Heart Palpitations During Perimenopause: Are They Normal?
In 2013, Kathy Geller Meyers, 53, of Hummelstown, Pennsylvania, was in good health—she was an avid half-marathon runner—when breast cancer treatments pushed her into early menopause. A bilateral mastectomy, a full hysterectomy, and a temporary regimen of tamoxifen (a drug used to treat breast cancer after surgery) contributed to the hot flashes and moodiness that normally accompany menopause. But it wasn’t until she experienced strange sensations in her chest that Kathy started to worry about her heart.
“It was only a little flutter in my throat at first, and then it became more bothersome,” Kathy recalls. “[My heart felt] like I had continuous stage fright.”
When her racing heart became worse, she decided to seek help. Her primary care doctor referred her to a cardiologist, and she began a 10-milligram dosage of propranolol, a prescription drug typically used to treat high blood pressure as well as an uneven heartbeat.
Although Kathy’s story and course of treatment might be unique, the heart palpitations she experienced during menopause are not.
Why Are Women Experiencing Palpitations in Midlife?
Janet Carpenter, Ph.D., is a professor at the Indiana University School of Nursing, Indianapolis, and also the lead researcher on a study investigating menopausal palpitations in women by analyzing data from clinical trials on menopausal health. According to her research, somewhere between 40 percent and 54 percent of women in perimenopause or menopause have reported strange sensations in their hearts.
“Women [in midlife] tend to describe them as rapid, fluttering, racing, or skipped heartbeats,” says Nieca Goldberg, M.D., a clinical associate professor at the NYU Grossman School of Medicine and cardiologist who sees women with this issue in her office with some frequency.
Because the language can vary, “it is not always clear they are describing the same thing,” Carpenter says. What seems clear is that many women are experiencing something strange in their hearts, and there’s not enough research currently to show why this is happening.
“We are careful to call them ‘palpitations during the menopause transition’ because we don’t know if they are directly attributable to menopause,” says Carpenter, who became interested in the topic after having her own midlife experience with heart palpitations. After visiting her doctor, they were able to rule out any serious heart issues, but the experience made it clear to her just how common this mysterious complaint is in midlife.
The Heart During Menopause
It’s possible that the hormonal changes in the body during menopause may be part of the cause of palpitations, though Goldberg is careful to say that it’s not estrogen alone that could be at fault. “It’s all the hormonal fluctuations in perimenopause in general,” she says.
During menopause, the body changes in many ways. Weight gain is common. Hot flashes are common. Losing sleep is common. The entire “environment” of the body shifts, Goldberg explains. These changes can—and often do—lead to palpitations that may resolve on their own, she says.
Terry Dunn, M.D., a Denver-based ob-gyn who specializes in women’s wellness, shares her perspective. “When you are in your reproductive years, you ovulate every month and produce estrogen, progesterone, and testosterone,” Dunn says. “The lack of estrogen manifests itself in different ways, but there are estrogen receptors in the heart. Over time, palpitations generally improve [possibly] because a woman’s body gets used to having estrogen levels that are not as high.”
The good news is that the heart itself may be perfectly healthy, even when the sensation feels scary. “If a person had an EKG, they might not have an increased heart rate while they’re having the palpitations,” says Michael Tahery, M.D., a board-certified ob-gyn in Los Angeles.
As Carpenter puts it: “It’s a little shocking we don’t know more about what this is, considering how many women experience it.”
When to Call the Doctor
It’s always smart to check in with a medical professional on any recurring changes you experience, regardless of how small they may seem. A heart flutter that lasts for more than a few days is cause for concern—especially if it’s persistent.
“If you’re sitting at your desk, you get a flutter, and it goes away, it’s not something to worry about,” Tahery says. “But if it’s associated with chest pain and is radiating to your arm, that’s different.”
In Carpenter’s research, she was able to find a link between the palpitations and other risk factors for cardiovascular health, like “sleep disturbances, depression, and stress”—all common symptoms women experience in menopause. It’s important to pay attention to any other symptoms you’re experiencing, too. Anxiety, insomnia, and dizziness that accompany palpitations are another reason to head in to see the doctor in person, Tahery says. You may be able to treat the underlying issue and potentially stop the palpitations in the process.
Additionally, it’s important to note that the signs of potential heart distress are different in women than in men. As with men, women may experience the telltale sign of a heart attack: chest pain that radiates down the arm. But women may also experience shortness of breath, passing out, nausea/vomiting, and back or jaw pain, according to the American Heart Association. Any of these symptoms accompanying heart palpitations should cause you to seek immediate medical attention.
Generally, it’s a good rule of thumb to discuss any symptom involving your heart health (such as dizziness, shortness of breath, or anything else that feels abnormal or out of sync) with your doctor on an ongoing basis, to catch any problem before it becomes serious. Even if it doesn’t feel like an emergency, Tahery says, it’s still worth bringing up at your next physical.
A Heart-Healthy Lifestyle Can Help During Menopause
When a woman comes into her office concerned about palpitations, Goldberg says she first analyzes how much caffeine the patient is drinking; how much sleep she’s getting; whether there are other symptoms, such as dizziness or fainting; or whether there’s interference with daily activities. After she asks about accompanying symptoms and rules out an emergency situation with the heart, if there’s no other explanation for the heart palpitations, then she recommends lifestyle changes.
“One of the first things I ask about is caffeine,” Goldberg says. “The palpitations can often be resolved just by drinking a cup fewer of coffee per day.”
There are other lifestyle choices that can affect heart health, as well. Exercise, for instance. Luckily, there’s no need to train for a marathon or take a vigorous spin session if that’s not your thing, says Tahery. “Consistency is more important than how strenuous an exercise is,” he says. For his patients with palpitations, he recommends relaxation exercises, like yoga or tai chi, as well as frequent walks or light weightlifting.
How Diet Can Affect Heart Palpitations
Of course, diet is a vital part of heart health, as well. Unhealthy eating habits may have contributed to more than 300,000 cardiometabolic deaths in U.S. adults in 2012, according to the findings of a study published in the journal JAMA in 2017 that focused on a review of clinical data. (These deaths were not from heart disease alone—they also included stroke and Type 2 diabetes.)
According to Tahery, eating nutrition-dense foods, such as whole grains, nuts, fruits, legumes, and leafy greens, is also a major part of any heart health lifestyle. “I’m a big fan of food as medicine,” he says. Tahery strongly prefers that, whenever possible, people get their nutrients through the food they eat rather than by taking supplements. However, a calcium supplement may help women who aren’t getting enough of the mineral through food, he says.
Another vitamin that may help is vitamin K2, he says. According to a study published in the Journal of Integrative Medicine in 2015, adequate intake of K2 may help slow arterial calcification and stiffening and protect heart health. For women, 90 micrograms is the intake recommended by the National Institutes of Health Office of Dietary Supplements.
It’s possible to get this easily in food, however, given that the amount found in half a cup of broccoli is 110 micrograms. It’s also recommended before you start any new supplements to check in with your doctor on any potential interactions with other medications.
Smoking is also a major cardiovascular risk factor. Quitting is possibly the most beneficial heart healthy change a woman can make.
In addition, sleep is vital at this time, as poor and short sleep are both linked to greater cardiovascular risk. In her practice, Goldberg says sleep is frequently the culprit when it comes to these palpitations, and since “sleep is often disrupted in perimenopause, we may see this more often in women at this stage of life.” She recommends all her patients get between seven and eight hours of sleep every night.
“The human body is like a car,” Tahery says. “It has four wheels, so you need a good diet, you need to exercise, you need to reduce your stress, and you need mental relaxation and physical relaxation.”
Carpenter points out that women like Kathy who have been on breast cancer drugs like tamoxifen also tend to report higher instances of heart palpitations for reasons that are yet unclear.
The Search for More Answers
There is still much research left to be done, says Carpenter, who is actively involved with another study on heart palpitations in midlife. “We see a lot of stigma and bias against symptoms that women present with in general,” she says. “We see this in cardiology. This is a historic bias.”
Carpenter is planning to do EKG work on women who experience palpitations. She intends to dig deeper into what’s really going on when they feel this sensation in their chest, and to, she hopes, get some answers.
The Take-Home on Heart Palpitations in Perimenopause and Menopause
The take-home here is that palpitations can be more common in the perimenopausal period. It’s unclear if they’re related to a drop in estrogen or rather the symptoms this can cause, such as lack of sleep, mood changes, and stress. In any case, it’s important to be aware of the symptoms and check in with your doctor regularly about what you’re experiencing and general heart health.
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