Heart Palpitations

The Physiology. Heart palpitations are subjective sensations of a racing, pounding, or fluttering heart often driven by the Autonomic Nervous System (ANS).

The ANS controls your heart rate and has two branches: the sympathetic ("fight or flight") and the parasympathetic ("rest and digest").

The Estrogen Connection. Estrogen is a key regulator of this system. It naturally facilitates the parasympathetic system, acting as a "brake" on your heart rate. As estrogen levels fluctuate and decline during perimenopause, this "calming" brake is removed. The result? Your nervous system becomes hyper-reactive to norepinephrine (adrenaline), causing your heart rate to spike or flutter in response to even minor stressors.

Vascular Changes. Estrogen also helps regulate Endothelial Nitric Oxide Synthase (eNOS), which keeps blood vessels flexible. Its decline can lead to subtle vascular instability, further contributing to the sensation of a "pounding" pulse in the neck or chest.

Crucial Note. While most menopausal palpitations are benign, cardiovascular disease risk does increase post-menopause. Always consult your doctor to rule out arrhythmia.

The primary driver of menopausal heart palpitations is the direct influence of fluctuating estrogen on the Autonomic Nervous System (ANS) and vascular structures.

When estrogen levels fluctuate:

• The nervous system becomes more reactive, increasing adrenaline and heart rate.

• Blood vessels may dilate or constrict unpredictably.

• Anxiety or hot flashes can further trigger sensations of a racing heart.

While menopausal heart palpitations are frequently benign and temporary, stemming from hormonal and nervous system changes, it is a clinical necessity to evaluate the symptoms to ensure no underlying cardiovascular condition or arrhythmia is present.

Palpitations that are infrequent and short-lived usually do not require extensive testing.

However, the transition through menopause marks a pivotal moment where the risk for heart disease and stroke accelerates, making vigilant monitoring of all cardiovascular symptoms essential. If a woman has a history of pre-existing heart disease, high blood pressure, or other risk factors, frequent or worsening palpitations warrant consultation with a healthcare provider.

Seek immediate emergency care if palpitations are accompanied by:

• Severe chest pain, pressure, or squeezing.

• Shortness of breath or difficulty breathing.

• Fainting (syncope) or severe dizziness.

• Pain radiating to the jaw, neck, or back (a common, often overlooked heart attack symptom in women).14

• Extreme, unexplained fatigue or nausea.

The Science. It isn't just hormones; it is the context of your life. Groundbreaking 2025 research from the Mayo Clinic has quantified the impact of caregiving on menopause. The study reveals that women in the "sandwich generation" (those caring for both children and aging parents) face nearly double the risk of moderate to severe menopause symptoms compared to non-caregivers.

The Soul. If you feel overwhelmed, your body is listening. The chronic production of cortisol (the stress hormone) from juggling these responsibilities compounds the hormonal instability of menopause. This "allostatic load" lowers your threshold for palpitations. Managing your stress load is not just "self-care"; it is a physiological necessity for heart health.

Palpitations tend to appear during perimenopause and fade as hormone levels stabilize after menopause. Frequency varies, from occasional flutters to daily episodes, often resolving within a few months to a few years.

Management strategies for menopausal palpitations focus on minimizing cardiovascular triggers and actively promoting the parasympathetic (rest and digest) state to counteract sympathetic overdrive.

Lifestyle and Behavioral Adjustments

• Limit caffeine, alcohol, and nicotine

• Practice breathwork or mindfulness to calm the nervous system

• Maintain hydration and electrolyte balance

• Exercise to maintain weight, blood pressure, and blood sugar levels

Targeted Nutritional Support

• Magnesium:  Has been shown in some studies to attenuate symptoms related to hypomagnesemia, which can include cardiac irregularities. It is positioned as support for electrolyte stability and neuromuscular function.

• Coenzyme Q10 (CoQ10): While research primarily supports CoQ10’s role in improving functional capacity and quality of life in heart failure patients, its use in general wellness is justified by its vital role in cellular energy metabolism, particularly as natural levels decline with age.

Our Scientific Foundation: Why We Trust These Sources

At Novapause, our "Science + Soul" commitment means our content is built on a foundation of the highest-quality, most trusted sources in medical science.

Trusted Sources

• National Institute on Aging (NIA): As the U.S. government's lead agency for research on aging, the NIA funds the foundational work that helps us understand the deep links between hormonal changes and health during the transition.

• Study of Women’s Health Across the Nation (SWAN): The SWAN study is the most important multi-site, longitudinal study of women in midlife ever conducted.

• The Journal of the Menopause Society: We follow the clinical guidance and research published by The Menopause Society, whose flagship journal, Menopause, provides the latest data on symptom management, hormone therapy, and the physiological changes during this transition.

Highlighted Research

• American Heart Association: Menopause and Heart Health

  The AHA highlights that menopause is associated with natural hormonal changes that may influence cardiovascular function. Estrogen fluctuations can affect blood vessel flexibility, cholesterol levels, and heart rate variability. While heart palpitations are often benign, the AHA emphasizes the importance of heart-healthy habits such as regular movement, stress reduction, balanced nutrition, and routine checkups to support long-term cardiovascular well-being.

• Mayo Clinic: Menopause and Palpitations

  Mayo Clinic explains that menopausal palpitations often result from hormonal shifts affecting the autonomic nervous system. These sensations may feel like fluttering or skipped beats and are usually harmless, though persistent or concerning symptoms warrant medical evaluation. They reinforce lifestyle approaches to help calm the nervous system.

• Cleveland Clinic: Hormones and the Heart

  Cleveland Clinic highlights that estrogen influences heart and blood vessel regulation. As levels fluctuate, changes in vascular tone and stress responses may trigger palpitations. They encourage monitoring overall cardiovascular health and discussing symptoms with a provider to rule out underlying conditions.