"I thought I was having a heart attack" -- Claudia's story.

Why perimenopause can make your heart race when nothing else is wrong.

"I thought I was dying." That is what she said first.

Claudia emailed me after a friend forwarded last week's issue. She said she had been carrying this for more than a year and needed someone to hear it.

She is 51. Operations manager at a shipping company.

A woman who has handled pressure her entire career the way most people handle breathing. Without thinking about it.

Then about fourteen months ago, sitting at her desk on a quiet Tuesday, her heart started hammering out of nowhere. Not from exercise, not from stress.

It lasted ninety seconds and stopped. She drove herself to the ER.

EKG normal, blood work normal. They said it was probably anxiety and sent her home.

Three weeks later it happened again while she was in bed reading. Same hammering, same fear, another ER visit, another clean workup.

Here is what got to Claudia. She is not an anxious person.

She has run departments through restructurings and raised two kids on her own. She knows what stress feels like in her body, and this was something different.

After that second visit, she stopped exercising, gave up coffee, and downloaded a heart rate app she checks several times a day. That is a lot of life to rearrange around something nobody can explain.

Ever had that experience? Something real is happening in your body, and because no test can name it, everyone decides it must be in your head?

Your heart rate is governed by the autonomic nervous system. That is the part of your brain and body that works without your conscious input.

Estrogen helps regulate this system. Specifically, it supports parasympathetic tone, the calming branch, the brake pedal that keeps your heart rate steady.

During perimenopause, when estrogen fluctuates unpredictably, that brake becomes less reliable. The sympathetic branch, the accelerator, can surge without cause.

Think of estrogen as the hand holding the brake steady on a steep hill. Claudia's hand is starting to shake.

Research from the Study of Women's Health Across the Nation has documented shifts in autonomic function during the menopausal transition, including changes in heart rate variability. That means the system responsible for keeping your heartbeat smooth and predictable becomes less stable at exactly the time you need it to stay quiet.

That is why Claudia's heart pounds while she is reading in bed. Her body is pressing the gas pedal when there is nowhere to go.

I am telling Claudia's story because she spent more than a year believing something was seriously wrong while being told she was fine. I have heard versions of this from dozens of women.

If your heart has started doing things it did not do three years ago and every test comes back clean, you are not making it up. You may be losing estrogen, not losing your mind.

🌬️ One thing that helps right now: extend your exhale. Breathe in for four counts, out for six to eight.

A longer exhale directly activates the parasympathetic nervous system, the same calming brake that estrogen used to hold steady. Two minutes of this when an episode starts, or nightly before bed, gives your nervous system the input it is no longer getting on its own.

📒 Second, start tracking. Write down when episodes happen, how long they last, what you were doing, and where you are in your cycle if you still have one.

This gives your doctor a pattern instead of a single complaint. It also reminds you that these episodes end, which matters when you are in the middle of one.

If palpitations come with dizziness, fainting, chest pain, or shortness of breath, see your doctor right away. And even if the episodes are brief and pass on their own, bring them up at your next visit and ask whether hormonal changes could be a factor, because most standard cardiac workups do not account for perimenopause.

Your heart is not failing you. It is responding to a hormonal shift that nobody warned you could feel like this.

You are not imagining it, and you are not in this alone.

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Disclaimer: This newsletter is for educational and informational purposes only. Nothing in this issue, including any sponsored content, is intended as medical advice, diagnosis, or treatment, and it is not a recommendation to use any specific product, test, or service. Always consult a qualified healthcare provider before making any decisions about your health, medications, supplements, or medical testing.