Perimenopause heart palpitations: what to know

Palpitations may feel like fluttering, pounding, skipped beats or a racing sensation in the chest, throat or neck. During perimenopause, they can appear around a hot flush, night sweat, poor sleep or an anxious moment. Caffeine, alcohol, dehydration, fever, anaemia, thyroid disease and some medicines can also affect the heartbeat.

The sensation does not by itself show whether the rhythm is harmless or abnormal. Note what you were doing, how long it lasted, whether the rhythm felt regular, and whether dizziness, chest discomfort or breathlessness occurred. A clinician may check your pulse, blood pressure, blood count, thyroid function or heart rhythm.

Stop and sit somewhere safe. Breathe slowly, avoid driving while dizzy, and record the time and symptoms. Maintain fluids, regular meals and sleep where possible, and notice whether caffeine, alcohol, nicotine, decongestants or supplements trigger episodes. Do not stop prescribed medicines without advice.

Arrange a review if episodes recur, last longer than usual, occur at rest, or interfere with sleep or activity. Bring a list of medicines and supplements, including hormone products, and mention any heavy bleeding or thyroid history.

Call emergency services for palpitations with chest pain or pressure, severe breathlessness, fainting, collapse, new confusion or marked weakness. Seek prompt assessment for a sustained racing heartbeat, repeated episodes, or palpitations with dizziness. Emergency symptoms should not be attributed to perimenopause without evaluation.

Ask: Could anaemia, thyroid disease or a medicine be contributing? Do I need an ECG or another rhythm check? Should I change caffeine or other triggers? Could heavy bleeding be lowering my iron? Which symptoms mean I should seek emergency care?