Feeling your heart race, pound or skip a beat can be unsettling. In perimenopause, palpitations are a known symptom, often during hot flashes or at night. They're usually harmless, but they should always be mentioned to a doctor.
In short
- The NHS says palpitations can be a sign you're going through the menopause.
- They're often linked to hot flashes, poor sleep, stress, caffeine or alcohol.
- Get urgent help if they come with chest pain, shortness of breath or fainting.
What do palpitations feel like?
Your heartbeat becomes more noticeable: racing, pounding, fluttering, or feeling like it skips or adds a beat. You might feel it in your chest, throat or neck, for seconds or minutes.
Why do they happen in perimenopause?
Changing estrogen levels affect blood vessels and the nervous system that sets your heart rate. Palpitations often come with a hot flash or a night sweat. Anxiety, broken sleep, caffeine, alcohol and nicotine can all add to them.
Other causes worth ruling out
Low iron (anaemia), an overactive thyroid, heart rhythm problems and some medicines can also cause palpitations, which is why a check matters.
What can help?
- Note when they happen and what you were doing.
- Cut down on caffeine and alcohol.
- Look after sleep and stress.
- Treat the hot flashes. If palpitations come with hot flashes, treating those may help too. Ask your doctor.
When to see a doctor
See your doctor if palpitations keep coming back or get more frequent, last more than a few minutes, or if you have a heart condition or a family history of heart problems.
Call emergency services if palpitations don't go away, or come with chest pain, shortness of breath, or feeling faint or fainting.
Frequently asked questions
Can perimenopause cause palpitations at night?
Yes, often together with night sweats.
Are perimenopause palpitations dangerous?
They're usually harmless, but a doctor should check for other causes.
What will the doctor do?
Often listen to your heart, check your pulse and blood pressure, and may suggest an ECG or blood tests.
Ready for your doctor
Log palpitations (as heart discomfort) with one tap in Pausie. You'll see them next to hot flashes and sleep, ready for your doctor. No account, and your diary stays on your phone.
This article is general information, not medical advice. Written by the Pausie team. Published and last reviewed 30 October 2026.