Heart palpitations

Palpitations are when your heartbeat becomes noticeable. The NHS website describes a heartbeat that races, skips or adds a beat, pounds, thumps or flutters, felt in the chest, neck or throat, for seconds or for minutes.

The NHS lists the menopause among the possible causes. The Pakistan Menopause Society's recommendations go further for perimenopause: they describe a hot flush as often coming with flushing, sweating and palpitations, and list palpitations among the early symptoms, which can start while your periods are still coming.

A sudden race in your chest while you sit still. A flutter, then a heavy beat, as if your heart tripped. Pounding that you can hear on the pillow at night. Sometimes heat follows, sometimes panic comes first, and it is hard to say which started it. The NHS menopause symptoms page says a hot flush can bring on palpitations or anxiety.

In Urdu most women say dil ki dharkan tez ho jati hai. Some say dil ghabrata hai, which can mean nerves as much as heartbeat, so it helps to be exact with your doctor.

When palpitations come with hot flushes, the PMS recommendations put them down to the same thing: the brain's temperature control going off balance as estrogen changes.

But palpitations have many causes, and perimenopause is only one. The NHS website lists strenuous exercise, lack of sleep, stress and anxiety, some medicines, alcohol, caffeine, nicotine and recreational drugs. It also lists conditions a doctor will want to rule out: iron deficiency anaemia, an overactive thyroid, a heart rhythm problem and heart valve disease. Nobody, you included, should call it just hormones before it has been checked.

• The NHS website says that when palpitations are not caused by a health condition, avoiding triggers such as stress, smoking, caffeine and alcohol can help.
• On chai, the PMS recommendations note that tea drinking is high in Pakistan and ask doctors to talk through how much you drink and when (Table 7). Chai and caffeine has more.
• The PMS recommendations ask doctors to record palpitations alongside how often hot flushes come, how bad they are and what sets them off (Table 2). Noting when yours happen gives your doctor that record. Trigger tracking shows how.

The NHS website says treatment depends on the cause, and that palpitations often need no treatment at all. A doctor may arrange an ECG, a test that checks the electrical signals from your heart, and may refer you to a heart specialist.

When palpitations come as part of hot flushes, the PMS recommendations group them with vasomotor symptoms, for which they list HRT as the first-line treatment in women who can take it (section 7.1). Whether that applies to you is your doctor's decision, after the heart has been checked.

Get emergency help now if palpitations do not go away, or come with chest pain, shortness of breath, or feeling faint or fainting. The NHS website says not to drive yourself: ask someone to take you, or call an ambulance. The PMS recommendations also list chest pain and sudden shortness of breath among the red flags that need evaluation or referral (section 2.3).

See a doctor soon, not urgently, if palpitations keep coming back or come more often, last longer than a few minutes, or if you have a heart condition or a family history of heart problems. Those are the NHS website's reasons for a GP visit.

The British Menopause Society notes that South Asian women have a higher rate of heart risk factors during the menopause transition, high blood pressure, insulin resistance and diabetes among them. The PMS recommendations ask doctors to use the menopause visit to check blood pressure, blood sugar and cholesterol. Heart health explains more.

A racing heart frightens the people who love you too. Telling them you are getting it checked is kinder than hiding it.

A racing heart on a long fasting day raises questions women rarely get a straight answer to. Questions about the fast belong with a qualified scholar. Questions about medicine timing in Ramadan belong with whoever prescribes it.