Does melatonin help with heart palpitations during perimenopause?

Heart palpitations during perimenopause, those unexpected flutters, skipped beats, or pounding sensations, are more common than many women realize. Declining estrogen affects the autonomic nervous system and cardiovascular function, and fluctuating estrogen levels can increase sympathetic nervous system activity, making the heart more reactive. Anxiety, hot flashes, and sleep disruption all amplify this reactivity. Melatonin does not directly regulate heart rhythm, but there are indirect pathways through which it may help reduce the frequency or intensity of perimenopause-related palpitations.

Melatonin is produced by the pineal gland and regulates the circadian rhythm, the internal clock governing sleep and wakefulness. During perimenopause, melatonin production declines alongside estrogen. Research by Toffol et al. (2014) confirmed lower melatonin levels in perimenopausal women with corresponding sleep disturbances. Poor sleep is directly linked to increased sympathetic nervous system activation. When sleep is fragmented, the nervous system spends more time in a heightened state of arousal, raising resting heart rate variability and making the heart more prone to irregular or noticeable beats. By improving sleep quality, melatonin may reduce sympathetic tone and, as a result, reduce palpitations that are amplified by nervous system overactivation.

There is no clinical trial evidence specifically demonstrating that melatonin reduces palpitations in perimenopausal women. The connection is based on the sleep-sympathetic nervous system pathway, which is real but indirect. Women who report that their palpitations seem worse after bad nights of sleep may find this pathway most relevant to their situation.

Melatonin's anti-inflammatory and antioxidant properties, reviewed by Rossignol and Frye (2011), may offer some cardiovascular benefit at a cellular level. Oxidative stress can affect the ion channels and signaling molecules involved in cardiac electrical activity. Whether melatonin supplementation at typical doses meaningfully reduces oxidative stress in cardiac tissue is not established in clinical trials for perimenopausal palpitations specifically.

Srinivasan et al. (2009) noted melatonin's potential cardioprotective properties, including its effects on reducing oxidative damage in cardiac tissue, in the context of aging and metabolic disease. Again, this does not directly translate to evidence that it stops palpitations, but it situates melatonin as a supplement with some cardiovascular relevance beyond sleep.

Bellipanni et al. (2001) found that perimenopausal women taking 3 mg of melatonin nightly for six months reported improvements in mood and general wellbeing. Reduced anxiety and better sleep are associated with lower sympathetic arousal, which may indirectly reduce palpitation frequency.

Research has examined supplemental doses ranging from 0.3 mg to 3 mg at bedtime. Zhdanova et al. (2001) found 0.3 mg was effective for sleep improvement in middle-aged women and produced fewer next-day side effects than higher doses. Talk to your healthcare provider about the right dose for your situation, especially given that palpitations can have cardiac causes that require medical oversight.

Safety: melatonin is generally well tolerated for short-term use. It may interact with blood thinners, immunosuppressants, and some diabetes medications. Autoimmune conditions require provider guidance before use. Higher doses can cause next-day drowsiness.

If you use PeriPlan to log your sleep quality, stress levels, and when palpitations occur, you may start to see a pattern: whether poor sleep nights consistently precede palpitation-heavy days, or whether palpitations cluster around particular cycle phases. This information is genuinely useful for conversations with your provider about whether the driver is hormonal, sleep-related, or something else.

When to see a doctor: Heart palpitations should always be evaluated by a healthcare provider if they are new, frequent, prolonged (lasting more than a few seconds), associated with chest pain, shortness of breath, dizziness, or fainting, or if they happen during exercise. Perimenopause does increase palpitation frequency, but arrhythmias, thyroid dysfunction, anemia, and other cardiac conditions can cause identical sensations and require their own diagnosis and treatment. A resting ECG is a simple, non-invasive first step that can provide reassurance or identify something that needs attention. Never attribute new or worsening palpitations to hormones alone without a proper cardiac evaluation.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.