Your heart suddenly pounds, flutters, or skips a beat — out of nowhere, sometimes lasting a few seconds, sometimes longer. If this has happened to you, especially at rest or in bed at night, it’s genuinely frightening the first time. And if nobody’s told you this can be hormonal, it’s easy to assume something is seriously wrong with your heart.
Let’s talk through what’s actually going on.
What it is
Heart palpitations show up as a sudden awareness of your own heartbeat — pounding, racing, fluttering, or a feeling like your heart skipped a beat. They can happen while you’re active, at rest, or even wake you up at night. They often show up alongside a hot flash, though not always.
Why it happens
Estrogen has a direct influence on the cardiovascular system, including how your heart’s rhythm is regulated. As estrogen fluctuates during perimenopause, it can trigger palpitations even in someone with a completely healthy heart. This is a real physiological response, not something you’re imagining or overreacting to. Unsettling as they feel in the moment, palpitations connected to perimenopause are common, and on their own, are usually not a sign of an underlying heart problem.
When it’s worth a closer look
Brief episodes — a few seconds of fluttering or pounding that pass on their own, especially alongside hot flashes or stress — are typically nothing to worry about. But it’s worth getting checked if palpitations last several minutes, come with chest pain, shortness of breath, dizziness, or fainting, or if they’re becoming more frequent over time. This isn’t because it’s likely to be serious — it’s because heart symptoms are always worth confirming rather than assuming.
This is one of 20 symptoms covered in Not Going Crazy: A Perimenopause Symptom Guide — a bite-sized guide covering exactly what’s normal, when it’s worth flagging, and exactly what to say to your doctor for each one. Get the full guide →
Not Going Crazy 
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