Heart Palpitations in Perimenopause: Why They Happen, When to Get Checked & Where Herbs Fit

Your heart suddenly starts pounding.

Maybe you’re lying in bed. Maybe you’ve just sat down after dinner. Maybe you’re doing absolutely nothing unusual when, seemingly out of nowhere, your heartbeat becomes impossible to ignore.

It races.

It flutters.

It feels as though it has skipped a beat.

Or you can suddenly feel it thumping in your chest or throat.

And naturally, your mind goes straight to:

What is happening to my heart?

Heart palpitations are commonly reported during the menopause transition. Women describe racing, pounding, fluttering, skipped beats, and sometimes the unnerving sensation that their heart is suddenly trying to make itself very noticeable.

But there is something important I want you to understand from the beginning:

Palpitations are a symptom. They are not a diagnosis.

And “perimenopause” is not an explanation in itself.

Hormonal fluctuations may be part of the picture, but so can iron deficiency, thyroid dysfunction, poor sleep, stress, caffeine, alcohol, medication, dehydration and cardiac rhythm disturbances.

This is why, as a herbalist, my first question is never:

“Which herb stops palpitations?”

I want to know:

Why is this particular woman experiencing them?

Because the answer determines whether I reach for hawthorn, motherwort, lemon balm, linden — or whether herbs should wait while something else is investigated first.

Why can your heart suddenly feel different in perimenopause?

Perimenopause is not simply a period of steadily declining oestrogen.

Ovarian hormone production becomes increasingly variable, and these fluctuations occur alongside changes in thermoregulation, sleep, vascular function and autonomic nervous system activity.

Your autonomic nervous system is particularly interesting here.

It continuously adjusts your heart rate, blood pressure, vascular tone, temperature regulation and stress response without you consciously thinking about any of it.

This is one reason a woman may notice her heart racing around a hot flush, during the night, after a particularly stressful day or when chronically sleep deprived.

But hormonal changes are only one layer.

A woman can be perimenopausal and iron deficient.

Perimenopausal and hyperthyroid.

Perimenopausal and consuming more caffeine because she is exhausted.

Perimenopausal and experiencing an arrhythmia.

Those distinctions matter.

Before I think about hawthorn, I look for the pattern

If you told me:

“My heart keeps racing.”

I would want considerably more information.

When does it happen?

At night?

At rest?

During or immediately after a hot flush?

After coffee?

After alcohol?

When you are particularly anxious or overstimulated?

Does it start suddenly?

What does it actually feel like: fast, pounding, fluttering, occasional skipped beats?

And what else is happening?

Heavy periods?

Fatigue?

Breathlessness?

Poor sleep?

Night sweats?

Tremor?

Changes in exercise tolerance?

Medication changes?

This is where herbal medicine becomes far more interesting than:

symptom → herb.

Because two women can experience what they both call “heart palpitations” and require completely different support.

Hawthorn: one of the great cardiovascular herbs

If there is one plant synonymous with the cardiovascular system in Western herbal medicine, it is hawthorn (Crataegus spp.)

And it is a herb I think deserves much more nuanced discussion than:

“Hawthorn is good for your heart.”

Hawthorn has a long history of traditional cardiovascular use, while modern phytotherapy has investigated particular hawthorn preparations for their effects on cardiac and vascular function.

Its chemistry is one reason it is so interesting.

Hawthorn contains several groups of phytochemicals, particularly flavonoids and oligomeric procyanidins (OPCs).

These compounds have been investigated in relation to:

• vascular tone
• endothelial function
• nitric-oxide-mediated vasodilation
• oxidative stress
• myocardial function
• blood pressure
• aspects of cardiac electrophysiology

In other words, hawthorn isn't simply a “calming herb that happens to be used for the heart”.

Its relationship with cardiovascular physiology is considerably more direct.

But there is an important catch.

Hawthorn berries and hawthorn leaf + flower are not interchangeable

This is something that often disappears completely on social media.

You will see:

HAWTHORN = HAWTHORN.

From a phytotherapy perspective, I don't think that is precise enough.

The hawthorn preparation with the strongest modern clinical research is generally hawthorn leaf and flower, particularly standardised extracts such as WS 1442.

These preparations are standardised to particular concentrations of oligomeric procyanidins and have been investigated extensively in cardiovascular research.

That evidence cannot automatically be transferred to hawthorn berry tea.

I use hawthorn berries in practice.

They have a long history of traditional cardiovascular use and can make a beautiful component of a longer-term cardiovascular formula.

But if I make a claim based on a clinical trial using a standardised leaf-and-flower extract, I need to tell you that.

Because:

same plant does not necessarily mean same preparation, same phytochemistry, same dose or same clinical effect.

That distinction is part of practising herbal medicine responsibly.

What might hawthorn actually be doing?

Rather than saying hawthorn simply “strengthens the heart”, I prefer looking at some of the physiological actions that have made it such an important cardiovascular herb.

1. Supporting vascular function

Hawthorn constituents appear to influence endothelial function and nitric oxide pathways.

Nitric oxide is one of the signalling molecules involved in relaxing vascular smooth muscle.

That makes hawthorn particularly interesting when I am thinking beyond the heartbeat itself and looking at the wider cardiovascular environment — circulation, vascular tone and blood pressure.

2. Antioxidant and endothelial support

The vascular endothelium is the thin cellular layer lining our blood vessels.

It is metabolically active tissue involved in vascular tone, inflammation, coagulation and cardiovascular health.

Polyphenolic compounds in hawthorn have demonstrated antioxidant activity, and vascular/endothelial effects are part of the reason hawthorn continues to attract cardiovascular research.

This becomes particularly interesting during and after the menopause transition because cardiovascular health deserves much more attention in women at this stage of life.

3. Effects on cardiac function

Certain standardised hawthorn preparations have also been investigated for their influence on myocardial function.

This is where I become particularly careful with language.

It would be easy to translate this into:

“Hawthorn makes your heart stronger.”

But that oversimplifies both the pharmacology and the evidence.

The clinically investigated extracts are specific preparations at specific doses.

A homemade hawthorn tea is not pharmacologically equivalent to them.

4. What about heart rhythm?

Hawthorn is often described in herbal literature as a herb for palpitations and disturbed cardiac rhythm.

There are pharmacological reasons this is interesting, and observational cardiovascular research has produced signals worth investigating further.

But we do not currently have strong clinical evidence demonstrating that hawthorn treats perimenopausal palpitations specifically.

That distinction is crucial.

So I don't tell a client:

“Take hawthorn because you're having perimenopausal palpitations.”

I may consider hawthorn within a cardiovascular formula once I understand the wider presentation.

Those are very different things.

Hawthorn is also a slow herb

Another reason I like hawthorn is precisely because it does not fit our modern obsession with immediate symptom suppression.

Traditionally, I think of hawthorn as a longer-term cardiovascular tonic, not something you take once because your heart fluttered after dinner.

Depending on the preparation and reason for using it, herbalists typically think in terms of consistent use over weeks rather than expecting an immediate effect from one cup of tea.

That makes it particularly well suited to formulas where the intention is broader cardiovascular support rather than acute symptom control.

And this is also why I don't love seeing it marketed as:

“Drink this when your heart starts racing.”

That misunderstands how I use the plant.

But hawthorn isn't always the herb I reach for first

This is where formulation becomes important.

Imagine three women.

All three tell me:

“My heart has started racing in perimenopause.”

But when I take their histories, I hear three completely different stories.

Woman 1: racing heart + nervous tension + feeling wired

Her heart pounds when she gets into bed.

She has spent the entire day rushing.

Her mind doesn't switch off.

She feels physically tense and hyper-aware of every heartbeat.

In this picture, I may think differently than if I were looking primarily at long-term cardiovascular support.

One traditional herb that becomes interesting here is:

Motherwort — Leonurus cardiaca

Motherwort is one of my favourite examples of a plant sitting at the intersection of cardiovascular and nervous system herbal medicine.

Traditionally it has been used where awareness of the heartbeat occurs alongside nervousness, agitation and emotional tension.

That traditional indication is very different from claiming that motherwort “treats arrhythmia”.

It doesn't give me permission to ignore unexplained cardiac symptoms.

But after appropriate assessment, the pattern:

heart + nervous tension + feeling wired

may make motherwort much more relevant to me than simply adding more hawthorn.

This is formulation.

Woman 2: palpitations + tension + poor sleep

Another woman tells me her heart becomes noticeable primarily in the evening.

She isn't describing dramatic episodes of tachycardia.

Instead, there is a background of tension, poor sleep and feeling unable to fully unwind.

Here I might start thinking about plants with a stronger nervous-system component.

Lemon balm — Melissa officinalis

Lemon balm is one of the herbs I use frequently when the picture includes nervous tension, restlessness and digestive or sleep disturbance.

It is not a “heart herb” in the same sense as hawthorn.

And that is precisely the point.

Sometimes the most appropriate herb for a woman complaining about her heartbeat is not primarily cardiovascular.

If nervous system activation is a significant part of the pattern, I want the formula to reflect that.

There is another reason I don't recommend lemon balm blindly: thyroid history and medication still matter when choosing herbs.

The whole person remains more important than the symptom.

Woman 3: tension + vascular picture

Another traditional companion to hawthorn is:

Linden — Tilia spp.

Linden is a beautiful example of a plant whose traditional indications bridge nervous and vascular tension.

I may consider it when I want something gentler and more relaxing alongside cardiovascular support, particularly where there is a sense of tension running through the entire presentation.

Hawthorn + linden therefore tells a different herbal story from hawthorn + motherwort.

The formula itself reflects what I think is happening.

And this is why I don't make “palpitation tea”

This is one of the biggest differences between personalised herbal medicine and buying a product based on a symptom.

Woman A:

palpitations + hot flushes + night sweats

Woman B:

palpitations + anxiety + poor sleep

Woman C:

palpitations + rising blood pressure + wider cardiovascular concerns

Woman D:

palpitations + heavy menstrual bleeding + exhaustion + breathlessness

They may all type:

“best herb for heart palpitations in perimenopause”

into Google.

But I would not formulate for them in the same way.

For one, hawthorn may form the cardiovascular backbone of a formula.

For another, I may pair cardiovascular support with motherwort.

Another presentation may make me think about linden or nervous-system herbs.

And the woman with heavy bleeding, exhaustion and breathlessness?

Before I get excited about herbs, I want her iron status and wider clinical picture properly assessed.

Same symptom. Different driver. Different priority. Different formula.

A word about safety with hawthorn

The fact that hawthorn is a plant does not mean we should use it indiscriminately.

This is especially important with cardiovascular herbs because the person may already be taking medicines that alter blood pressure, heart rate or cardiac function.

I would want to know about medications including:

• cardiac medications
• blood-pressure-lowering medicines
• digoxin
• beta blockers
• calcium-channel blockers
• nitrates
• anticoagulant or antiplatelet medication

Potential interactions depend on the preparation, medication and individual, and some proposed interactions have stronger evidence than others.

But this is not an area where I recommend guessing.

If you have diagnosed cardiovascular disease or take cardiovascular medication, hawthorn should be discussed with an appropriately qualified healthcare professional before use.

Herbs should never be used to explain away a cardiac symptom

This deserves its own section because herbal medicine and medical assessment are not competitors.

If your palpitations are new, persistent, worsening or recurrent, have them appropriately assessed.

And palpitations occurring alongside chest pain, fainting or near-fainting, significant shortness of breath or feeling acutely unwell require urgent medical attention.

I don't care how strongly you suspect perimenopause.

I don't care whether somebody on Instagram told you it was cortisol.

And I certainly don't want you drinking hawthorn tea at home trying to make a potentially significant symptom disappear.

Responsible herbal medicine knows when herbs fit — and when investigation comes first.

My approach to perimenopausal palpitations

When I work with a woman experiencing palpitations, I am essentially looking at several layers.

First: safety.

Is there anything here requiring medical investigation?

Second: pattern.

When does it happen? What accompanies it? What changed?

Third: potential contributors.

Hormonal fluctuations, vasomotor symptoms, sleep, iron status, thyroid function, stress, caffeine, alcohol, nutrition, medications and cardiovascular health can all matter.

Fourth: herbal strategy.

Only then do I decide whether the botanical priority is predominantly cardiovascular, nervous system, vasomotor — or a combination.

And finally:

Which preparation? Which dose? Which combination? Which person?

Because “hawthorn” isn't a protocol.

Neither is “perimenopause”.

The part I want you to remember

If your heart suddenly starts racing during perimenopause, you are not unusual for noticing it.

But don't let anyone reduce the explanation to:

“It's just hormones.”

And don't replace that explanation with:

“Take hawthorn.”

Both are too simplistic.

Hawthorn is one of our most important traditional cardiovascular herbs and a fascinating plant from a modern phytotherapeutic perspective.

Motherwort may become particularly interesting when cardiovascular sensations and nervous tension overlap.

Linden may help me think about vascular and nervous tension.

Lemon balm may be more appropriate when the wider picture is dominated by nervous-system activation and poor sleep.

But none of those choices exists in isolation.

The skill of herbal medicine isn't knowing which herb is “good for the heart”.

It is knowing why you are choosing that herb, which part and preparation you are using, what evidence supports that choice, what the traditional indication contributes, what the safety considerations are — and whether herbs are even the priority right now.

That is the difference between using herbs because they appear on a list…

and practising herbal medicine.