Can This Patient Be Cured? Heart Palpitations

Mandy, a 49-year-old cosmetics salesperson, had been experiencing a strange fluttering sensation in her chest once or twice a day for two months. Understandably concerned, she scheduled a visit with a cardiologist. An electrocardiogram showed that the electrical activity of her heart was normal. Results of blood work and other tests came out normal, too. But Mandy was still experiencing heart fluttering, so she came to see me.

After reviewing her symptoms, health history and heart function, I asked about her lifestyle. First, her dietary habits-Mandy said she didn't consume much caffeine or sugar, both of which can trigger heart palpitations (the medical term for "fluttering") in some people. She did tell me that she had noticed the sensation became more pronounced whenever she drank alcohol, so she tried to avoid it. Her stress level? Like many people, Mandy described it as "up and down-yet she said that the fluttering was no more intense during high-stress periods than during times of relative calm.

Next, I asked about her menstrual cycle. Mandy said her periods were starting to become irregular and that she experienced occasional hot flashes. She said that she had noticed an increase in the fluttering sensation about four to five days before her menses began. I told her that due to hormonal fluctuations, heart palpitations are fairly common in women during menopause and just before, during the stage called perimenopause.

I performed a comprehensive hormone test, which showed that Mandy's progesterone level was quite low. Progesterone affects circulation, specifically in the coronary arteries, and blood flow to the heart. Supplementing with natural progesterone has helped many of my patients with exactly the sort of palpitations Mandy was experiencing. For her, I prescribed a natural progesterone cream and recommended that she apply it to her forearms each evening, except during her menstrual flow.

In addition, I suggested that she take supplements of calcium and magnesium, both twice daily, morning and evening. These minerals help relax the nervous system and regulate heart rate and rhythm. Within two weeks, Mandy's daily heart palpitations had vanished. Now, three years later, Mandy feels that fluttering sensation only very occasionally. She no longer uses the progesterone cream, but she does find that if she stops taking the calcium and magnesium supplements for more than a week or so, mild palpitations return.

I have found that progesterone deficiency is a greatly underdiagnosed cause of heart palpitations in women of menopausal age. Many end up on cardiovascular medications, such as beta-blockers (atenolol, for example), which can cause fatigue. Addressing the root issue-which often is, as in Mandy's case, progesterone deficiency -is a better bet for safely and effectively correcting the problem.