113. When your heart races in midlife- hormones and your heart

Is your heart suddenly racing out of nowhere—and you're not even stressed? You’re not alone. Many midlife women are blindsided by unexpected heart symptoms like palpitations, racing pulses, and sudden spikes in blood pressure. It’s terrifying, confusing, and all too often dismissed as “just anxiety.”

In this heartfelt episode, I share my own journey with perimenopausal tachycardia—when my resting heart rate soared to 170 BPM—and the deeper discoveries that followed. If you’ve ever wondered whether your heart symptoms are hormonal, this episode is for you.

In this episode:

• My personal story with unexplained heart racing during perimenopause
• Why midlife heart symptoms are often misunderstood or dismissed
• The powerful role estrogen and progesterone play in cardiovascular health
• How hormone shifts affect blood pressure, heart rate variability, and anxiety
• Wearable tech (like WHOOP and Oura) as tools to track heart and hormone changes
• Functional medicine insights into cortisol, histamine, and HPA axis dysfunction
• When to seek emergency care—and when to explore deeper hormone testing

Resources Mentioned:

WHOOP wearable tracker: https://www.whoop.com

Oura Ring: https://ouraring.com

Learn more about Meadow Wellness and our Renew Her program: https://www.meadowhillwellness.com/ 

Connect with me, Dr. Sara Poldmae:

Website: https://risingwomanproject.com

Instagram:  https://www.instagram.com/drsarapoldmae 

Transcript

Sara Poldmae: 0:01

Sarah, welcome to menopause. Rise and thrive. I am Dr. Sarah pulled me and this podcast is your go to guide for navigating perimenopause and menopause. If you are feeling a little overwhelmed, trust me, you are in great company. Each week, I'll bring you expert advice, raw, honest conversations and simple tips to help you stay grounded and maybe even find some humor in the process. Let's rise, thrive and tackle this wild ride together. Hi everybody. Welcome back to menopause. Rise and thrive, the show that helps you rise strong and live well through midlife. I am your host. Dr Sarah pulled May, and today we're talking about something that caught me off guard when I first started going through perimenopause, and that is my heart I'm not talking about heartbreak, though there's plenty of that midlife too, but actual heart symptoms, the pounding heart, the racing pulse for no reason, the kind of moment where you wonder, Am I anxious, or is this actually my heart? And if you've ever asked yourself that question, then today's episode is for you. I still remember the first time that this happened. I was at work. I wasn't particularly stressed. I just was about to start my patient day. It was a pretty relaxed patient day. I looked at my schedule, and I saw that I was seeing a few of my longtime patients that I absolutely adore and really enjoy spending time with and helping, and then all of a sudden, my heart was racing, like I'd run up a flight of stairs. My Apple Watch showed that my heart was beating at I kid you not, 170 beats per minute at rest. I didn't feel anxious. I wasn't panicked, but my body thought I thought I was. I did start to get anxious, because 170 beats per minute is more than what I think of as just having a little bit of a heart racing episode. I could feel my heart beating really fast, so I started to get a little worked up. So I said to myself, Okay, I'm going to get up. I'm going to walk around. I went to look at myself in the mirror. I looked fine. I wasn't warm, I wasn't flush. Didn't feel like a hot flash. But I glanced down and saw that my fingernails were actually turning blue, and that's a clear sign that things are definitely not good. So I had my employee, Mary rush me to urgent care around the corner, and by the time I had gotten there, my heart rate had settled down. I think it was at like 110 when I was going through the check in process. And they weren't overly concerned. They basically dismissed me without any testing. I think they did do a lab panel, but they didn't actually do any cardiac tests, besides taking my blood pressure, and they said, Yeah, you might just be stressed. Definitely follow up with your primary, and your primary might want to follow up with a cardiologist. So I did just that. I went to a cardiologist, and the first thing they did was check my thyroid so your thyroid can really flip at the at the drop of a hat. And we wanted to make sure that that didn't cause this tachycardia, tachycardia being a fast heart rate. And my thyroid was fine. And so the next step at the cardiologist was I wore a two week heart monitor, I got a cardiac ultrasound, some more blood work, all to be told by my cardiologist that I was in my mid 40s, so it was probably just perimenopause. Well, I was super, super grateful that there wasn't anything wrong with my heart that they could find. But as a practitioner, I knew to start looking deeper. I did go on some meds to lower my heart rate, because the the the rush of heart rate, it kept happening every few days. One day I was driving my daughter to school. It's just really disconcerting. I never had it go quite as high as 170 beats per minute, but it would easily go to 150 or 160 for no reason. So I took meds for a few months, and then slowly started to wean off of them with my cardiologist working with me. And thankfully, that part of my life is over at this point, but it was super, super scary. And really, I've always specialized in women's health, but it really made me want to dive deeper into perimenopause. So that's where I find myself today. I've really my clinical practice is devoted to women in midlife, and I really know how these symptoms. Of midlife can get brushed to the side. We're not always listened to, and it can be scary and frustrating and painful and all of those things. So I've seen the same thing with so many women time and time again that come into my clinic and they have sudden heart rate increase or blood pressure issues that they never had before. Palpitations are really super common in midlife and and women say I just don't feel like myself. I'm kind of jittery and I feel wired, but I'm also tired and like, almost like they're coming out of their own skin. So they often come in thinking they're developing an anxiety disorder or need a cardiologist, and those referrals are definitely important. So if there is any anxiety, we need to look at that and make sure that we get you less anxious. And if you are having palpitations, surges in your heart rate, blood pressure issues, we do need you to get checked out by a cardiologist. We want to make sure that you're safe. But what's even more important in the long term is that women educate themselves so that they know the way some of these hormone shifts during midlife can play into your cardiovascular health and midlife is a pivotal turning point with our cardiac risk factors. All of our cardiovascular risk factors go up in midlife, but it also can cause symptoms that are relatively benign. So again, we want to check out any symptoms we're having to make sure that they aren't going to be something that needs to be treated from a cardiovascular perspective, and often they're not, but we want to keep ourselves safe in the immediacy while we look at and unearth any underlying causes. So just to talk about a few of the key hormones at play, estrogen. Estrogen is obviously a very important hormone for us, and a lot of women don't know that estrogen has a huge role in keeping blood vessels elastic and supports healthy cholesterol levels. So when estrogen starts to do this crazy dance and drop in perimenopause, we often see benign arrhythmias, changes in heart rhythms come up, and they're definitely worth investigating, but can be just a symptom of these fluctuating estrogen levels, magnesium, electrolyte balance and gut health all play a part in keeping our cardiac rhythm stability. So if all checks out and your heart is fine. There are places we can take you, things we can do for you that will help to calm your heart down, estrogen, also a lack of estrogen, our blood vessels actually become stiffer. Our blood pressure can start to rise. Our bad cholesterol often increases while our good cholesterol starts to drop, our heart rate variability decreases, and heart rate variability is a really important health marker that we can track on our own using either an oura ring, or I personally use a device called the whoop which does a great job At tracking my sleep, my workouts, and my heart variability and all sorts of things. So if your heart rate variability is really low overnight, or your heart rate stays high at night, it is not just stress. It's your actual physiology shifting and hormones can definitely be at play. And just a quick note, while we're on the subject of these wearable devices, let me tell you that this device comes in handy to remind me of how much my body hates alcohol. So when I have had just one alcoholic beverage and then I go to bed, my heart rate spikes. So normally, my resting heart rate is in the mid 60s. If I have just one alcoholic beverage that night, my my resting heart rate could be mid 70s and even close to 80, which is a huge jump, and my heart rate variability plummets, and this can be just after one drink. But I was on vacation this past winter, and I had three drinks over a five hour period. And you should have seen my metrics, it looked like I was basically dying. I was in a heart high stress state for the entire night. I got basically no REM no deep sleep. It was terrible, and I felt it the next day. So I know alcohol is not directly related to our discussion today, but alcohol definitely has an impact on our hearts, and I think that needs to be pointed out more often than it is when estrogen fluctuates wildly, we can have a high histamine response, which can actually lead to bad. Dilation and your heart racing. Some women feel better with lower histamine diets, during hormonal surges, and even, you know, during specific times of their cycle. So if you're still cycling and you feel like you're having these, you know, heart racing episodes, we could certainly look at that, especially right before you're about to get your period. So there's a lot of ways that we look at things in functional medicine that are just a little bit different. We look at the ebbs and flows of your hormones, the rhythms that you experience, and see how they may be related to your your heart rate and anxiety and all that good stuff. So estrogen definitely plays a huge role in heart health. And you know, hormone therapy, hormone replacement therapy, is sometimes a valid option for treating things like hot flashes and protecting your bones, but it can also be cardio protective. Then there's progesterone. Progesterone helps to regulate calming neurotransmitters like GABA and it also contributes to heart rate regulation. So when progesterone drops, you may feel more anxious. You may feel more panicky. Resting heart rate can also increase. Sleep disruptions often begin when your progesterone starts to decline, a lot of women report that they start feeling more sensitive to caffeine when they're going through perimenopause. And another thing to mention is cortisol, stress hormone, cortisol and the nervous system so in midlife, stress is starting to ramp up with a declining resilience, and suddenly your adrenals are picking up all the slack cortisol spikes can become more unpredictable, and your sympathetic nervous system just stays in fight or flight mode like way too long. So many women describe feeling wired, not anxious, but wired, and then also tired, and this is often due to what we see as an HPA access dysfunction, not psychological anxiety. So you know, going on an anxiety anti anxiety med would be just a band aid. It may help you to feel better, and we certainly don't want you to feel poorly. We don't want you to be anxious. But there might be other ways to solve perimenopausal anxiety that really address this HPA access dysfunction, rather than just masking it. This is a very common thing that we see in clinic with our women in midlife, and we can do some specialized testing to look at your cortisol rhythms that can help give you some answers and lead us in our treatments. So that pounding heart you absolutely want to get yourself to see your doctors, but remember, this can also happen in perimenopause and menopause. It's not in your head. It could be your hormones. But of course, if you're experiencing these symptoms, let's just make sure that there's nothing wrong with your heart itself. We want to keep you safe in the immediacy while we peel back the layers of what could be causing all of this. So here's what I want every woman in midlife to know. A racing heart does not always mean that you have anxiety, it could be hormonal dysregulation, and still get it checked out. I can't say that enough blood pressure shifts in midlife, and it deserves a functional lens, not just medications. So again, if you have really unstable high blood pressure, we want you treated to get you safe. But if you're just noticing subtle blood pressure shifts, we may be able to help that without meds, the loss of estrogen and progesterone directly affects your cardiovascular system. It's not indirect. It's there. Hormones are drivers behind cardiovascular health. Hormone therapy when prescribed appropriately and at the right time. For you, especially transdermal estrogen, can really protect your arteries when appropriately prescribed. So one of the major rules of thumb from the North American menopause society, which I believe, is changing its name to just the menopause society, one of the things they say is it really needs to be. We need to initiate hormone therapy within 10 years of your final menstrual period, and then also before the age of 60. The real benefits for cardiovascular protection come sooner in your menopausal journey, if you start hormone replacement therapy too late, can actually be a risk factor cardiovascularly. So you really need clinicians that know what they're doing when you're working on hormone replacement therapy. Please don't go online and just pick up the meds you think that you need. It's really important to have people that you trust by your side. Functional Testing can reveal power. Patterns long before standard labs can catch up. So if you're looking for some really advanced testing on things like neurotransmitters, cortisol, imbalance, all of that good stuff, see a functional medicine provider, especially one like us who specialize in midlife women only, in our clinic, we use a combination of these Advanced Functional Medicine labs and other diagnostics, nervous system regulation tools, acupuncture, all the goods to help patients to truly understand what their body is saying and what to do next, because symptoms are your body's way of saying something isn't right, and we don't want to always go for that quick fix to get rid of the symptom, because we're not correct in the imbalance. We want to look at what's really happening there. So if any of this sounds familiar to you, if your heart's been talking, pounding, skipping or racing, I want you to know that you're not alone. I have been there myself. I know how scary it is, but you are not broken. Your body is your best doctor. It's asking for attention. My own journey through midlife heart symptoms helped me to really refine the care that I offer, and it really deepened my empathy. Because to be scared the way that I was scared, it really made me a better clinician. So if you're curious about your own cardiovascular health and midlife or you've had weird heart symptoms brushed off as just anxiety, let's talk. First, go see your docs, make sure that everything is safe. But then, at Meadow wellness, and through our concierge program renew her, which is designed exclusively for women in midlife, we can look at your whole picture, your hormones, your stress, your lifestyle, because your heart deserves that kind of attention. Remember, heart disease is still the number one killer in women. There is not nearly enough research out there about midlife. They're starting. It's not there yet, but menopause is known to be a turning point for cardiovascular risk. So we can take this opportunity to focus on correcting any risk factors that we have control over. So let's decode what your body is trying to tell you and get you back to feeling calm, strong and steady. I hope this helped some of you out there. I wanted to share my journey, because again, I know that some of these symptoms can get really big and really scary, really quickly, and we are here for you. So don't hesitate to reach out. We'd love to hear from you. You