Menopause and Heart Palpitations: What to Know

Feeling your heart flutter, race, or skip a beat can be one of the first noticeable signs of perimenopause. Research suggests that up to 47 percent of menopausal women experience heart palpitations, but that number may be higher since they often fly under the radar as a perimenopause symptom.

Case in point: Oprah has spoken about her struggle to get doctors to take her heart palpitations seriously and recognize them as part of the menopause transition. ¹

While heart palpitations in menopause or perimenopause don’t usually indicate a heart condition, they can be distressing. That’s understandable—figuring out when they’re harmless and when they warrant medical attention isn’t always clear.

Here’s what you need to know about palpitations at this stage of life, including expert-backed ways to calm a racing heart.

About the Experts:

Janet Carpenter, Ph.D., RN, FAAN, the interim dean at the Indiana University School of Nursing, and a leading authority on menopausal heart palpitations.

Nancy Reame, Ph.D., RN, FAAN, a professor at Columbia University who studies menopausal heart palpitations

What Do Heart Palpitations During Menopause Feel Like?

Menopausal heart palpitations can feel like a fluttering or pounding in your chest. They might also feel like loud, racing, or skipping heartbeats—or just an “uncomfortable awareness” of your pumping heart.² Some women get a bit dizzy or lightheaded during these episodes, but that doesn’t happen to everyone.

These flutters can last a few seconds or longer and range from mild to severe. ³

Menopause heart palpitations can also be hard to put into words, says Janet Carpenter, Ph.D., a leading authority on the subject.

In a small recent study, Carpenter and her colleagues interviewed women about their experiences with menopause heart palpitations. One woman described her heartbeat as “surging forward quickly,” while others said their hearts felt like they were “lurched” or “exaggerated.” One even compared the sensation to riding a “giant Ferris wheel” while puttering around the house. ⁴

“It wasn’t just a racing heart or skipped beats,” Carpenter says. “Some women described a dropping sensation, like the feeling in your chest on a roller coaster.”

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What Causes Menopause Heart Palpitations?

Experts aren’t entirely sure what causes menopausal heart palpitations, but declining estrogen may play a role, says Nancy Reame, Ph.D., who studies menopause heart palpitations. However, no clinical trials or observational studies have definitively proven the connection.

Researchers aren’t even sure that heart palpitations during menopause are caused by menopause, as opposed to another factor of aging, says Reame. ⁵

Part of the reason heart palpitations in perimenopause or menopause are so poorly understood is that they’ve received research attention. “We’ve historically trivialized menopause symptoms, and there’s also been a bias in cardiology against women—they haven’t been included in too many cardiac studies,” said Carpenter.

What is clear: Estrogen receptors exist in tissues throughout the body, including the cardiovascular system. Research has shown that estrogen impacts heart health in several ways, influencing stroke risk, hypertension, and heart attacks.

Another unknown is whether palpitations are tied to a specific phase of menopause transition. Carpenter’s team analyzed data from one of the largest, most diverse studies on menopause to date, and identified and evaluated palpitation experiences over the course of the menopause transition.

They found that the women most likely to have palpitations had them with the same frequency from early perimenopause through early post-menopause. Frequency only declined about six years after menstruation ended. That means, for these women, it took a few years after their estrogen fell to minimal levels for their palpitations to calm down. ⁶

Can Hot Flashes Trigger Heart Palpitations?

Heart palpitations likely occur separately from hot flashes, and Carpenter says there is no strong research connecting the two.

“When women have hot flashes, their heart rates can rise, people have thought of palpitations as being caused by hot flashes or associated with them,” Carpenter says. “They are very different sensations, and the palpitations occur separately from the hot flashes.”

The truth is, experts don’t know what triggers menopause heart palpitations. The American Heart Association cites numerous potential triggers for palpitations in general—anxiety, fright, strenuous exercise, smoking, drinking, and caffeine—but according to Reame and Carpenter, none of them are linked specifically to menopause heart palpitations.

How Palpitations Compare to Other Irregular Heartbeats

A typical, healthy heartbeat is predictable and feels comfortable. It may speed up during an argument or cardio session, and slow down when you’re calm. Heart palpitations are different. The thumps, flutters, and beats feel off, but they don’t necessarily signal a health problem.

Here’s how they compare to true heartbeat irregularities.

Arrhythmia vs. palpitations

Arrhythmia is a medical term for irregular heart rhythms, while heart palpitations are the sensation of an irregular heartbeat. A common misconception is that palpitations automatically signal arrhythmia, but that’s not always the case, Carpenter says.

One researcher who looked at palpitation complaints and clinical arrhythmias in multiple studies found only a “surprisingly weak correlation” between the two. ⁷

Carpenter’s upcoming research in Menopause (anticipated July 2025) suggests the same finding. Her team found that half of the women who reported menopause heart palpitations had normal heart activity on an EKG. In other words, palpitations may feel alarming, but they don’t necessarily indicate an underlying heart condition.

Atrial fibrillation vs. heart palpitations

Atrial fibrillation (AFib) is a serious type of arrhythmia in which the heart’s upper and lower chambers beat out of sync, causing rapid and chaotic rhythms that can increase stroke risk.

AFib often comes with shortness of breath or lightheadedness and is more common in older adults, like menopausal women. Some research suggests that women dealing with high stress and insomnia after menopause may have a greater risk of developing AFib. ⁸

When to See a Doctor About Heart Palpitations

Most palpitations are harmless, but if you have a history of heart disease, talk to your doctor. Seek immediate medical attention if palpitations are accompanied by dizziness, chest pain, or feeling like you might black out. Chest pain, in particular, warrants an ER visit, Carpenter says.

Treatments for Perimenopause Heart Palpitations

Even benign palpitations can be bothersome, and you don’t need to push through the discomfort if you don’t want to. There are treatments available, although more research is needed to know for sure how much they help. ⁹ Two medications that doctors commonly prescribe for heart palpitations in perimenopause or menopause:

Beta-blockers for heart palpitations

Beta-blockers are sometimes prescribed for palpitations, whether menopausal or not. However, Carpenter notes that most women she’s studied experience about one palpitation episode per day. For those whose episodes are frequent or interfere with daily life, beta-blockers may be an option.

HRT for menopause heart palpitations

Hormone replacement therapy (HRT) is sometimes prescribed for heart palpitations in menopause, even though gold-standard research on its effectiveness is lacking.

Carpenter says this makes sense: Nearly half of menopausal women experience palpitations, but they often have other symptoms as well. When a doctor prescribes HRT, they may be aiming to address multiple symptoms at once, such as hot flashes or insomnia that might accompany the palpitations.