# Palpitations in perimenopause: when to get checked · Peri Signals > Source: https://perisignals.com/articles/heart-palpitations-perimenopause Symptoms ## Heart palpitations in perimenopause A heart that suddenly races, pounds or skips a beat is common in perimenopause, and the NHS names the menopause as one cause of palpitations. Most episodes are harmless, but palpitations that keep coming back or last more than a few minutes need a GP, and palpitations with chest pain, breathlessness or fainting need 999 straight away. By Nora Whitfield, 4 November 2026 ### What perimenopause palpitations feel like A palpitation is a heartbeat you suddenly notice. The [NHS page on heart palpitations](https://www.nhs.uk/symptoms/heart-palpitations/) says you may feel it in your chest, your neck or your throat, and describes four ways it can feel: * racing or beating very fast * irregular, with a skipped or extra beat (doctors call these ectopic beats) * pounding or thumping * fluttering An episode can last a few seconds, a few minutes or longer. In perimenopause they often arrive out of nowhere: sitting at a desk, reading in bed, or in the minute before a hot flash. Many women describe it as the heart "jumping", and the shock of it is often worse than the feeling itself. The same NHS page lists the menopause among the causes, and the [NHS perimenopause symptom list](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/) includes palpitations alongside hot flashes, sleep problems and mood changes. It is also one of the symptoms the NHS gives as a reason to contact a GP, which is why this page spends most of its length on when to get checked. ### How common a racing heart is in perimenopause The clearest picture comes from the [SWAN study of palpitations across the menopause transition](https://pmc.ncbi.nlm.nih.gov/articles/PMC9797427/), published in _Menopause_ in 2022\. It followed 3,276 American women, aged 42 to 52 when they joined, for up to 22 years, asking at each visit on how many days of the last two weeks they had felt their heart "pounding or racing". Half the women had a steadily low chance of palpitations throughout. The other half fell into two groups: about one in three had a moderate chance and about one in six a high chance, and in both groups palpitations clustered in perimenopause and the first years after the last period, then faded later in postmenopause. Earlier, smaller studies quoted in the same paper found palpitations in up to 42% of perimenopausal women. Two findings matter most to a worried reader. The women in the high group were more likely to have hot flashes or night sweats, sleep problems, higher stress and more depressive symptoms, so palpitations tend to come with the rest of the transition. And when the researchers looked at the arteries of these women years later, palpitations were not linked to hardened or narrowed arteries. That is reassuring about the pattern across thousands of women. It cannot tell you what is behind your own episodes, which is a doctor's job. ### Palpitations at night Night is when many women first notice them. You are lying still in a quiet room, and a heartbeat that went unnoticed all day becomes hard to ignore. In perimenopause, night sweats and broken sleep add to it: SWAN found the women most likely to have palpitations also reported more hot flashes, night sweats and sleep problems, and the NHS lists lack of sleep itself as a common trigger. If an episode wakes you, note the time, how long it lasted, and whether a night sweat came with it. A pattern of episodes around sweats and wake-ups is useful to a doctor, and so is a racing heart at night with no sweat at all, which points the conversation elsewhere. ### Other causes of a pounding heart in your 40s Palpitations in midlife are often perimenopause, but the NHS lists several other common causes, and some of them overlap with this stage of life: * **Caffeine, alcohol and nicotine.** All three are on the NHS list. A second coffee you have drunk for years, or a glass of wine that now comes with a racing heart at 3am, is worth noting down. * **Stress and anxiety.** The NHS names them as common causes. Anxiety can also be a perimenopause symptom in its own right, so the two often arrive together. If your worst days fall in the week or two before a period, read [PMDD or perimenopause](/articles/pmdd). * **Exercise and lack of sleep.** Hard exercise and short nights can both make the heartbeat more noticeable. * **Medicines.** The NHS suggests checking the leaflet of anything you take, including new prescriptions. * **Iron deficiency anaemia.** The [NHS](https://www.nhs.uk/conditions/iron-deficiency-anaemia/) names heavy periods as a very common cause. If your periods have become heavier, see [heavy periods and blood clots in perimenopause](/articles/heavy-periods-perimenopause) and mention both at the same appointment. * **An overactive thyroid.** The [NHS symptom list for hyperthyroidism](https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/symptoms/) includes an irregular or unusually fast heart rate, along with sweating, feeling hot, poor sleep, anxiety and weight loss, so it can pass for perimenopause. Our page on [perimenopause or thyroid](/articles/perimenopause-or-thyroid) sets out which signs point which way. * **Heart rhythm problems.** The NHS also lists arrhythmia and heart valve disease. These are the reason recurring or long-lasting palpitations get looked at even when perimenopause seems the obvious explanation. Pregnancy can cause palpitations too, and it is still possible in perimenopause. If your period is late, [can you get pregnant during perimenopause?](/articles/can-you-get-pregnant-during-perimenopause) explains when a test makes sense. ### When to see a GP about palpitations According to the NHS, you should see a GP if you have had palpitations and feel well, but: * they keep coming back, or are happening more often * they last longer than a few minutes * you have a heart condition * heart problems run in your family The usual first test is an [electrocardiogram (ECG)](https://www.nhs.uk/tests-and-treatments/electrocardiogram/), where small sticky pads on your skin record the electrical signals of your heart. The NHS says you may be referred to a heart specialist, a cardiologist, for further tests. Ask at the same visit about a blood count and a thyroid test, since anaemia and an overactive thyroid are both on the list above and both are found with a blood sample. ### When palpitations are an emergency The NHS says to call 999 or go to A&E if you have palpitations right now and they do not go away, or if they come with any of these: * chest pain * shortness of breath * feeling faint, or fainting In the US, call 911\. Do not drive yourself: ask someone to take you or call an ambulance, and bring the medicines you take. If you had those symptoms but they have stopped, the NHS advice is to ask your GP surgery for an urgent appointment or contact 111 the same day, rather than waiting for a routine slot. ### What to note before the appointment Palpitations are usually over by the time you see anyone, so a test on the day may not catch one. A record of the episodes is what lets the doctor judge them. For two or three weeks, write down: * the date, the time and roughly how long each episode lasted * what it felt like: racing, skipping, pounding or fluttering * what you were doing, and whether a hot flash or night sweat came with it * caffeine and alcohol that day, and how you slept the night before * your period dates and how heavy each one was * any dizziness, breathlessness or chest discomfort, even if mild If you can, take your pulse during an episode and note whether it felt regular or irregular. Our [printable symptom diary and appointment checklist](/articles/printable-perimenopause-symptom-diary-and-appointment-checklist) has space for palpitations next to sleep, mood and bleeding, and the [perimenopause symptom checklist](/articles/could-it-be-perimenopause-a-symptom-checklist-with-what-to-do-next) helps if you are not yet sure perimenopause is what is happening. ### My take If you are in your 40s, your cycles are shifting and the palpitations are brief and come with hot flashes or bad nights, they are very likely part of the transition, and I'd treat them like any other perimenopause symptom: keep a few weeks of notes and raise them at your next appointment. I'd book sooner if they are coming more often or lasting longer than a few minutes, and I'd ask for a blood count and thyroid test at that visit, especially if your periods have become heavier. Chest pain, breathlessness or feeling faint with a racing heart is the one case where I would not wait to see how it goes. ### Related reading Palpitations are one of many symptoms covered in [perimenopause symptoms and how to track them](/articles/perimenopause-symptoms). For thinking and memory changes that often show up in the same years, read [brain fog in perimenopause](/articles/brain-fog-perimenopause), and the [symptoms topic](/topics/symptoms) collects every symptom page on the site. Written by Last checked 2026-11-04 --- [Peri Signals](/) Perimenopause symptoms, explained and tracked Plain answers on perimenopause symptoms for women 35 to 65: what is common, what to tell your doctor, and how to keep a useful symptom record. Some links on this page may earn us a commission. It never decides what we write about or recommend. © 2026 Peri Signals. Independent and reader-supported.