Heart Palpitations and Menopause

Hydrate, hydrate, hydrate. We cannot overstate the importance of hydration, and that doesn’t just mean drinking an additional glass of water. There are other easy dietary changes to consider, such as eliminating or decreasing caffeine and alcohol and reviewing your medications for dehydrating side effects, including over the counter meds like decongestants with phenylephrine.

Palpitations make your heart feel like it’s racing — as if you just ran a marathon or got off a roller coaster. It’s not uncommon to feel like your heartbeat is irregular, too.

While heart palpitations can happen at any time during the menopausal transition (perimenopause → postmenopause), they’re typically associated with hot flashes/hot flushes and night sweats, two of the most common vasomotor symptoms.

Although the causes of hot flashes aren’t yet fully understood, evidence points to fluctuations in hormone levels. Specifically, we’re talking about declining estrogen levels, which then affect the thermoregulatory center in the brain. In other words, the drop in estrogen alters our body’s ability to regulate temperature.

When estrogen/oestrogen levels drop, the hypothalamus (which acts as our body’s thermostat) becomes more sensitive to slight changes in body temperature. Thinking it’s overheated, the hypothalamus starts working to cool the body by shunting blood away from the core to your skin, which kick-starts a chain of events that causes flushing, sweating, and an internal sensation of heat despite the fact that our body temperature isn’t actually rising. Our blood vessels at our skin’s surface dilate, which can cause our blood pressure to drop, and our body is left with no other choice but to increase our heart rate in order to maintain an adequate output. And that increased heart rate is what feels like a palpitation.

Outside of hot flashes, decreased ovarian estrogen production is also independently associated with an increased heart rate (sinus tachycardia) and increased frequency of non-threatening irregular heartbeats (aka arrhythmia).

Although the case for hormonal changes is a strong one, it’s definitely not the only trigger. Other factors that can cause or exacerbate heart palpitations include:

Stress
Intense exercise
Caffeine
Nicotine
Stimulants
Anxiety
Alcohol
Fever
Severe anemia (likely due to heavy bleeding that causes iron deficiency)
Low blood sugar or blood pressure
Certain heart conditions or heart rhythm abnormalities
Hyperthyroidism (overactive thyroid)
Certain medications (Albuterol, asthma inhalers, certain cough/cold meds, thyroid meds, etc.)

In the moment, when you feel your heart rapidly beating, it’s hard to differentiate between a “normal” palpitation and a time-to-see-your-doctor palpitation. We totally get it. But if it…

Lasts more than a couple of minutes
Is associated with chest pain
Lasts LONGER than your hot flash
Causes you to faint

…then best to call your healthcare provider ASAP.

A note on heart health for women

Heart attacks often present differently in women than men, meaning many times, women don’t feel the classic chest + left arm pain. Instead, women may have shortness of breath, nausea/vomiting, and back or jaw pain.

If you experience any of the below, call 9-1-1 and get to a hospital right away:

Pressure, fullness, squeezing or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back
Pain/discomfort in one or both arms, the back, neck, jaw or stomach
Shortness of breath with or without chest discomfort
Breaking out in a cold sweat, nausea/vomiting or lightheadedness

For more information on women’s heart health, visit the American Heart Association.

Pro tip #1

Hydrate, hydrate, hydrate. We cannot overstate the importance of hydration, and that doesn’t just mean drinking an additional glass of water. There are other easy dietary changes to consider, such as eliminating or decreasing caffeine and alcohol and reviewing your medications for dehydrating side effects, including over the counter meds like decongestants with phenylephrine.

What you can do

Pro tip #2

Ever heard of HeartMath? This innovative technology helps us understand how our heart rate is tied to things like cognition, emotions, and other menopausal symptoms, palpitations included. Their research has shown that our feelings very significantly affect the heart’s rhythm! And, you can use the Heartmath app and sensor to help understand the link between YOUR breathing, heart rate, and emotional state - a very powerful relationship!

Pro tip #3

Oftentimes, heart palpitations alone aren’t cause for concern and will go away on their own. But you should still take them seriously and talk to your doctor. It’s urgent if palpitations are associated with chest pain, shortness of breath, or lightheadedness. Keep track of when they occur (and if you still get your period, what time of the month), and take note of your medications (prescription & OTC).

We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.

Lifestyle

Exercise

Although it sounds counterintuitive (because exercise = racing heart), aerobic activity is necessary for lowering our risk of heart disease. The American Heart Association (AHA) recommends:

150 minutes/week of moderate-intensity aerobic activity like walking OR 75 minutes/week of vigorous aerobic activity like jogging (or a combo of both spread throughout the week)
2 days/week of moderate-high intensity muscle-strengthening activity via resistance/weights

It’s also important to monitor just how much time we spend sitting.

Unfortunately, a morning workout doesn’t compensate for being sedentary for the remainder of the day.

Even light-intensity activity (walking to get the mail, going downstairs to go to the bathroom, investing in a standing desk) can offset some of the risks of being stationary so much of the day.

Nutrition & Diet

To reduce the chances of heart palpitations, it’s important to limit dietary triggers — we’re lookin’ at you, caffeine and alcohol.

If your palpitations are associated with hot flashes, consider incorporating foods such as soy, flaxseed, and legumes while avoiding spicy foods (if spicy food is a trigger for you — otherwise — no need to avoid it!) You can read more about the science behind why these ingredients help (or hurt) hot flashes in our full guide.

Holistic Practices

The following integrative, holistic therapies can be effective in managing and mitigating the symptoms of hot flashes, which is why we’re recommending them here for heart palpitations as well.

Mindfulness-based stress management

While many alternative therapies haven’t been clinically studied, the impact of mindfulness-based yoga on stress and anxiety has — and the results are promising. Since stress has been identified as a hot flash trigger, it’s worth giving relaxation techniques like meditation or yoga a whirl — while recognizing, of course, that it takes time to cultivate a practice and begin reaping the benefits (this isn’t a “quick fix”)

Breathwork

Heart palpitations often result in sensations of anxiety, which in turn can make palpitations worse –– a lose-lose, we know. In moments like this, different breathing techniques may be used to calm anxiety and even directly increase something called “vagal tone” — the physiologic calming of the nervous system that can result in the lowering of heart rate. Deep, slow breaths, or paced breaths may be used here.

Cognitive Behavioral Therapy (CBT)

CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries — that may be triggering or exacerbating hot flashes. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and a mindset to improve the hot flash experience (vs the hot flash itself). This modality is ideal for those looking to address underlying causes while working towards long-term management.

Acupuncture & Acupressure

Acupuncture is when extremely thin needles are inserted into the skin at strategic points (don’t worry — it doesn’t hurt!) and acupressure is when gentle pressure is used to stimulate certain points on your body. Both techniques have been studied in reducing hot flash severity and decreasing frequency (in addition to promoting sleep and reducing anxiety). A 2016 study, which compared an acupuncture group with a control group, found that hot flash frequency declined by 36% over six months with the acupuncture group, compared to just 6% with the control (no acupuncture).

As far as the effect of these treatments on palpitations of menopause directly, unfortunately studies are of low quality and at best show a trend towards less palpitations with acupressure, but as of now we cannot directly recommend these practices specifically for palpitations.

Sleep environment

When it comes to night sweats, it’s important to keep your bedroom cool. Right around bedtime, our body temperature drops 1-2 degrees, which signals to our internal clock that it’s time to hit the hay. In doctor-speak, this is what’s called “thermoregulation.” We recommend keeping your bedroom at a cool 60 – 67°F and, if that’s not enough, trying the following:

Cooling sheets made with bamboo, which effectively wicks moisture (read: sweat) from your skin
Cooling mattress pad or blanket, or a heated blanket for your bed partner (look into one with dual controls if you want to accommodate a bed partner)
Cooling system for your bed that uses circulating water to maintain a consistent, cool temperature (e.g., this hydro-powered one from ChiliSleep)
A fan! Simple, low-cost, and effective

Prescriptions and supplements

Fortunately, most palpitations are benign and do not require any therapy. Sometimes, however, they may be prolonged or associated with different conditions requiring medications or other treatments. So, if your palpitations are severe or persistent, we would recommend that you get evaluated.

Hormonal

So can MHT reduce palpitations? Although menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) will not reduce palpitations from certain causes, IF your palpitations are associated with fluctuating and declining estrogen, MHT can be an effective treatment. We are still not sure 100% whether MHT and specifically estrogen helps by direct effect on heart rate or via control of those pesky hot flashes – or both.

Still have questions? We’re answering them in our full HRT guide or just ask us directly ([email protected]).

Non-Hormonal

Cardiac medications (e.g., beta-blockers like propranolol) can be used, but only under the advice of a healthcare professional or cardiologist in the context of a separately diagnosed or underlying cardiac condition.

We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

Pro tip #2

Ever heard of HeartMath? This innovative technology helps us understand how our heart rate is tied to things like cognition, emotions, and other menopausal symptoms, palpitations included. Their research has shown that our feelings very significantly affect the heart’s rhythm! And, you can use the Heartmath app and sensor to help understand the link between YOUR breathing, heart rate, and emotional state - a very powerful relationship!

Pro tip #3

Oftentimes, heart palpitations alone aren’t cause for concern and will go away on their own. But you should still take them seriously and talk to your doctor. It’s urgent if palpitations are associated with chest pain, shortness of breath, or lightheadedness. Keep track of when they occur (and if you still get your period, what time of the month), and take note of your medications (prescription & OTC).

Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem.

As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.

References

Last reviewed 7/25/24

Carpenter, J. S., Tisdale, J. E., Chen, C. X., Kovacs, R., Larson, J. C., Guthrie, K. A., Ensrud, K. E., Newton, K. M., & LaCroix, A. Z. (2020). A Menopause Strategies–Finding Lasting Answers for Symptoms and Health (MsFLASH) Investigation of Self-Reported Menopausal Palpitation Distress. Journal of Women’s Health. Carpenter JS, Cortés YI, Tisdale JE, Sheng Y, Jackson EA, Barinas-Mitchell E, Thurston RC. Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease. Menopause. 2023 Jan 1;30(1):18-27. doi: 10.1097/GME.0000000000002082. Epub 2022 Oct 16. PMID: 36256921; PMCID: PMC9797427. Enomoto H, Terauchi M, Odai T, Kato K, Iizuka M, Akiyoshi M, Miyasaka N. Independent association of palpitation with vasomotor symptoms and anxiety in middle-aged women. Menopause. 2021 May 24;28(7):741-747. doi: 10.1097/GME.0000000000001776. PMID: 34033601.

Asplund, R. (2003, December). Nightmares, cardiac symptoms and the menopause. PubMed.

American Heart Association Recommendations for Physical Activity in Adults and Kids. (n.d.). Www.Heart.Org.

Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses. North American Journal of Medical Sciences, 3(1), 20.

Menopause.org, Burns, D. S., & Carpenter, J. S. (2012). Paced Respiration for Hot Flashes? The Female Patient.

Norton, S., Chilcot, J., & Hunter, M. S. (2014). Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats). Menopause, 21(6), 574–578.

Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) study. Menopause, 23(6), 626–637.

Grady, D., Herrington, D., Bittner, V., Blumenthal, R., Davidson, M., Hlatky, M., Hsia, J., Hulley, S., Herd, A., Khan, S., Newby, L. K., Waters, D., Vittinghoff, E., Wenger, N., & for the HERS Research Group. (2002). Cardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy. JAMA, 288(1), 49.

Menopause and Heart Disease. (n.d.). Www.Heart.Org.

Sheng Y, Carpenter JS, Elomba CD, Alwine JS, Yue M, Chen CX, Tisdale JE. Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric. 2022 Apr;25(2):128-140. doi: 10.1080/13697137.2021.1948006. Epub 2021 Aug 4. PMID: 34346265; PMCID: PMC9710005.

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