The Nurse Note

When Your Heart Suddenly Starts Racing

Is this perimenopause — or something I should check?

You’re sitting quietly when your heart suddenly flutters, thumps, skips — or feels as if it has decided to sprint without you.

It may last only a few seconds, but that can be long enough to stop you in your tracks and make you wonder: Is this perimenopause? Anxiety? Or something I need to check?

Heart palpitations are the feeling that your heartbeat has suddenly become more noticeable. They may feel like racing, pounding, fluttering, or skipped or extra beats. Some women feel them in the chest; others notice them in the neck or throat.

Yes, palpitations can happen during perimenopause, and some women notice them during a hot flash. But “this can happen in perimenopause” is not the same as “it must be hormones.” A new or changing heart symptom shouldn’t automatically be brushed aside.

A small tool that does a lot: pause and capture

When it happens, first notice how you feel. If the sensation passes and you otherwise feel well, jot down these five things before the details disappear:

1. When it started and how long it lasted
2. What it felt like — racing, fluttering, pounding, skipping, or extra beats
3. What you were doing just before it began — resting, exercising, waking from sleep, drinking coffee, or feeling stressed
4. What came with it — a hot flash, anxiety, dizziness, breathlessness, feeling faint, or chest discomfort
5. Your pulse or smartwatch reading, if it’s easy to check — without delaying medical help if you feel unwell

You’re not trying to diagnose your own heart rhythm. You’re simply capturing the pattern, so you can give your provider something more useful than “my heart does something strange sometimes.”

Look for patterns — not one easy explanation

Palpitations can be connected with lack of sleep, stress, exercise, caffeine, alcohol, nicotine, or certain medications. They can also occur with iron-deficiency anemia, an overactive thyroid, or an abnormal heart rhythm.

That doesn’t mean something serious is causing them. It means “probably hormones” shouldn’t be the end of the conversation.

What deserves a medical appointment

Arrange an appointment if the palpitations:

• Are new or keep coming back
• Are becoming more frequent
• Last longer than a few minutes
• Occur if you have a heart condition or a family history of heart problems

Bring your short record along with a list of your medications and supplements. Depending on the pattern, your provider may decide that an ECG or other evaluation makes sense.

When to seek urgent help

Seek emergency medical help if the palpitations are happening now and don’t go away — or if they occur with:

• Chest pain or pressure
• Shortness of breath
• Feeling faint or actually fainting

If the episode has stopped but any of those symptoms occurred with it, seek urgent medical advice rather than waiting for a routine appointment.

Many palpitations turn out not to be dangerous. But reassurance is far more useful after the symptom has been properly understood — not when “it’s probably menopause” is used to dismiss it.

You don’t have to panic, and you don’t have to brush it off. Notice it. Record it. Check it when appropriate.

Sources & further reading

• American Heart Association — Arrhythmia symptoms
• The Menopause Society — Menopause education for patients
• The Israeli Menopause Society — האגודה הישראלית לגיל המעבר

Navigator, not diagnostician. This is education to help you have a better-informed conversation — not a diagnosis. Your treating clinician makes the calls about testing and care.

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About the author

Dina Bright Yosef, RN, BSN is a Menopause Navigator & Consultant with more than 20 years of experience in women’s health. Through education and one-to-one Clarity Sessions, she helps women understand perimenopause, connect the dots between their symptoms, and feel confident about their next steps.