Hormone Therapy and Heart Palpitations: What to Know

Heart palpitations feelings of a fast, fluttering, or pounding heartbeat can occur with hormone changes and may happen in people using hormone therapy. Hormonal shifts related to menstruation, pregnancy, or menopause are recognized triggers for palpitations, and thyroid hormone levels also play a role. ^[1] While palpitations are often harmless, they can sometimes signal an underlying arrhythmia (irregular heart rhythm) that needs evaluation. ^[2]

Why palpitations can happen with hormone therapy

• Estrogen changes and arrhythmias: Fluctuations in female hormones can influence certain arrhythmias (like supraventricular tachycardia), and risk may vary during phases such as pregnancy, breastfeeding, and menopause. ^[3] This hormonal involvement means palpitations can be temporary and may improve as hormone levels stabilize or therapy is adjusted. ^[3]
• Thyroid interaction: Estrogens can increase the binding proteins for thyroid hormones, sometimes requiring a higher dose of thyroid replacement to keep free thyroid hormone in range; imbalances in thyroid levels (too much or too little) can cause palpitations. ^[4] If you take levothyroxine, an overdose or hyperthyroid state can lead to palpitations, so dose and timing matter. [PM16] Too much or too little thyroid hormone can trigger palpitations even when unrelated to thyroid medication. ^[1]
• Fluid and blood pressure effects: Estrogens may cause some fluid retention, and increased blood pressure has been reported with estrogen use, both of which can contribute to a sensation of pounding heartbeat in some people. ^{[4] [5]}

Are palpitations dangerous?

Most palpitations are benign and brief, but some can indicate arrhythmias that may require treatment. ^[2] Seek urgent care if palpitations are accompanied by chest pain, fainting, severe shortness of breath, or if they are persistent and worsening. ^[6]

Practical steps to cope with palpitations

• Track patterns: Note timing, duration, triggers (caffeine, alcohol, stress, exercise), and relation to your hormone doses; palpitations can occur at rest or with activity and may be felt in the chest, throat, or neck. ^[6]
• Review medications: Discuss with your clinician whether your estrogen or testosterone dose, route (pill, patch, gel), or timing could be adjusted to reduce symptoms. ^[3] If you are on thyroid replacement, consider checking TSH and free T4 since estrogen can alter thyroid hormone requirements. ^[4] [PM16]
• Limit stimulants: Cold remedies with pseudoephedrine, excess caffeine, and certain asthma medications can provoke palpitations avoid or use cautiously. ^{[1] [7]}
• Manage stress and sleep: Stress and anxiety are common triggers; relaxation techniques, mindfulness, and regular sleep can help. ^[7]
• Monitor blood pressure: Because estrogen can raise blood pressure in some users, regular home checks may identify a treatable contributor to palpitations. ^[5]
• Hydration and electrolytes: Maintain good hydration; low potassium or magnesium can worsen palpitations (ask your clinician before supplements).

When to adjust or investigate therapy

• Consider route changes: Transdermal estrogen (patch/gel) tends to cause steadier hormone levels than oral forms, which may reduce fluctuations that some people feel as palpitations. ^[3]
• Check for thyroid balance: If palpitations began after starting or changing estrogen, re-evaluate thyroid labs and replacement doses, as estrogen can increase binding and reduce free levels. ^[4] [PM16]
• Screen for arrhythmias: If episodes are frequent, prolonged, or symptomatic, an ECG or wearable monitor can look for SVT or other arrhythmias influenced by hormones. ^{[3] [2]}

Red flags that need prompt medical attention

• Palpitations with chest pain, fainting, severe breathlessness, or ongoing dizziness should be evaluated urgently because they may reflect significant arrhythmia. ^[6] Rarely, severe arrhythmias can cause blood pressure drops and shock symptoms that need immediate treatment. ^[8]

Bottom line

Hormone therapy can be associated with palpitations, often through normal hormone fluctuations, thyroid interactions, blood pressure changes, or stimulant co‑use. Most episodes are not dangerous, but a careful review of your hormone regimen, thyroid status, blood pressure, and triggers usually helps reduce symptoms and identify when testing is needed. ^{[2] [3] [4] [5]} Work with your clinician to tailor dosing and consider monitoring if symptoms persist or are concerning. ^{[6] [3]}