Perimenopause heart palpitations: what they are, and when to worry
A fluttering, pounding or skipped beat — often at night, often with a hot flash. Common, frequently harmless, and still worth telling your doctor about.
The short answer
Heart palpitations are common in perimenopause — a 2022 review found up to 42% of perimenopausal women report them — and they're linked with hot flashes, poor sleep and lower physical activity. The NHS advises seeing a GP about palpitations. Get emergency help if they come with chest pain, fainting or severe breathlessness.
First: when palpitations need urgent care
Call emergency services if palpitations come with chest pain or pressure, fainting or nearly fainting, severe shortness of breath, or confusion — or if you have a known heart condition and they feel different from usual.
For palpitations without those red flags, the NHS still advises seeing your GP. They’re often harmless in perimenopause, but only a proper check can tell you that.
What perimenopause palpitations feel like
The NHS describes palpitations as a heartbeat that feels faster, slower or more noticeable. Women describe a flutter, a pounding in the chest or neck, a thud, or a skipped beat — often at night, lying down, or during or just before a hot flash.
How common are they?
Very. A 2022 scoping review in Women’s Health found that up to 42% of perimenopausal women and 54% of postmenopausal women report palpitations. The same review notes they’re under-studied compared with hot flashes — which is part of why so many women are told little about them.
What they’re linked with
The review identified several factors with strong evidence of an association:
- Worse hot flashes and night sweats
- Worse sleep (see why you wake at 3 a.m.)
- Lower physical activity
- Poorer quality of life
Common everyday triggers many people notice include caffeine, alcohol, stress and poor sleep — worth tracking to see which apply to you.
What to tell your doctor
A short log makes the appointment far more useful:
- when it happens (time of day, lying down, after caffeine or alcohol, with a hot flash)
- how long it lasts, and whether it feels fast, irregular or pounding
- anything that comes with it — dizziness, breathlessness, chest discomfort
- your cycle and other symptoms at the time
Your doctor may check your pulse and blood pressure, arrange an ECG or heart monitor, and blood tests such as thyroid function and iron — both of which can cause palpitations too.
What can help
- Improve sleep and cool the bedroom — hot flashes and poor sleep are both linked to palpitations.
- Move more, regularly: lower physical activity was one of the factors linked with palpitations.
- Note whether caffeine or alcohol make them more frequent, and cut back if they do.
- Slow breathing can ease the anxiety that often rides along with a palpitation.
Common questions
Are heart palpitations normal in perimenopause?
They're common — up to 42% of perimenopausal women report them in one review — but they should still be checked by a doctor. Get emergency help if they come with chest pain, fainting or severe breathlessness.
Why do I get heart palpitations at night in perimenopause?
Palpitations are linked with hot flashes and poor sleep, both of which often happen at night. Note when they occur and tell your doctor.
Can perimenopause palpitations be dangerous?
They're often harmless, but palpitations can also come from heart rhythm problems, thyroid issues or anemia. A doctor can check with simple tests such as an ECG and bloods.
Sources
- Carpenter et al. — Correlates of palpitations during menopause: a scoping review (Women's Health, 2022)
- NHS — Symptoms of menopause and perimenopause
- Troìa et al. — Sleep disturbance and perimenopause: a narrative review (Journal of Clinical Medicine, 2025)
This guide is educational. It doesn't diagnose or treat anything and isn't a substitute for personalized medical advice.