Racing heart, anxiety and blood pressure in perimenopause: what can cause them, what the doctor checks, and how to keep a two-week record

At night your heart races, you wake around three in the morning and ask: heart, panic or menopause? Research says palpitations are common in this life stage, but they can also have other causes. Below is what your doctor checks. You can also record two weeks of episodes, on paper or in the symptom diary in Sam. There you note each day what you felt. Sleep and resting heart rate from Apple Health sit in the same app, a few taps away.

This is general information and it does not replace an assessment. Palpitations need a medical check, even when menopause looks like the likely cause. Whether it is your heart, hormones, thyroid or anxiety is decided by the examination, not by this text and not by your record.

Can the menopause transition cause palpitations?

In research, yes. A scoping review of 84 studies by Carpenter and colleagues found that palpitations are common during peri- and post-menopause. The review cites estimates of up to 42% of perimenopausal and 54% of postmenopausal women reporting them.

Let's Talk Menopause, an interview with a US cardiologist, says palpitations are common during perimenopause and are linked to the changes in oestrogen and progesterone. Hot flushes can also bring them, the NHS adds, because a hot flush can cause palpitations or anxiety.

Yet palpitations are not on every menopause symptom list. NICE's official guideline lists hot flushes and sweats, vaginal dryness, effects on mood, joint and muscle pain and low sexual desire, but not palpitations. And palpitations can come from your heart, from your thyroid or from a medicine. That is why they need a check before they are put down to the change.

What does research say about sleep, stress and blood pressure?

The same review looked at what goes with palpitations. Its likely correlates were ethnicity, less physical activity, worse hot flushes, worse sleep and lower quality of life. For each factor the evidence is still thin, and too few studies covered anxiety and stress for a firm conclusion. These are group findings, not a verdict on your own pattern.

Heart health deserves attention around the change. Let's Talk Menopause notes that at the time of menopause blood pressure, blood sugars, cholesterol and weight can change. It also notes that women's rate of heart disease rises at that point. Your doctor weighs what any of this means for you.

What does the doctor check before blaming menopause?

Palpitations can point to a heart rhythm issue. They can also come from the thyroid, from high blood pressure, from a lot of alcohol or caffeine, or from a medicine. Do not stop a medicine on your own; talk to your doctor first. The NHS says to contact your GP if you think you have menopause symptoms, or if you have symptoms like a fast heartbeat.

An ECG shows the heart rhythm at that moment. Let's Talk Menopause notes that an ECG is a snapshot, so if you are not having a palpitation then, it may be missed. A doctor may then use a monitor you wear for a day or more. The Menopause Charity adds that women often have had heart scans and 24-hour recordings that come back normal. For what to note during a recording, see Holter monitor diary: what to note.

NICE says perimenopause is identified without laboratory tests in women aged 45 or over. The signs are vasomotor symptoms that have recently started and a changed cycle. Menopause means no period for 12 months. NICE advises not to use routine hormone blood tests to identify these in women over 45.

Is it a panic attack or a heart problem?

Not reliably by yourself, because the features overlap. The Menopause Charity notes that panic attacks, intense sudden feelings of fear, can occur unexpectedly and for many are completely new. Racing heart, sweats, feeling faint and anxiety can belong to both a panic response and a physical cause. A panic disorder is a decision your doctor or therapist makes after physical causes are checked. See the guide on documenting panic attacks for your appointment.

Does blood pressure change, and how do you measure it?

Let's Talk Menopause notes that blood pressure can change around the menopause transition. It adds that this is a good time to track your heart health numbers. A change in numbers alone does not tell you whether something is wrong. What a value means for you is your doctor's call.

Measuring at home can give useful data. A commonly used method is to sit quietly for a few minutes with the arm supported at heart level. Then measure twice with a minute between the readings, at roughly the same times each day. Do not take a measurement during a racing episode as a resting value; note it separately. More on the technique in how often to measure blood pressure.

When is palpitation an emergency?

Most palpitations are benign, Let's Talk Menopause says, but not all. See a doctor if you have back pain, nausea or vomiting, or if your episodes last a long time or become more frequent.

If a racing heart does not go away, or comes with chest pain, shortness of breath or feeling faint or fainting, call your local emergency number (112 in the EU, 999 in the UK, 911 in the US); the NHS gives this advice. Call too for sudden severe chest pain or pressure, pain spreading to your arm, jaw or back, or severe trouble breathing. Do not wait to see if it passes, and do not drive yourself.

How to keep a two-week episode log

A record does not replace an ECG, but it gives your doctor data instead of memory. Let's Talk Menopause suggests starting with a diary: when the palpitation happens, what you were doing, and what you recently ate or drank. You can add to that:

• Date, time, how long it lasted, and what you felt: racing, fluttering or pounding, and whether it came suddenly or built over minutes.
• Pulse if you can measure it, and blood pressure after a few minutes seated if you are not in distress.
• What came before or after: a hot flush, night sweat, waking at night, coffee or alcohol in the past hours, stress, activity, or a new medicine.
• Sleep: when you went to bed, how many times you woke, and how rested you felt in the morning.
• Anxiety from 0 to 10, and whether the thought came that you might die or lose control.
• Your cycle: how often and how heavy your bleeding has been in recent months.

Take all your medicines and supplements, your log, and any family history of heart problems to the appointment. A doctor visit checklist for a chronic condition helps you prepare. For people who support you, there is a page for family and caregivers.

Pull your two weeks of symptoms together in Sam

You bring a two-week course instead of the memory of bad nights. The symptom diary in Sam works without a diagnosis.

• Instead of loose paper: you mark each day which symptoms you had and how strong, such as racing heart, hot flushes, night sweats or anxiety.
• Instead of Apple Health alone: sleep, resting heart rate and heart rate variability from Apple Health sit in the same app, a few taps from your symptom days.
• Instead of memory in the waiting room: the monthly report shows your symptom days in a calendar and your most common symptoms.
• Instead of stray papers: ECG results, doctor letters and blood values go into Health Vault.

Sam does not measure blood pressure and does not tell you whether heart, hormones or anxiety sit behind it. That is your doctor's call.

Try Sam Health

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Panic attack patterns: documenting for the doctor
• Holter monitor diary: what to note
• How often to measure blood pressure
• Doctor visit checklist for a chronic condition

Sources

Updated: October 2026

• NHS: Symptoms of menopause and perimenopause (page last reviewed 19 May 2026) and Heart palpitations (page last reviewed 17 March 2026)
• NICE: Menopause: identification and management (NG23) (published 12 November 2015, updated 15 April 2026)
• Let's Talk Menopause (US non-profit), interview with a cardiologist: Heart palpitations
• The Menopause Charity: Anxiety and Join the dots: A-Z symptoms list (last updated January 2024)
• Carpenter JS et al.: Correlates of palpitations during menopause: a scoping review, Women's Health 2022
• NHS: Blood pressure test (page last reviewed 25 November 2025) for two readings a minute apart, and Preeclampsia Foundation: Blood Pressure: Check. Know. Share. (updated March 2025) for sitting with the arm at heart level