The question
Out of nowhere, your heart starts racing, fluttering, or pounding. It might last a few seconds or a few minutes. It might happen at rest, at night, or in the middle of something completely ordinary. If you have never had palpitations before and they have appeared suddenly, it is understandable that they are alarming.
The short answer
Sudden palpitations are very common and, in the majority of cases in otherwise healthy people, are not a sign of dangerous cardiac disease. The most common causes include hormonal change, caffeine and alcohol, anxiety, dehydration, and thyroid dysfunction. For women in their 40s and 50s, the hormonal changes of perimenopause are a particularly significant and frequently overlooked driver.
Common explanations
Perimenopause: Oestrogen plays a stabilising role in the cardiovascular system. As it fluctuates during perimenopause, palpitations become common — affecting up to 40 percent of perimenopausal women.
Caffeine and stimulants: Many women find their tolerance to caffeine decreases during perimenopause, meaning amounts that previously caused no problem now trigger palpitations.
Anxiety and stress: The physiological arousal of anxiety raises heart rate and can produce palpitations — and anxiety is also very common during perimenopause.
Dehydration: Low fluid intake reduces blood volume, causing the heart to work harder.
Thyroid dysfunction: An overactive thyroid speeds up heart rate and is more common in women during midlife.
When palpitations need urgent attention
Seek urgent care if palpitations occur with chest pain or pressure, shortness of breath, fainting or near-fainting, or pain in the arm or jaw.
What to do next
If palpitations have been concerning you, a consultation to properly assess what is driving them is worthwhile. Our nurse practitioners understand the hormonal context of midlife.