What palpitations are
A palpitation is simply an awareness of your own heartbeat, whether it feels fast, hard, irregular, or like a missed beat. Everyone's heart does this from time to time. What changes in perimenopause is how often it happens, and how noticeable it becomes.
Why perimenopause brings them on
Oestrogen influences the autonomic nervous system, the background controller of your heart rate, and helps blood vessels relax. As oestrogen fluctuates and declines through perimenopause, that autonomic balance tips, often towards the side that speeds the heart, which is part of the same shift that raises resting heart rate at this stage (Journal of Central South University Medical Science, 2024). Palpitations also cluster with the other symptoms of the transition rather than arriving in isolation, and are among the physical symptoms women report during these years (Sexual & Reproductive Healthcare, 2025).
Many women notice them most in the evening or around a hot flush, which fits the pattern of an autonomic system that has become more reactive.
How to read them
Occasional palpitations that pass quickly, especially around a flush or a stressful moment, are usually part of the picture and not a cause for worry. As with resting heart rate, the useful thing is the pattern over time rather than any single episode. A one-off flutter tells you little. A change in how often and how intensely they happen is worth noticing.
When to talk to a GP
This is the important part. Please see your GP, or seek urgent help, if palpitations come with chest pain, breathlessness, dizziness, or fainting, if they are prolonged or very frequent, if your heartbeat feels persistently irregular, or if you simply feel that something is wrong. Palpitations have causes beyond hormones, including thyroid changes and anaemia, and those deserve checking. anna does not diagnose, and this article is not medical advice.