Why Is My Heart Racing in Perimenopause?

It’s 2 a.m. and your heart is thumping like someone is knocking from the inside. You’re lying still. You haven’t had coffee since morning. Your face is hot, your shirt is damp, and you’re wondering if this is a hot flash or something you should call someone about.

What palpitations feel like

The NHS³ says heart palpitations are when your heartbeat becomes more noticeable. It can feel like racing, pounding, fluttering or irregular beating. Our article on hot flashes explains the heat side, and perimenopause covers the wider picture.

What else sets them off

Hormone changes aren’t the only trigger. The NHS³ lists strenuous exercise, sleep deprivation and emotional stress, along with alcohol, caffeine, nicotine and recreational drugs, and says hormonal changes during menopause and pregnancy can contribute. The PMC² review lists caffeine, alcohol, nicotine and illicit drugs as the main triggers, and says management encourages lowering stress, quitting smoking and cutting back on caffeine and alcohol.

If you’re not sleeping, that can feed it. See trouble falling asleep and night sweats.

What a clinician checks

The PMC² review says most palpitations come from benign conditions, with common ones being extra beats from the upper or lower chambers that need reassurance rather than aggressive treatment. It describes a 12-lead ECG as the gold standard for diagnosis, and says that if symptoms come and go, a portable monitor worn for 24 to 48 hours (a Holter monitor) is useful.

It also says thyroid function tests are indicated when someone has symptoms of an overactive thyroid.

The NHS¹ says an ECG may be ordered, and that treatment depends on the cause, with avoiding triggers like stress and caffeine helping.

Red flags

Don’t wait if

1. Emergency

   The NHS³ says to call emergency services or go to A&E if palpitations come with chest pain, shortness of breath or feeling faint or fainting, and not to drive yourself.

The PMC² review lists these as needing urgent evaluation:

• Fainting or near-fainting
• Chest pain or shortness of breath
• A new irregular heart rhythm
• A resting heart rate above 120 or below 45 beats per minute
• Known heart disease or a family history of sudden death

The play

Try this: a palpitation log

When your heart races or flutters, write down the time, how long it lasts, what you were doing, what you’d had to eat, drink or take (caffeine, alcohol, nicotine, medicines), whether a hot flash came with it, and how you felt afterward.

Bring the log to your appointment. It’s what a clinician needs when the heart behaves in the exam room.

When to get checked

Don’t wait if

1. Emergency

   Get emergency care right away if palpitations come with chest pain, shortness of breath, or feeling faint or fainting.

The NHS³ says to see a GP if palpitations recur frequently or last longer than a few minutes, or if you have a heart condition or a family history of heart disease. On its menopause symptoms page, it says to see a doctor if you have symptoms like a fast heartbeat.

Book an appointment if any of these fit:

• Palpitations are frequent, or last longer than a few minutes
• You have a heart condition, or a family history of heart disease
• They’re getting worse over time
• You have symptoms of a thyroid problem along with them
• You haven’t been checked since they started

A racing heart at 2 a.m. is common in this stage, and usually benign. It’s worth one visit and an ECG to be sure.