Perimenopause and palpitations: what to know

Changing oestrogen levels may affect the body's temperature regulation and nervous system, so palpitations can appear alongside hot flushes, night sweats, disrupted sleep, or emotional changes. Perimenopause is one possible explanation, not a diagnosis for every heartbeat change.

You may notice a sudden thump, a flutter in your chest, a fast pulse, or the sensation that your heart has paused and restarted. Episodes can happen at rest, during a hot flush, after waking at night, or during stress. Caffeine, nicotine, alcohol, dehydration, fever, poor sleep, some medicines, anaemia, thyroid problems, and heart rhythm conditions can also contribute.

Make a note of when an episode starts, how long it lasts, what you were doing, and whether your pulse feels regular or uneven. Record related symptoms such as sweating, dizziness, chest discomfort, or shortness of breath. This gives a clinician useful context.

During a brief episode, sit down, breathe slowly, and avoid driving until you feel steady. Drink water if you may be dehydrated. Review caffeine, nicotine, alcohol, supplements, and cold or decongestant medicines that may coincide with symptoms; do not stop a prescribed medicine without advice.

Arrange an appointment if palpitations keep returning, become more frequent, disturb sleep, or begin after a new medicine. A clinician may check your pulse and blood pressure, review your cycle and symptoms, and arrange tests such as an electrocardiogram or blood tests when appropriate. Mention whether pregnancy is possible, because a missed period has causes beyond perimenopause.

Seek emergency help if palpitations come with chest pain or pressure, severe shortness of breath, fainting, new confusion, marked weakness, or a feeling that you may collapse. Seek prompt medical advice for an episode that does not settle, a very fast or clearly irregular heartbeat, or repeated dizziness.

Do not assume a symptom is caused by perimenopause when it is new or intense. If you have known heart disease, a thyroid condition, significant anaemia, or a family history of an inherited rhythm problem, describe that history when you seek care.

Ask: Could these episodes be related to perimenopause or another cause? Do I need an electrocardiogram or blood tests? Which symptoms mean I should seek emergency help? Could any of my medicines or supplements be contributing? What symptom record would help you assess the pattern?