute and the director of its women’s heart health clinic.
In addition to heart disease, palpitations can also be a sign of an abnormal heart valve, heart attack, heart failure, or cardiomyopathy, per Penn Medicine. Cardiomyopathy is a collection of different conditions of the heart muscle that can cause the heart muscle to stiffen, thicken, thin out, or fill with substances the body produces that shouldn’t be there, according to the Centers for Disease Control and Prevention (CDC).
What’s more, recent research suggests heart palpitations that occur during menopause may be associated with a higher risk of heart disease. The observational study, published in December 2022 in Menopause, found that the severity of certain menopause symptoms, including heart palpitations, were linked to a higher risk of heart disease and death from any cause.
It’s not totally clear why heart palpitations in perimenopausal or menopausal women are understudied and underrecognized compared with other menopausal symptoms, says Carpenter. “It could partly be due to the fact that there’s been a historic bias against women in cardiology,” she says.
Dr. Parwani agrees. “Most of the time, heart palpitations during menopause are benign and not concerning,” she says. “However, there has been a historical and illustriously documented bias against women in cardiology with poor understanding and/or trivialization of heart symptoms, including palpitations, that results in missed or delayed diagnosis of serious cardiac events.”
At the same time, symptoms of menopause have often been trivialized as “no big deal,” Carpenter notes. “Heart palpitations are at the intersection of these two things. If people have been attributing the palpitations to menopause there may be a general feeling that these will probably go away, don’t worry about it,” she says.
Another reason that heart palpitations may be underrecognized is that some previous research has grouped heart palpitations as part of a hot flash, rather than its own symptom, says Carpenter. “There are some studies that define hot flashes in terms of heat, sweating, and heart racing or pounding, suggesting that palpitations occur at the same time as the hot flashes,” she says.
“However, when I talk to women, these palpitations are often separate from the hot flashes; they’re feeling these when they lie down at night or in the middle of the day — sort of odd times that aren’t related to the hot flashes,” says Carpenter. This suggests that palpitations are a symptom separate from hot flashes, she adds.
Who’s More Likely to Experience Palpitations?
Carpenter and colleagues published a study in the December 2020 issue of the Journal of Women’s Health that looked at 759 women who were perimenopausal and post-menopausal and had vasomotor symptoms, meaning they were experiencing hot flashes 14 or more times a week and the hot flashes were bothersome or severe on four or more days or nights per week.
Investigators found that on average about 1 in 4 women reported palpitation distress that they could rate from “not at all” to “a lot” of bother.
Researchers also found that the likelihood a woman would report palpitation distress was higher in those with worse insomnia, depressive symptoms, perceived stress, and menopausal quality-of-life issues.
How to Talk With Your Doctor About Heart Palpitations
If you’re concerned about heart palpitations, it’s important to talk with your healthcare provider.
“It’s best to talk to a cardiologist and be further evaluated to find out about the cause of heart palpitations,” Parwani says. “Many times, these palpitations are sudden and require a monitor such as a Holter or loop recorder to catch them. In certain situations, they can be managed with medications. If they are serious, there are procedures like ablation that can help prevent palpitations.”
Dr. Slotwiner notes that it’s important to tell your doctor characteristics of what you’re feeling, as well, including:
Do the palpitations occur with particular activities, while you're at rest, or both?
Do the palpitations feel like single extra or skipped beats, or do the palpitations last for minutes or hours?
Does your heart feel like it’s beating too fast, too hard, or both?
Does your heart rate feel irregular?
Do you have any additional symptoms when you feel palpitations, such as feeling sweaty, light-headed, or short of breath, and do you have chest pain?
How frequently do your symptoms occur?
Also track your other menopause symptoms, Carpenter suggests. “If you’re under a lot of stress or having insomnia, that could influence the palpitations,” she says.
If you feel you’re not being listened to by your doctor, Slotwiner recommends asking if the doctor has seen a recording of your heart rhythm when you have felt palpitations (this is the type of data obtained from a heart monitor). “If the doctor is not able to explain what your heart rhythm is when you feel palpitations, you should ask for a heart monitor so the data can be obtained,” he says. “Lastly, it may be time to seek the opinion of a different physician.”
If heart palpitations come with signs of a cardiac event — such as loss of consciousness; chest pain; difficulty breathing; pain or discomfort in one or both arms, the back, neck, jaw, or stomach; nausea or vomiting; or light-headedness — you should call 911 and get to a hospital right away, according to the AHA.
The Takeaway
Menopause symptoms vary from person to person, but some research reports that menopausal heart palpitations, although often benign, can be a cause for concern in over half of all women during menopause and may signal underlying health issues or an increased risk of heart problems. As estrogen levels drop during menopause, some people may experience irregular heartbeats or fluttering, possibly due to estrogen’s crucial role in supporting the strength of the inner artery wall.
If you notice heart palpitations, track when and how often you experience them, as well as the speed and strength of the heartbeat and any other symptoms. Discussing these with your doctor can provide a clearer picture and help healthcare professionals rule out
