Your Heart Palpitations Might Be Perimenopause, Not Stress

Waking up at 3:00 AM with a racing heart can be terrifying.
If your tests are normal but you are told it is “just anxiety,” this video explains how perimenopause can cause heart palpitations, nighttime panic symptoms, and a hypersensitive nervous system even when you are not stressed.

In this video, I explain the biological reason heart palpitations happen during perimenopause, how estrogen and progesterone fluctuations affect the autonomic nervous system, and why these symptoms are often misdiagnosed as anxiety or panic disorder. If you have felt dismissed, gaslit, or confused by symptoms that feel physical and very real, this conversation will help you understand what is actually happening in your body.

This video is for women navigating perimenopause, menopause, and midlife hormonal changes who want clarity, validation, and better language to advocate for themselves in medical settings.

If this helped you feel less alone, like the video so more women can find it, and share it with someone who has been told “everything looks normal” but still doesn’t feel okay.

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Kimberly Hoyt is a physician assistant with two decades of clinical experience who helps women navigate perimenopause and menopause with clarity and confidence. Her work focuses on midlife health and education, helping women understand what is happening in their bodies so they feel prepared, informed, supported and empowered.

Medical Disclaimer: The information shared on this channel is for educational and informational purposes only and is not intended as medical advice. Kimberly Hoyt, PA-C, and associated content are not a substitute for professional medical care, diagnosis, or treatment. Viewing/Listening to this content does not establish a patient-provider relationship. Always consult your own healthcare provider before making changes to your health plan, starting supplements, or addressing medical concerns.

General Disclaimer: I am not a CPA, attorney, insurance/real estate agent, contractor, l...

Transcript

Kimberly Hoyt: 0:00

Your heart is pounding out of your chest in the middle of the night. You go to the ER, the doctor has run all the tests and everything's normal. They said, oh, it's just stress or anxiety, but here's what they didn't tell you. This could be signs of perimenopause, and there's a specific biological reason why it happens. And it has nothing to do with panic disorder. By the end of this video, you're going to understand why your body is doing this and why you weren't crazy for thinking something more than just stress was going on. Let me paint a picture that you might recognize. You wake up at 3:00 AM with your heart racing. Maybe there's some chest pressure or tightness or feel like you can't catch your breath. It feels urgent, scary even so you go to the doctor, they run the blood work in an EKG, and everything comes back normal. They don't give you a reason why this happens, but they just chalk it up to it's probably stress. Or maybe they suggest maybe you need some therapy, and here is the disconnect. You've had stress before. You've been busy, you've been tired, you've been worried, but this feels physical and totally different. It feels like a glitch in your actual hardware system because you don't feel anxious until after the heart starts racing. You leave the office or the ER filling gaslit. You don't know the reason this is happening either. You just know it's not in your head, and that stress is an incomplete answer. Here is what is actually happening, and this is why perimenopause is wild. Estrogen doesn't just regulate your reproductive system. It has receptor sites throughout your entire body, including your heart and your autonomic nervous system. Think of estrogen as shock absorbers for your nervous system. Your autonomic nervous system is your body's internal autopilot. It controls your heart rate, breathing, and blood pressure without you ever thinking about it. In perimenopause, estrogen doesn't simply decline. It fluctuates, and sometimes wildly. Progesterone steadily disappears. Estrogen stimulates the nervous system. Progesterone calms it. So when estrogen spikes or fluctuates with that decreased level of progesterone, the nervous system loses its ability to regulate itself. It results in this hypersensitive stress response, even at rest. This is why you get heart palpitations at 3:00 AM while you're just laying there sleeping or trying to. Your heart is structurally fine, but the signaling is off. You aren't having a psychological breakdown. You're experiencing a hormonal misfire. To make it worse, your stress bucket has changed. In your thirties, your bucket was huge and estrogen helped keep a steady drain at the bottom so it never overflowed. Now because of these fluctuations, that bucket has shrunk and things that used to be minor inconveniences feel like a physical threat to your system. This is why you feel that tired but wired, you're exhausted. Yet your nervous system is stuck on high alert. It's not that you can't handle your life anymore, it's that your biological buffer is gone. Now if you're sitting there thinking, finally someone is actually describing what I feel, please hit that like button. It helps this video reach other women who are in that 3:00 AM spiral of worry. And if you've had a symptom like this, been dismissed by a professional, drop a comment below. We're building a resource here so women can see they aren't alone in this. Now let's talk about why your doctor might have missed this and what you can actually do about it. So when you show up in the ER with these symptoms, the doctors are gonna do what they're trained to do. They are gonna rule out emergent, life-threatening conditions, heart attacks, those type of things. And that's good medicine. But once the EKG is clear and labs are normal. Their training often stops there. Most clinicians receive very little training on the systemic reach of perimenopause. If it isn't a hot flash or a skipped period, it often gets labeled as anxiety or no label at all. Just-"good news, it's not your heart." Their gap in training doesn't negate your experience. The fact that they don't have a framework to connect the dots, doesn't mean the connection isn't real. I'd also like to point out that research on women and especially on perimenopause, is very limited. Now the conversation is changing and changes are coming, but it's going to take time. You will need to advocate for yourself. So what do you actually do with this information? First, keep doing the right thing. If you are having heart palpitations or chest pain, go to the doctor. Rule out the serious stuff, but once that is ruled out and things are coming back as normal, that is when you change the conversation. Second, start tracking the pattern. Don't just track the symptoms, track the timing. If you notice that these panic type symptoms always happen a few days before your period, or right when your cycle usually spikes, that is proof and it's good information to show your doctor that this isn't just random mental health issue, that it's a physical cycle. And third, you want to use bridge language. Most women go in and say, I'm feeling really anxious. The doctor hears anxiety and then stops looking for another diagnosis. Instead, try saying something like this: I've noticed these physical symptoms, the racing heart and the chest tightness, and it happens at very specific times in my cycle. I'm not feeling stressed when they start, but they're causing me a lot of physical distress. I'm concerned this might be a perimenopause symptom. How can we investigate that further? This does three things. It points to a physical trigger, the cycle. It clarifies that the physical sensation comes before the worry, and then it asks the doctor to look at the system, hormones and all, not just the feeling of anxiety. Finally, find someone who is well-versed in menopause and perimenopause. If your a doctor insists that this is just stress, even after you've shown them the patterns, it might be time to find someone who has specific training in perimenopause. They're out there and they can help put the shock absorbers back in place. If this video gave you that moment of validation. That validation that I'm not crazy, hit that like button not for me. But so other women who are searching for answers at 3:00 AM can find this and finally breathe a sigh of relief. Tell me in the comments, what symptom did you have dismissed? Let's build this resource here so no one feels alone in this. You aren't dramatic and you aren't losing your mind. I'll see you in the next video where we talk about how to actually calm the sensitized nervous system.