Kumakabog ang dibdib? Palpitations in perimenopause

Do not wait or search further if your palpitations come with any of these:

• Chest pain, pressure or tightness, or pain spreading to the arm, jaw or back
• Fainting, or nearly fainting
• Breathlessness at rest or lying down
• A very fast heartbeat that will not settle after several minutes of rest
• Sudden weakness, face drooping or slurred speech

Ischaemic heart disease is the leading cause of death in the Philippines (Philippine Statistics Authority, 2024), and its symptoms in women can be subtle. Being checked and told "okay ka" is never a waste.

That is how one Filipina on Reddit described her perimenopause. Others say "feeling ko na hihighblood ako". At the 2025 UP Manila symposium on menopause, PGH doctors described a patient whose palpitations led to repeated ER visits before menopause was recognised as part of the picture (UP Manila).

The lesson cuts both ways: get checked, and if the checks are normal, ask whether perimenopause could be the reason.

Estrogen affects the nerves that control your heart rate and blood vessels. As it swings, that control gets jumpier. During a hot flash, your blood vessels open and your heart speeds up to move heat to your skin, so many women feel a pounding heart with each flash. Mayo Clinic lists a rapid heartbeat as one of the usual signs of a hot flash.

Anxiety adds fuel. Perimenopause can bring new anxiety or panic, and panic itself causes a racing heart, which then feels scary, which causes more panic. See mood and anxiety.

Poor sleep, coffee, energy drinks and stress all make the heart more twitchy.

This is the most important section on this page. Palpitations deserve a proper check before you put them down to hormones:

• Thyroid problems. An overactive thyroid causes a fast heartbeat, sweating, tremor and weight loss. A TSH test costs ₱490 per test (Exact Check) and FT4 ₱470 per test (Exact Check). Other labs charge ₱600 to ₱1,100 per test (Hi-Precision, Healthway (estimates)). See perimenopause or thyroid?.
• Anemia. Heavy perimenopause periods can lower your hemoglobin, and the heart beats faster to compensate. A complete blood count checks this.
• Heart rhythm problems such as atrial fibrillation. The NHS lists being 55 or older as a risk factor. An ECG, and sometimes a 24-hour Holter monitor, can catch them.
• High blood pressure. Very common at midlife. Check it at home or at a botika.
• Caffeine and stimulants: coffee, milk tea, energy drinks, some cold and diet medicines.
• Medicines. Asthma inhalers, thyroid tablets at too high a dose, decongestants and some supplements can cause palpitations. Bring your medicine list.
• Low blood sugar, especially with diabetes medicine.
• Anxiety and depression.

The symptom checker lets you record palpitations with your other symptoms so the full picture reaches your doctor.

First, the checks above. Once a doctor has ruled out other causes, the options are (ratings from The Menopause Society 2022 and 2023 statements and NICE NG23 2024; medicines are prescription only):

Treating the hot flashes. Some evidence. If palpitations come with flashes, treating the flashes often calms them. Hormone therapy is the most effective option for flashes (The Menopause Society 2022), but we did not find good trials on palpitations themselves. See HRT for menopause. Estradiol gel (Oestrogel): ₱1,185.50 per 80 g pump pack (Watsons).

Non-hormonal options for flashes. Strong evidence for flashes. Paroxetine (Seroxat) 20 mg ₱68.75 per tablet (Watsons) and gabapentin (Reinin) 300 mg ₱42 per capsule (Watsons). Paroxetine may also help anxiety. See non-hormonal treatments.

CBT. Some evidence. CBT helps with anxiety, panic and the distress of hot flashes (NICE 2024).

Cutting caffeine and alcohol. Limited evidence. Simple and worth a two-week trial: switch to decaf or limit to one cup in the morning.

Supplements. None are proven for palpitations. Some "energy" or weight-loss products contain stimulants that make them worse. See our honest supplement ratings.

Prices checked October 2026.

A consult to start the checks costs ₱600 to ₱2,000 per visit (St. Luke's, Makati Med, TMC, Cardinal Santos, Healthway), or ₱300 to ₱600 per visit (Government hospitals) at government hospitals. Teleconsults run ₱699 per 15 min (Doctor Anywhere, Medifi).

Write down when palpitations happen, how long they last, what you were doing, and whether they come with flashes, dizziness or chest discomfort. If you can, take your pulse during an episode or use a phone or watch that records heart rate. Log it in the symptom diary. Also note your coffee and milk tea intake, any new medicines or supplements, your period pattern, and whether anyone in your family has heart rhythm problems or died suddenly young. These details help your doctor decide which tests you actually need. Our talk to your doctor script helps if you have been told "stress lang 'yan", and find a doctor lists menopause-literate OB-GYNs.