Heart Palpitations and Hormones

Palpitations are the awareness of your own heartbeat, often described as a racing, pounding, fluttering, or skipped sensation. They are extremely common and usually harmless, but because some hormonal conditions can make the heart beat faster or more forcefully, they are sometimes a useful clue. This page explains the possible links and why a clinician's assessment matters more than guessing.

How palpitations can relate to hormones

The heart's rate and rhythm respond to signals from the nervous system and to chemical messengers circulating in the blood. Several hormones can raise the heart rate or increase the force of each beat, so that a normal heartbeat becomes noticeable. Stress hormones such as adrenaline naturally surge during excitement, fear, or physical effort, which is why palpitations often accompany anxiety or exercise.

Thyroid hormones set the body's overall metabolic pace, and when they are too high the heart tends to beat faster and harder. Shifts in sex hormones, blood sugar, and other internal signals can also change how aware you are of your heartbeat. Because so many ordinary situations produce palpitations, the sensation is best treated as a clue rather than a diagnosis.

Which hormones and conditions may be involved

Many factors can contribute. None can be diagnosed from the symptom alone, but a clinician may consider:

• Thyroid hormones. An overactive thyroid (hyperthyroidism) commonly speeds the heart and can cause palpitations, sometimes alongside an irregular rhythm.
• Adrenaline and the stress response. Anxiety, panic, caffeine, and the surge of stress hormones can all make the heartbeat noticeable.
• Blood sugar. Low blood sugar can trigger a fast heartbeat, sweating, and a shaky feeling, particularly in people who use certain diabetes medicines.
• The menopause transition. Some people notice palpitations during this time, often together with hot flashes.
• Rare adrenal tumours. Uncommon tumours that release stress hormones can cause episodes of palpitations, sweating, and high blood pressure, and a clinician would consider these only in specific circumstances.

Non-hormonal causes to keep in mind

Not every palpitation is hormonal. Caffeine, alcohol, nicotine, dehydration, fever, anaemia, intense exercise, strong emotion, and lack of sleep can all bring on palpitations. Some medicines and supplements have the same effect. Many people also have harmless extra or skipped beats that feel alarming but are not dangerous. Heart rhythm disorders are an important cause that a clinician will want to rule out when the pattern, frequency, or accompanying symptoms suggest it. Because everyday triggers are so common, a careful history usually comes first.

Tests a clinician might consider

Assessment usually begins with the story of what the palpitations feel like, how long they last, and what brings them on, along with an examination. Depending on the findings, a clinician might consider:

• An electrocardiogram (ECG) to look at the heart's rhythm, sometimes with longer monitoring to capture intermittent episodes.
• Thyroid tests such as TSH if an overactive thyroid is suspected.
• A full blood count to check for anaemia.
• Blood glucose when episodes suggest low blood sugar.
• Other tests in specific situations, guided by the overall picture.

You can read more about individual tests in our blood tests section and about the messengers themselves in the hormones section. Related conditions are covered in the conditions section, and other symptoms are listed in the symptoms section. See also excessive sweating.

When to see a clinician

It is reasonable to seek medical advice when palpitations are frequent, prolonged, or distressing, when they begin without an obvious trigger, or when they come with other symptoms such as breathlessness, dizziness, or chest discomfort. Seek urgent care if palpitations are accompanied by chest pain, fainting, severe shortness of breath, or collapse. A clinician can take a history, examine you, arrange any appropriate tests, and explain what the results mean. This page is educational and is not a substitute for personalised medical advice.