Female Cardiology: Hormones and Palpitations

June 23, 2024

Female Cardiology: Hormones and Palpitations

Dr. Nicole Sundene

Female Hormone Specialist

Palpitations and hormones go hand in hand especially when women are in perimenopause or menopause in their forties and fifties. While many of my patients refer to me as their "Natural Cardiologist," really what I am doing is working to perfect hormones and nutrition which then results in better Cardiology numbers. Too many times I have seen women prescribed a variety of cardiac drugs for high blood pressure, high cholesterol, palpitations, and heart issues when the real underlying “Root Cause” is female hormone imbalance, hypothyroidism, or Hashimoto’s.

So today I am blogging for those women with sudden onset palpitations, high blood pressure, and cholesterol that previously were healthy before forty and are suddenly shocked that I have found something "off."  Some women in my practice begin to experience these heart symptoms in their twenties and thirties. Women can quickly be prescribed high blood pressure medication like propranolol for racing heart, when the real problem is their racing or fluctuating hormones. 

The reason for this, is that a variety of hormones that we will discuss today impact the heart. Hormones are part of our emergency and reproductive systems and therefore will impact a wide array of bodily systems.

When hormones are fluctuating, then heart rate fluctuates as well, so it is imperative that we do not ignore women’s hormones and only focus on heart function. 

Perimenopausal women and those with Hashimoto's Thyroiditis often report to me going to the ER multiple times for terrifying chest pain and palpitations only for the ER doc to tell them they are totally fine, and to go see me to get their hormones checked. 

The irony in my Holistic Women's Health practice, is that ER doctors are often my #1 referral source because they have either A) Done a full work up and found nothing wrong or B) Know the consequences of patients not properly taking care of their health. Once one of my ER doctor friends has run a full cardiac panel of labs, CT, EKG, Echocardiogram, Stress Test, and so forth that all come back normal….that is when they send them to the hormone doctor. They don't know exactly what the problem is, but they know it may be a woman nearing menopause with hormones that are suddenly changing and thus impacting cardiac function. 

Menopause causes increased inflammation and decreased thyroid function.

As I discuss further in my High Cholesterol and High Blood Pressure blogs, thyroid hormone stimulates the heart to contract. Without sufficient thyroid hormone we have lazy contractions or a fluttering heart rate. These lazy rapid flutters are not efficient and women get either palpitations, high blood pressure, or PVC’s “Preventricular contractions.” 

While nutritional supplements and herbs can help these symptoms we also need to address what is going on at the “Root Cause,” the fact my patient is likely entering perimenopause, or menopause, or experiencing hypothyroidism, Hashimotos, or another autoimmune disease, such as Grave’s disease that can impact the heart. 

Whether estrogen is too high or too low inflammation spikes. Both estrogen deficiency in menopause and estrogen excess in perimenopause and PMS trigger inflammation. 

This is why women feel the worst during their PMS phase, and also why I call Perimenopause “Permanent PMS.”

When inflammation is higher our body functions less optimally and annoying PVC’s and palpitations can occur. 

Hypoglycemia especially from insulin resistance is another common cause of palpitations I find in my patients. When blood sugar drops it triggers cortisol which is a stress response that causes our hearts to pound as our body thinks it is “Running From a Bear” with stress

Correcting and stabilizing blood sugar in women with palpitations is imperative for proper cardiac function and prevention of terrifying palpitations that have sent many women to the ER thinking they are having a heart attack. 

While iron is not an actual hormone, iron deficiency anemia from heavy perimenopausal bleeding is another cause of palpitations that I regularly find. So I cannot post about palpitations without a brief reminder to women to take their iron! No you are not getting enough from food if you are having your period. I disagree!! Especially with heavy bleeding, if you bleed more than five days you absolutely must be on iron or your heart cannot function properly. Annoying palpitations, hair loss, depression, and scary levels of dizziness occur in this group of my patients. 

This is why I tell every woman to take a multivitamin with iron in the form of ferrous bisglycinate at around 28mg daily at minimum to correct anemia from perimenopausal heavy bleeding. Your heart should not have to overwork because there is not enough hemoglobin to carry oxygen around to your organs and brain. This is dangerous! And also really bad for your hair. No women are going bald under my strict watch! That multivitamin is like putting money in the bank. You must do it!

Hashimotos and thyroid issues are the #1 most common hormonal issue I find causing palpitations. Oftentimes womens thyroids are not even truly hypothyroid but just functioning in a suboptimal low range. This is when the family doc says “Thyroid is fine” but they have just checked the TSH and not properly evaluated the free T3 and free T4 which have dropped to the bottom of the normal range.

Oftentimes borderline low Free T3 is what I find with my women with palpitations. Their T3 may be in the normal range but I often find it at 2.0 which is the very bottom of the normal range. 

While this is considered “normal” it may not be optimal if you are exhibiting symptoms. Especially scary palpitations causing expensive trips to the emergency room to no avail, and nothing is found actually wrong with the heart or cardiovascular system. 

While a car can drive on both a full tank of gas and an empty tank of gas, nobody likes to drive around all day on an empty tank of gas because we all know that inevitably the car will stop running. This is what often happens to my patients that hover in the bottom of the normal thyroid range. Certain days they are fine, and other days they are having symptoms.

With using natural medicines to improve thyroid function and/or natural thyroid hormones we can correct these thyroid palpitations that occur from the thyroid functioning too low. 

Too high of thyroid function from autoimmune disease like Grave’s, Hashimotos, or with inappropriate dosing can result in painful crushing palpitations that can cause sweating and make many women convinced they are having a heart attack. 

The majority of my autoimmune patients have gone to the ER at some point for these terrifying palpitations. The reason for this is that an immune system that is attacking is also causing a lot of inflammation and the heart does not like inflammation.

Cortisol stress hormones trigger palpitations when under physical, emotional stress, at times of low blood sugar, and in women with Congenital Adrenal Hyperplasia (CAH) that have excessively high production of adrenal gland hormones such as DHEA and Cortisol.

CAH is often misdiagnosed as PCOS, and appears very similar to PCOS although the hormone imbalance is not caused by insulin resistance triggering the DHEA, the DHEA is simply too high due to increased adrenal gland production. These patients often have abnormal facial hair, acne, anxiety, rage, blood sugar issues, weight loss or gain issues, nausea, and vomiting.

The moral of the story with hormones and heart issues is to get your hormones checked by a skilled holistic hormone doctor... preferably me 😉

Female hormones naturally change and fluctuate throughout a woman’s monthly cycle as well as during her thirties, forties and fifties thanks to perimenopause and menopause.  Hormones absolutely impact the cardiovascular system and should be checked especially when women were previously healthy and suddenly started to have palpitations or heart symptoms. 

Other hormonal conditions such as diabetes, insulin resistance, PCOS, adrenal fatigue, hypothyroidism, Hashimoto’s and autoimmune disease can also impact the heart

Need my help getting to the “Root Cause” of what is off with your cardiovascular system? Solving the cause of women’s palpitations is one of my favorite joys as a Women’s Health and Hormone Doctor! I would be happy to help. Simply visit my schedule page to treat yourself to a Naturopathic visit! 

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroid, Hashimotos, PMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Location: 14300 N Northsight 
Blvd Ste 124
Scottsdale, AZ 85260
Ph: 480-837-0900
Fax: 480-409-2644
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