I’ve had your client’s menopause palpitations on my mind this week.
According to new research, menopause palpitations are more common than women think. [Carpenter, Sheng, et al, 2022].
As the authors noted, ‘compared with the abundance and breadth of research on menopausal vasomotor symptoms (hot flushes) and sleep, there is a relative scarcity of research on menopausal palpitations. However, up to 42% of perimenopausal women and 54% of post-menopausal women report having palpitations.’
Although 44%–87% of women aged 40–59 years living in America believed their palpitations required treatment, a systematic review found no Level 1 evidence for managing menopause palpitations. This and other evidence suggests palpitations in peri- and post-menopausal women are common yet relatively understudied in comparison to Vasomotor Symptoms (Hot Flushes).
As such, the authors contend that, like other symptoms, they may be normalized and/or trivialized, as they have mostly been attributed to psychosomatic (e.g. anxiety, stress) determinants, rather than cardiac causes. (Carpenter et al, 2022).
This is a shame, because when it comes to menopause-related palpitations, (yes, your clients need to get their Doctor to check them out), there is something that the Sports Medicine doctors might not be sharing with the menopause Doctors …. and that is, that when women are low in iron, or over-training with all the exercise they are doing which impacts magnesium and calcium uptake in muscles, including cardiac muscle – these situations may lead to palpitations too.
There are also other factors that impact palpitations, including:
- low body fat levels,
- inadequate calorie intake from fasting
- chronic insomnia
- stress (past and present)
- anxiety and,
Whether your clients are experiencing menopause-related palpitations or not, then it’s important that you have some understanding of the link between menopause hormonal changes and anxiety and of course, what suggestions you can make to help them from a lifestyle perspective.
Yes, HRT can help (they need to talk to their Doctor), but research also indicates that a specific type of rhythmic, slow breathing may help to claim back calm, remove the chaos in their busy mind and reduce thei heart rate when ‘life’ and menopause-related anxiety and/or palpitations distract them.
Menopausal palpitations are described as loud, racing, or skipped heart beats, flip-flops, fluttering, or pounding that occurs with or without dizziness and/or lightheadness.
They are associated with demographic, clinical, symptom, and quality of life (QOL) factors states the Journal of Women’s Health (Carpenter, Tisdale et al, 2020).
Whilst your clients need to have them checked out with their Doctor, you might also suggest that they get bloods checked for Vitamin D, calcium, magnesium, potassium and of course, B12 and iron levels.
All of these nutrients are important for women’s cardiac health as they move through menopause. I’ve written about this HERE.
Feelings of anxiety are distressing for your clients. I know this myself, so the evidence on slow breathing is important for you to teach your clients. 6-10 breaths per minute and diaphragmatic breathing is best.
I describe how to do this below. I just wish that I knew to do this type of breathing when I was feeling anxious and overwhelmed at work and was experiencing palpitations.
Yoga helps, so does meditation, but if your clients don’t enjoy these activities, then other forms of breathing-related exercise helps to reduce anxiety, including swimming and walking. I talk about this below.
The Physiological Effects of Slow Breathing on Anxiety and Cardiovascular Health as Women Age
If your clients have got a lot going on in their life, have you ever given the rate of their breathing a thought?
Slowing down the rate of our breathing is an important tool for managing menopause symptoms such as anxiety and palpitations.
Health and longevity research on HOW to change physiological parameters such as blood pressure, heart rate and anxiety with improved breathing practices has only emerged in past decade.
This is despite the fact that the act of controlling one’s breathing for the purpose of restoring or enhancing one’s health, has been practiced for thousands of years in Eastern cultures.
Slower breathing allows both heart rate and blood pressure to decrease.
This is important for your clients to learn, if their stress levels are high or if they have, or still are, experiencing long-covid syndrome.
The type of breathing I’m talking about is known as ‘autonomically optimised respiration’.
This term refers to the rate of breathing that has a beneficial effect on:
- the lowering of heart rate,
- the lowering of blood pressure and
- reduced stomach vagal tone – (this refers to the anxiety we often feel in our stomach when we are stressed).
To achieve these positive benefits, women need to slow down their rate of breathing to 6-10 breaths per minute, with an increased tidal volume (inspiratory and expiratory capacity) achieved by diaphragmatic activation.
Nasal breathing is also considered an important component of optimised respiration for health. [Russo, Santerelli & O’Rourke, 2017].
Lungs are Ageing as Women Move Through Menopause:
It’s important for women going through menopause and into their post-menopause years to understand that their lungs are ageing and therefore, becoming less efficient.
This alone can be problematic for their cardiovascular health and subsequent palpitations. The biomechanics of lung ventilation are carefully co-ordinated with blood oxygen, carbon dioxide and pH homeostasis (balance). How women breathe not only reduces anxiety, blood pressure and palpitations, but also has an effect on moods and hot flushes/ flashes too.
And the slower women breathe, the better.
In fact, 6-10 breaths per minute has the most effect on slowing heart rate and lowering blood pressure. (Russo et at, 2017).
If your clients are feeling anxious, whether at work or at home, then please take note of the strategy of slow breathing, including alternate nostril breathing to teach them.
If your clients feel busy, time-poor, over-whelmed, over-weight and are experiencing depression, anxiety, dizziness or cardiac palpitations, then can I motivate you to focus them on controlled slow breathing at a rate of 6-10 breaths per minute? I want you to re-learn how to breathe.
Diaphragmatic breathing is best.
Whilst I teach women how to do this on my 12 week MyMT™ programmes, there are also coaches who are trained as Breathing Practitioners.
The beauty about knowing that the research has defined ‘effective’ breathing which has physiological benefits for our health, as a rate of 6-10 breaths per minute is ‘gold’.
Even if your clients only manage a few minutes at the end of the day lying quietly on the floor or in bed, closing their eyes and concentrating on pulling their abdominal muscles in when they exhale and allowing the lungs to expand when they inhale, then they will be on their way to helping themselves to reduce anxiety, heart-rate, blood pressure and yes, reducing their belly fat too.
Which MyMT™ Education Course Will You Choose?
From a biological point of view our menopause transition means that the reproductive hormones, oestrogen and progesterone, are declining as part of our ageing.
We all know that puberty is the period when oestrogen and progesterone first arrive, so in effect menopause is the opposite or the book-end to puberty.
As I mention in my online Masterclass on Menopause, your client’s menopause symptoms is their body attempting to compensate for the changing balance of hormones as all of the reproductive hormones decline in midlfe.
Sometimes, those same hormones end up fighting each other instead of adjusting. But every one of their symptoms is reversible if the right lifestyle changes are put into place, which then allows the female body to adapt to its ‘new normal’ as it ages.
This is what 12 week MyMT™ CPD Practitioner Course teaches you – all the scientifically evidenced step-by-step lifestyle strategies which help you to understand how to help your clients to work with their changing hormones in menopause and post-menopause, not against them.
For those of you who aren’t ready for the 12 week course, then there are shorter self-learning courses for menopause weight loss coaching and an introduction to the physiology and psychology of behaviour change for midlife women and this is tailored to those of you who are Health Coaches.
If you have any questions, then please contact, Georgia, the Course Convenor, on firstname.lastname@example.org
My video below explains a little bit about me and how I came to set up My Menopause Transformation Lifestyle Programmes.
Carpenter JS, Sheng Y, Pike C, Elomba CD, Alwine JS, Chen CX, Tisdale JE. (2022). Correlates of palpitations during menopause: A scoping review. Womens Health (Lond). 18:17455057221112267.
Carpenter, J. S., Tisdale, J. E., Chen, C. X., Kovacs, R., Larson, J. C., Guthrie, K. A., Ensrud, K. E., Newton, K. M., & LaCroix, A. Z. (2021). A Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) Investigation of Self-Reported Menopausal Palpitation Distress. Journal of women’s health, 30(4), 533–538. https://doi.org/10.1089/jwh.2020.8586
Carmody JF, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. 2011 Jun;18(6):611-20.
Harvard Health Publishing (2018). Breathing life into your lungs. Online Version.https://www.health.harvard.edu/lung-health-and-disease/breathing-life-into-your-lungs.
Herawati I, Mat Ludin AF, M M, Ishak I, Farah NMF. Breathing exercise for hypertensive patients: A scoping review. Front Physiol. 2023 Jan 25;14:1048338.
John JB, Chellaiyan DVG, Gupta S, Nithyanandham R. How Effective the Mindfulness-Based Cognitive Behavioral Therapy on Quality of Life in Women With Menopause. J Midlife Health. 2022 Apr-Jun;13(2):169-174.
Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874
Romieu, I. (2005). Nutrition and Lung Health. Int. J. of Tuberc Lung Dis. 9(4), 362–374.
Russo, M., Santarelli, D. & O’Rourke, D. (2017). The physiological effects of slow breathing in the healthy human. Breathe, 13, 298-309.