Of all the symptoms I experienced during perimenopause, the one that frightened me most wasn't the brain fog — though that was deeply unsettling in its own way. It was the palpitations.
They would come out of nowhere. I'd be going about my day, feeling perfectly calm, and suddenly there it was — a heavy, rapid thudding in my chest, followed almost immediately by an intense wave of lightheadedness, as though I was about to pass out. It happened multiple times a day at its worst. I started to feel nervous about driving. I wondered whether something was seriously wrong with my heart.
I had investigations done — heart tracings, blood tests and other checks — and everything came back normal. But it wasn't until I started hormone replacement therapy and the palpitations almost completely disappeared that I finally connected the dots. It was menopause all along.
You're not imagining it — and it's probably not your heart
If you've experienced palpitations during perimenopause or menopause, firstly: you're far from alone. Research shows they affect between 20-40% of perimenopausal women and up to 54% of postmenopausal women. That's a significant number of women lying awake wondering whether to worry.
The reassuring news is that a large study following over 1,500 women found that palpitations during the menopause transition were not associated with underlying heart disease or arterial stiffness. They appear to be linked to hormonal fluctuations and vasomotor changes — the same mechanisms behind hot flushes — rather than indicating something sinister going on with your heart.
When to see your doctor — please don't skip this part
This is really important: even though my palpitations turned out to be menopause-related, I only made that connection after having proper cardiac investigations done first. The checks came back normal, and it was only later — when I started HRT and the palpitations resolved — that the picture became clear.
That's exactly the right order of events, and I'd encourage you to do the same. Please see your GP and get palpitations properly investigated before drawing any conclusions — don't assume it's menopause without ruling out other causes first.
And if you experience any of the following, please seek medical attention promptly — don't wait:
Chest pain or tightness alongside palpitations
Fainting or loss of consciousness
Significant shortness of breath
Palpitations that last more than a few seconds or feel prolonged
These symptoms always warrant assessment regardless of where you are in your menopause journey. Your instincts exist for a reason — trust them.
The real cardiovascular story in menopause
Here's what the research tells us is actually happening to your heart health during this transition — and it's less about palpitations and more about something quieter and less visible.
In the window surrounding your final menstrual period, your cholesterol profile changes significantly. LDL cholesterol — the type associated with cardiovascular risk — rises, while the protective HDL fraction declines. These shifts are driven directly by the drop in oestrogen, not simply by getting older. Studies following thousands of women over many years consistently show these lipid changes are linked to menopausal status rather than age alone.
What this means practically: your cardiovascular risk deserves attention at midlife — not because menopause makes heart disease inevitable, but because this is a window where proactive monitoring and lifestyle choices matter. Knowing your cholesterol numbers, staying physically active, eating well, and having an honest conversation with your doctor about your overall cardiovascular risk profile are the most important things you can do.
Your heart health in midlife is worth paying attention to — not with fear, but with the same informed, proactive approach you'd bring to anything else in your life.
Stay happy and healthy,
Erika :)
Dr Erika Life Reno Medic — helping professional women thrive through perimenopause and beyond
Cardiovascular health, cholesterol, and the lifestyle strategies that protect your heart through menopause are all topics we cover in the Reclaim programme. Enrolments are now open for April — I'd love to have you join us:
Ready to take the next step in your menopause journey?
📅 Book a consultation here: https://www.liferenomedic.com/book
