Yes. Anxiety, heart palpitations and more frequent headaches are all linked to perimenopause in large studies. They are common and usually not dangerous. But the same symptoms can come from thyroid problems, medications, caffeine or heart disease, so new or changing symptoms deserve a check. Chest pain, fainting or a sudden severe headache need emergency care.
This guide walks through what is typical, what should be looked at within a few days, and what should never wait.
What perimenopause is, and why symptoms shift
Perimenopause is the transition before your final period, when the ovaries’ hormone output becomes uneven. According to the National Institute on Aging, most women begin the transition between ages 45 and 55, and menopause is confirmed only after a full year without a period.
Cleveland Clinic notes that perimenopause usually starts in the mid-40s, lasts about four years on average and can last up to eight. Irregular periods, hot flashes, night sweats, sleep problems and mood changes are the classic signs. Anxiety, palpitations and headaches can travel alongside them.
Can perimenopause cause anxiety?
Yes, for some women it can. The risk seems highest in women who were not especially anxious before the transition.
In the Study of Women’s Health Across the Nation (SWAN), researchers followed 2,956 women for 10 years. Women who had low anxiety at the start were more likely to report high anxiety during early perimenopause, late perimenopause or after menopause than before it, with odds roughly 1.6 times higher (Bromberger et al., Menopause, 2013). That held even after accounting for stressful life events, money strain and hot flashes.
Women who were already highly anxious tended to stay that way, without a clear change by menopause stage. In other words, perimenopause can be the trigger for some women, and not the explanation for everyone.
Signs anxiety needs more than reassurance
- Panic attacks, or anxiety that keeps you from work, driving or sleep
- Low mood, loss of interest, or hopelessness alongside the anxiety
- Any thoughts of harming yourself (call or text 988 right away)
Can perimenopause cause heart palpitations?
Yes, palpitations are common in perimenopause, and in most women they are not a sign of heart disease. They still need an evaluation the first time, because some rhythm problems do.
SWAN researchers tracked palpitations in 3,276 women across the transition (Carpenter et al., Menopause, 2023). About half had a moderate or high likelihood of palpitations during perimenopause and early postmenopause, which then tapered off. Palpitations were not linked to early signs of artery disease such as carotid plaque or arterial stiffness.
Other common causes are worth ruling out. MedlinePlus lists anxiety and stress, caffeine, nicotine, alcohol, decongestants, diet pills, fever, some prescription medicines and an overactive thyroid. MedlinePlus also advises seeing a provider if you have never had palpitations before.
Can perimenopause cause headaches?
It can make headaches more frequent, especially in women who already get migraines. A new headache pattern after age 50 should always be checked.
In the American Migraine Prevalence and Prevention Study, 3,664 women with migraine were grouped by menopause stage (Martin et al., Headache, 2016). High-frequency headache, 10 or more days a month, affected 8.0% of premenopausal women and 12.2% of perimenopausal women. After adjusting for depression, weight, medications and medication overuse, perimenopause was still linked to higher odds.
Poor sleep, night sweats and stress can stack on top of hormone shifts. A headache diary that tracks your cycle, sleep and caffeine is useful to bring to an appointment.
When to worry: a three-level guide
Use this as a general guide, not a diagnosis. When in doubt, get checked sooner.
Usually perimenopause, but mention it at your next visit
- Brief fluttering or pounding that comes with hot flashes or stress and passes on its own
- Anxiety or irritability that rises and falls with your cycle
- Headaches that follow your usual pattern, just more often
Get checked within a few days
MedlinePlus advises contacting a provider right away if:
- You have palpitations for the first time, or they are new or different
- You often feel extra beats (more than 6 per minute, or in groups of 3 or more)
- Your resting pulse is over 100 without exercise, anxiety or fever
- You have heart disease or risk factors such as high blood pressure, high cholesterol or diabetes
Also book a visit for very heavy bleeding, large clots, bleeding between periods or after sex, which Cleveland Clinic lists as reasons to call. Headaches that are new for you, especially after age 50, should be seen promptly; MedlinePlus advises the emergency room if you cannot see your provider right away.
Call 911 or go to the emergency room
For palpitations, MedlinePlus says to call 911 with:
- Chest pain
- Shortness of breath
- Fainting or loss of consciousness
- Unusual sweating, dizziness or lightheadedness
For headaches, MedlinePlus says to seek emergency care when a headache:
- Comes on suddenly and is explosive, or is “the worst ever”
- Comes with slurred speech, vision changes, trouble moving an arm or leg, loss of balance or confusion
- Comes with fever, stiff neck, nausea and vomiting
- Follows a head injury
These are not perimenopause symptoms to wait out. Telehealth is not the right place for them.
How a hormone evaluation helps
An evaluation sorts out which symptoms fit perimenopause and which point somewhere else. Only a review of your history and, when appropriate, lab work can tell.
Many perimenopause symptoms overlap with thyroid disease, anemia, sleep problems, depression and medication side effects. A careful clinician looks at the whole picture before assuming hormones are the cause, and before deciding whether any treatment makes sense. If you are not sure where your symptoms fit, our women’s hormone evaluation is designed for exactly that conversation.
What an appointment at Hormone Balance Centers looks like
Hormone Balance Centers is a telehealth practice for eligible adults in Utah and Idaho, with appointments by secure video and evening times available. Women’s hormone evaluation is its own pathway, separate from men’s care, and covers menopause, perimenopause, sleep, mood, energy and libido.
- Call or text 385-361-8549 to get started.
- Labs. Your provider decides which tests are appropriate for you.
- Meet online with Adam Russell, PA-C, a board-certified Physician Assistant with experience in endocrinology and internal medicine, to review your symptoms, history, labs, risks and goals.
- A plan. If treatment is appropriate, you get an individualized care and monitoring plan. If your symptoms point to something hormones will not fix, that is part of the answer too.
Care is self-pay. The practice does not bill insurance directly, but you can ask for documentation for possible out-of-network reimbursement.
Frequently asked questions
Can perimenopause anxiety feel like a panic attack?
It can. Anxiety rises for some women during perimenopause, and a racing heart, sweating and a sense of dread can feel like panic. Because a heart rhythm problem can feel similar, a first episode with chest pain, fainting or shortness of breath needs emergency care.
Are perimenopause heart palpitations dangerous?
Usually not. In a large study, palpitations during the transition were not linked to early artery disease. Some rhythm problems and thyroid conditions cause palpitations too, so new, frequent or changing palpitations should be checked, and palpitations with chest pain or fainting need 911.
Why are my migraines worse in my 40s?
Hormone fluctuations in perimenopause are linked to more frequent headaches in women with migraine. Sleep loss, night sweats and stress can add to it. A headache that is new, sudden or severe, or that starts after 50, should be checked rather than blamed on hormones.
Do I need labs to know if my symptoms are perimenopause?
Not always, but labs help rule out other causes. Your provider decides which tests are appropriate based on your symptoms and history. Only an evaluation, and labs when indicated, can tell what is driving your symptoms.
Talk with a provider
If anxiety, palpitations or headaches are changing how you feel day to day, you do not have to guess. Call or text 385-361-8549, learn about our women’s hormone evaluation, or get started online. For chest pain, fainting or a sudden severe headache, call 911.
Sources
- National Institute on Aging. What Is Menopause? https://www.nia.nih.gov/health/menopause/what-menopause
- Cleveland Clinic. Perimenopause. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
- Bromberger JT, et al. Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation. Menopause. 2013;20(5):488-495. https://pmc.ncbi.nlm.nih.gov/articles/PMC3641149/
- Carpenter JS, et al. Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease. Menopause. 2023;30(1):18-27. https://pmc.ncbi.nlm.nih.gov/articles/PMC9797427/
- Martin VT, et al. Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine. Headache. 2016;56(2):292-305. https://pubmed.ncbi.nlm.nih.gov/26797693/
- MedlinePlus. Heart palpitations. https://medlineplus.gov/ency/article/003081.htm
- MedlinePlus. Headaches: danger signs. https://medlineplus.gov/ency/patientinstructions/000424.htm