A 55-year-old woman, with a known history of hypertension and diabetes, came to gynaecologist Dr Sonamm Tiwari’s clinic at Hiranandani Hospital in Vashi, Navi Mumbai, with complaints of intermittent palpitations for over two months. The flutters, she said, lasted from a few seconds to half a minute. She had no family history of heart disease, exercised regularly, didn’t smoke or drink alcohol. “On systemic examination, we found nothing unremarkable. A cardiovascular examination revealed regular pulse and rhythm…no heart murmurs, friction or gallops. There were no strong carotid upstrokes and no jugular vein distension,” said Dr Tiwari. Just to be sure, she conducted a detailed cardiac workup, including ECG and 2D Echo of the heart, both of which were normal. But soon, blood tests confirmed her menopausal status. She then counselled and reassured her patient and asked her to do follow-ups to ease her menopausal journey. After one year, the patient’s complaints finally subsided without the need for further treatment. During menopausal transition, the ovaries begin to work less effectively with the production of hormones like estrogen and progesterone declining over time. It is believed that such changes cause palpitations. Dr Tiwari explains what happens: What are the symptoms of menopause? Menopause is defined as the absence of the menstrual cycle for an entire year. It usually begins between the ages of 45 and 55 but can occur earlier or later. Also, it can occur differently. However, symptoms may be more severe after a sudden menopause caused by ovarian cancer, a hysterectomy or prolonged smoking, for example. Menopause can cause many unpleasant symptoms, such as hot flashes, which is a sudden feeling of warmth all over the body. About 75 per cent of menopausal women suffer from hot flashes. Other symptoms include: - Difficulty sleeping (insomnia) - Vaginal dryness - Decreased libido due to hormonal imbalance. - Weight gain - Depression, anxiety or low mood - Memory lapses or difficulty concentrating - Urinary urgency (an urgent, more frequent need to urinate) - Sore or tender breasts - Headaches - Rapid heartbeat - Decreased muscle mass - Painful or stiff joints - Decreased bone mass - Thinning of hair Why do women experience heart palpitations during menopause? As women get older, their reproductive cycle slows down and eventually comes to a halt. In the years leading up to menopause, the ovaries produce less of the hormone estrogen, which is the most common cause of the change in menstrual patterns. The symptoms women experience during menopause are all part of the body's adaptation to these changes. Heart palpitations are not talked about much but they are completely dependent on changing hormone status, namely decrease in estrogen, and are temporary. This type of symptom also occurs with other hormonally challenging conditions such as pregnancy or menstruation. Estrogen protects the arteries of a woman’s heart by reducing build-up of fatty plaque. Low estrogen increases cholesterol levels which means post menopause, women become more prone to developing heart disease. What do heart palpitations during menopause feel like? Palpitations are essentially irregular heartbeats that are more noticeable than normal heartbeats. A heart may flutter, race, thump or beat irregularly. These irregular or exaggerated beats are often short-lived, lasting a few seconds to minutes. Although these palpitations are harmless, women with these symptoms should still see a doctor to rule out other causes. Do hot flashes cause heart palpitations? Heart palpitations often occur with hot flashes during menopause. Heartbeats may increase by 5-15 beats during a hot flash. Other causes of palpitations are: - Caffeine, alcohol consumption or smoking - Asthma inhalers and some cough medicines - Intense physical activity - Stress - Fever or dehydration - Problems with the thyroid gland - Low sugar levels or low blood pressure How to deal with palpitations during menopause? If the palpitations are short-lived and occur occasionally, they could be related to menopause. However, if the palpitations occur more frequently, last longer, or get worse over time, you should see a doctor because it could be a serious heart problem that needs to be treated. If the palpitations are accompanied by shortness of breath, dizziness or chest pain, you should seek emergency medical attention immediately. Also just because you have gone through menopause that does not mean the heart trouble is over. On the other hand, a woman's risk for heart disease increases significantly after menopause. As estrogen production comes to a near standstill, the risk of stroke and heart attack increases. Therefore, a healthy lifestyle, healthy diet and exercise and quitting smoking can help reduce the risk. Palpitations can also be an early warning sign of a heart problem in some women. During and after menopause, women should pay closer attention to their heart health. To protect your heart, you can follow some of the tips below: - Get 30 minutes of exercise a day at least five days a week. - Eat more fruits and vegetables. Reduce added sugars, caffeine, fried foods and salt. - Maintain a healthy weight. - Try relaxation techniques such as deep breathing, yoga and meditation. Hormone replacement therapy can help some women with palpitations, hot flashes and vaginal dryness. But this therapy can also increase the risk of heart disease, blood clots, stroke and breast cancer. It is best to discuss hormone therapy with your doctor to find out if it works for you or not.
