Hormones and heart palpitations

If you’ve ever experienced a heart palpitation, you know that the feeling of having a fast, fluttering, or pounding heart is scary, to say the least. But despite the freakiness, experts say heart palpitations happen pretty often—and they’re usually not dangerous or a sign of your impending doom.

“They’re very common,” Malissa Wood, M.D., co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, tells SELF. “Most people will have palpitations at some point in their lives, even if are short-lived.” Nicole Weinberg, M.D., a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, agrees, telling SELF that heart palpitations are “extremely common” in young women.

According to the Mayo Clinic, heart palpitations can feel like your heart is skipping beats, fluttering, beating too fast, or pumping harder than usual. “If you feel your heart beating at all, that can be a palpitation,” Wood explains. You might feel heart palpitations in your throat, neck, or chest, and they can occur when you’re active or resting, and whether you’re standing, sitting, or lying down, the Mayo Clinic says.

It’s not just a sensation that your heart is skipping beats or beating too fast—your heart is actually doing this, Weinberg says, noting that there can be several reasons for it. A major cause of heart palpitations in young women is having too much caffeine, she says. Wood agrees: “That second or third latte of the morning can bring out extra beats.”

Stress and anxiety are also big causes of heart palpitations, Wood says. “When your adrenaline level goes up, it makes you feel the palpitations because your heart is beating stronger or faster,” she explains. Lack of sleep can also be an issue, she says, adding that “all of the things that make you on edge can cause palpitations.”

Jennifer Haythe, M.D., assistant professor of medicine at Columbia University Medical Center, tells SELF that nicotine can also cause palpitations. “It’s a stimulant that can irritate the heart and cause extra beats,” she explains.

Hormones can play a role as well. That can be from taking new hormonal birth control pills, missing a menstrual cycle, or “any sort of hormonal changes,” Weinberg says. Pregnancy can also cause heart palpitations because your baseline heart rate increases in order to provide for you and the baby, Haythe says. “Even though there’s nothing wrong with you, you may feel a sense of palpitations,” she says.

Dietary changes can cause palpitations, too, Weinberg says, but it tends to be person-specific. “I do have some patients that say whenever they eat a lot of foods, like dairy or gluten, or when they’re not having their regular three meals a day…those are things that can bring on palpitations,” she says. Similarly, low blood sugar can give you heart palpitations, especially if you haven’t been eating enough but have been working out, Haythe says.

While Wood says heart palpitations are largely not dangerous, she points out that they can be caused by a thyroid condition, high electrolyte levels, or even heart disease in some cases. If you find that you’re having heart palpitations that last for several minutes at a time, you feel like you’re going to pass out when you have them, you experience them when you exercise, or you have chest pain or shortness of breath with palpitations, Wood says you need to get yourself checked out.

Weinberg agrees. “A few isolated palpitations are not a big deal, but if they’re associated with other symptoms or coming more frequently, that’s something that would be alarming,” she says. If you find that you get heart palpitations here and there with no other symptoms, Haythe says it’s a good idea to mention it to your doctor during your annual checkup. Your doctor may want to have you do a basic electrocardiogram, just to make sure everything is OK with your heart. “Take your symptoms seriously,” Haythe says. “But in the majority of cases, it’s nothing to worry about.”

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My Birth Control Pill Almost Killed Me

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At 5’9,” 140 pounds, and 36 years of age, the stats were on my side: I was nearing my 40s, but in what I’d consider the best shape of my life.

Physically, I felt great. I worked up a sweat running, at barre class, or learning pole fitness-the latter of which I’d even entered a competition for. But, mentally, I was a ball of stress. I’d made it through a divorce, moved to a new town with my daughter, and embraced a new title: single working mom. My writing career was booming. I had a new book on the horizon, and regular TV appearances. But at times, I felt the walls closing in. (But hey, as tough as everything was, at least I had my health.) That is until one day, the walls became those of a hospital room.

RELATED: 3 Birth Control Questions You Must Ask Your Doctor

But let’s start from the beginning: a Tuesday morning in June. The summer sun was shining and I had a busy day lined up. As I headed out for the first meeting of the day, I noticed sharp pains in my side. I chalked it up to a muscle strain. After all, I was often strained after a rigorous pole fitness session. But while trekking through Manhattan, the pains moved to my back; later that night, to my chest, to the point where I saw stars.

I considered a trip to the ER, but didn’t want to frighten my four year old. I remember standing in front of the mirror in my PJs reasoning: I couldn’t possibly be having a heart attack-I was much too young, too slim, and too healthy. I knew I was stressed, so I entertained the idea of a panic attack. Then I settled on a self-diagnosis of indigestion, took some meds, and fell asleep.

But the next morning, the pain persisted. So, nearly 24 hours after my symptoms started, I headed to the doctor’s. And after a couple of brief questions-the first of which was, “You’re over 35 and on the Pill, correct?” my doctor sent me straight to the ER for a scan of my lungs to “rule out” a blood clot. Along with other risk factors-none of which I appeared to have other than my age-the Pill could cause blood clots, she said.

According to Lauren Streicher, M.D., the likelihood of a blood clot for a woman who’s not on birth control pills is two or three for every 10,000. The likelihood when on birth control pills is eight or nine for every 10,000 women. That was just a worst-case scenario though. I’d simply be sent home with some pain meds, I thought.

When I arrived, I was fast-tracked to the head of the line. “We never mess around when it comes to chest pains,” the nurse explained. She went on: “Even though I doubt anything is seriously wrong with you other than a pulled muscle. You seem so healthy!”

Unfortunately, she was terribly mistaken. A couple of hours and one CT scan later, the ER doc delivered frightening news: I had a large blood clot in my left lung-a pulmonary embolism-which had already damaged part of my lung in what’s known as an “infarction,” cutting off blood flow for an extended period of time to the bottom portion of the organ. But that was the least of my worries. There was a risk it could move to my heart or brain where it would surely kill me. Clots often form in the legs or the groin (often after sitting for a long time, such as on a plane) and then “break off” and travel to areas like the lungs, heart, or head (causing a stroke). The doctor informed me I’d be put on intravenous Heparin, a medication that would thin my blood so the clot wouldn’t grow-and hopefully wouldn’t travel. As I waited for that medication, every minute seemed like an eternity. I thought of my daughter being without a mom, and of the things I’d yet to accomplish.

As doctors and nurses pumped my blood full of IV blood thinners, they scrambled to figure out what could have caused this. I didn’t look like the “usual” patient on the cardiac care floor. Then, the nurse confiscated the package of birth control pills, and advised I stop taking them. They “could be” the reasoning this was happening, she said.

RELATED: The Most Common Birth Control Side Effects

Most women I know worry about gaining weight on the birth control pill, but fail to recognize there’s a laundry list of “warnings” on the label. One tells you there are blood clot risks for smokers, women who are sedentary, or over the age of 35. I wasn’t a smoker. I certainly wasn’t sedentary, and I was just a hair over 35. The label also mentions genetic clotting disorders, though. And soon, doctors told me they would test for a gene I had never heard of: Factor V Leiden, which causes those that carry it to be predisposed to life-threatening blood clots. Turns out, I have the gene.

Suddenly, my life was a new set of stats. According to the Mayo Clinic, both men and women can have Factor V Leiden, but women who have it may have an increased tendency to develop blood clots during pregnancy or when taking the hormone estrogen, commonly found in birth control pills. It’s advised that women who carry this gene do not go on the pill. The combination can be lethal. I’d been a ticking time bomb all those years.

It’s estimated that about four to seven percent of the population has the most common form of Factor V Leiden known as heterozygous. Many either don’t know they have it, or never experience any abnormal blood clots from it.

A simple blood test-prior to going on any hormone therapy-can tell if you have the gene and are unknowingly at risk, as I was. And if you are already on the Pill, it’s important to know the signs-abdominal pain, chest pain, headaches, eye problems, and severe leg pain-for clots.

I spent eight long days in the hospital, but emerged with a new lease on life. At first, I was in rough shape-excruciating lung spasms, and bouts of coughing up blood, as the clot began to dissolve. But I got myself back into fighting form (now I focus on weight training and cardio activities that carry minimal injury risk), and was determined to regain control of my body.

I’ve got to take care of myself first and foremost, so I can be the best mom I can be. It’s something I’ll have to live with for the rest of my life, with a daily regimen of blood thinners and regular doctor visits. I’ve also had to reconsider my method of birth control since anything hormone based is out.

But I write this today as one of the lucky ones: I was diagnosed, and live to tell about it. Others haven’t been as fortunate. I’ve since learned that pulmonary embolisms kill one-third of the 900,000 people who develop them each year, often within 30 to 60 minutes after symptoms start. Celebrity stylist Annabel Tollman, a fashion industry friend, died suddenly last year at 39-reportedly of a blood clot. It is not known whether or not she was on the pill. But since then I’ve learned of more and more women who’ve been affected.

As I researched and shared on social media, I came across women who shared my tale, and headlines that screamed, “Why are young and healthy women dying of blood clots?” Knowing that doctors give out birth control pills like candy (around 18 million women in the U.S. reportedly use them), it’s important to discuss any potential risk factors before going on it. Family history, blood tests, and simply speaking up are all crucial parts of a decision. The bottom line: When in doubt, ask.

  • By Jené Luciani

7 Weird Things That Can Mess With Your Heartbeat

A few weeks ago I thought I was having a heart attack. My morning started out normal: I woke up at my usual hour, feeling what I thought was a little bit of tiredness. But as I went about my morning routine, things grew scary. I broke out in a cold sweat as I brushed my teeth. My skin turned white as paper. And then, scariest of all: my heart was pounding like crazy. As a health writer I know these aren’t textbook signs of a heart attack, but I also know that dangerous cardiovascular events in women can be more subtle than those in men.

Later that day I went to urgent care, but an EKG and blood tests showed nothing out of the ordinary. Turns out my heartbeat went haywire as a result of a side effect from a medication. The technical term for this: heart palpitations, which can be brought on by many things.

RELATED: I Had a Perfectly Normal EKG at My Check-Up—and the Next Day I Had a Heart Attack

“When a person says they’re having heart palpitations they’re referring to a sensation of their heart beating differently. Or they may simply have an awareness of their heart beating,” explains Shephal Doshi, MD, director of cardiac electrophysiology at Providence Saint John’s Health Center in Santa Monica, California.

Learn about some top triggers of palpitations, plus what to do about them.

RELATED: 9 Subtle Signs You Could Have a Heart Problem

Panic attacks

If you feel as if your heart is racing like it’s going to beat out of your chest, it could be a panic attack, Dr. Doshi says. Shaking, sweats, and an overwhelming feeling of impending doom are also common symptoms. Panic attacks are not dangerous, though they can feel absolutely terrifying. “Sometimes you may have an arrhythmia that’s actually causing the panic attacks, so see a doctor to rule out something more serious,” Dr. Doshi adds. Otherwise, recurring panic attacks can be treated with talk therapy to identify triggers and anti-anxiety medications.

RELATED: 12 Signs You May Have an Anxiety Disorder


So your heart’s beating faster than normal. Before you start worrying, did you just have a big cup of Joe? “Caffeine is a stimulant,” says Brian Kolski, MD, an interventional cardiologist with St. Joseph Hospital in Orange, California. This means that it “stimulates the autonomic nervous system (the involuntary nervous system which controls heart rate and more), which can cause an increase in palpitations.” Dr. Kolski recommends seeing your doctor if palpitations become excessive or are accompanied by dizziness, lightheadedness, or chest pain—even if you suspect it’s caused by caffeine.

RELATED: 12 Surprising Sources of Caffeine


Decongestants such as pseudoephedrine (the active ingredient in Sudafed) are also stimulants. “Some people who may be sensitive to these drugs can experience heart palpitations,” adds Dr. Doshi. Over-the-counter meds are usually safe, but you should talk to your doctor or pharmacist if you have any other medical conditions. If you have a heart arrhythmia, for example, your doctor may advise against taking certain decongestants, Dr. Doshi says.

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Losing too much fluid, not drinking enough, or a combination of the two can quickly lead to dehydration, which, when severe, can lead to heart palpitations along with dry mouth, dark urine, and muscle cramping. “Dehydration can cause changes in your body’s electrolytes and also lowers blood pressure,” Dr. Doshi says. “This puts stress on the body and, as a result, could cause an abnormal heartbeat.” Prevent it with regular trips to the water cooler—your body needs 2.2 liters (or about nine cups of fluid) every day to function properly, per the Institute of Medicine.

RELATED: 7 Easy Ways to Drink More Water

Prescription meds

Many prescription medications, including those for asthma or thyroid problems, can cause palpitations, says Dr. Kolski. “Some medications affect how other medications are metabolized, while others cause changes in the electrical conduction system of the heart.” These heartbeat changes aren’t normally a cause for alarm, but they can be bothersome. Make sure your doctor knows about every drug or supplement you’re taking before you start any new medications. Also, pay close attention to the possible side effects listed on the drug information that comes with your medicine when you pick it up from the pharmacy, so you won’t freak out if it happens. If your regular medicines are messing with your heartbeat day-to-day, talk to your doctor to see if there’s a different drug that might work better for you.

RELATED: 19 Signs Your Thyroid Isn’t Working Right


Most commonly caused by iron deficiency, anemia means your body isn’t making enough healthy red blood cells to carry adequate oxygen to your tissues. Although it doesn’t always cause heart palpitations, people with anemia may sometimes feel their heart beating harder, says Kolski. “Since you have fewer red blood cells, a faster heart beat increases oxygen delivery when you’re anemic.” Other symptoms include fatigue and hair loss.

RELATED: 15 Signs You May Have an Iron Deficiency

Heavy metals

People who work in construction, as metal workers, or in other industrial settings can be exposed to mercury, cadmium, and other heavy metals regularly. Long-term exposure can lead to inflammation, blood clots (thrombosis), and other heart-related problems. “Heavy metal exposure can be directly toxic to heart muscle,” Dr. Kolski says. “ can also cause problems with electrolytes. Anything that causes a derangement in electrolytes can cause heart palpitations.”

RELATED: 10 Best Foods for Your Heart

In general, heart symptoms should never be taken lightly; if you ever feel like something’s up with your ticker, see a doctor ASAP (in the ER or an urgent care center) for a full evaluation.

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Q I regularly have heart palpitations the week before menstruating, especially when I’m anxious or going to sleep. My heart tests are normal. Where are the palpitations coming from? Can you put my mind at ease?

Renee, Athens, Ga.

A: This should quiet your mind, if not your heart: Palpitations are rarely serious. Having them before your period (or anytime there are big hormonal shifts, such as during pregnancy and menopause) is fairly common.

Since your heart’s gotten a clean bill of health, it’s time to check other body parts.

Let’s start with your brain: When you’re anxious, your brain churns out chemicals that ramp up your adrenalin, which makes your heart speed up and go flippity-flop. You could have an anxiety disorder and be having mild flippity-flops all day, but you’re too busy to notice them until you lie down to sleep.

Your thyroid could be to blame, too. Too little or too much thyroid hormone can make your heart do a tap dance worthy of the Rockettes.

If your doc says you’re in good health, try meditating away the palpitations or just ignoring them — unless your heart rate jumps to more than 100 beats a minute. If you don’t have a fever and haven’t just been mugged, call 911, pronto. Ditto if you also have chest pain, dizziness, shortness of breath or start sweating heavily.

Q: After my husband developed deep vein thrombosis and a pulmonary embolism, we learned that he has protein C deficiency. His brothers also have had blood clots. Are our children and grandchildren at risk of developing them?

A: About one in 300 people have a mild deficiency of protein C, a blood chemical that helps prevent clotting. People who don’t have enough protein C are more vulnerable to deep vein thrombosis (DVT), a clot in a deep vein that can be life-threatening if it causes a stroke or goes to the lungs, as happened with your husband.

A genetic mutation causes this deficiency, and it’s usually inherited. That likely explains the clots in your brothers-in-law. Your kids and grandkids can be tested for the mutation (it’s in the PROC. gene). They also should be tested for clotting speed and protein C levels.

The outlook for people with mild protein C deficiency is good. If they do have a DVT, they’ll need to go on blood-thinning drugs for a few months and be cautious about anything that increases the risk of clots (like sitting still for long periods of time).

Pauline, Tampa, Fla.

A: Only Bill Haley and the Comets thought it was a great thing to rock around the clock. There are a couple of possible causes for the sensation you’re describing. Some people experience it after a boat trip or a long flight. It’s called mal de debarquement syndrome (French for “sickness of disembarkment”), and it can last for years.

Alternatively, your “rocking vertigo” could be benign paroxysmal positional vertigo (BPPV), an inner-ear disorder that occurs when small calcium particles in your ear canals break loose or clump together. The particles tell your brain about moves you’re making, but when those particles are messed up, your brain gets wildly exaggerated info — for instance, you just rolled over in bed but your brain thinks you did a flying twist off a pommel horse.

While BPPV is associated with aging, you don’t have to live with it. Your docs should be able to show you some easy head movements that tilt the particles out of your inner ear. If that doesn’t do the trick, or they seem baffled, see a physical therapist specializing in balance disorders. Even if rock ‘n’ roll is here to stay for you, a therapist can show you ways to maintain a more balanced life (playing ping-pong often helps).

YouDocs Mehmet Oz and Mike Roizen are authors of YOU: Losing Weight. Order it at StarStore.ca. Submit questions and find more info at RealAge.com

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Q&A: Herbs Control PMS Palpitations

Click here for the original post.

Q: In a health tip on hormones, you wrote that virtually any cyclical symptom is probably caused by hormone fluctuations. You described a patient who got such severe heart palpitations that her cardiologist considered heart surgery before one herb managed to get her hormones under control. Could you tell me which herb was used and how it worked?

A: The herb is chasteberry, also called vitex. How it helps PMS is a little complicated, so bear with me.

First, there are two aspects to PMS, hormonal and serotonin-related.

Hormonal PMS is caused by an imbalance between your two sex hormones, estrogen and progesterone. Basically, when there’s too much estrogen and insufficient progesterone to balance it you get symptoms like breast tenderness, fluid retention, and headaches.

Serotonin PMS occurs because of the relationship between estrogen and your feel-good serotonin. Picture them attached like roller coaster cars, estrogen up front, pulling feel-good serotonin up and down. During the ten days or so before your period, estrogen levels fall, pulling down serotonin with it.

During this time you’re emotionally very vulnerable, snarky, and generally miserable. You ache for some nice dark chocolate because it will drive up your serotonin. If you already have a low-serotonin disorder (like depression, anxiety, fibromyalgia, chronic fatigue, irritable bowel, or migraine), it will likely get worse during your PMS days and improve on about the second day of your period, when your estrogen starts to rise again.

The herb chasteberry acts on your pituitary gland, the master gland whose hormones control the output of all your other glands, including the delicate balance between estrogen and progesterone. Taking chasteberry (found in my Triple Whammy PMS Formula with Chasteberry) from mid-cycle up to the start of your period usually brings PMS to a screeching halt after two or three periods.

The patient I referred to had a heart that was highly vulnerable to these internal hormone shifts. When her hormones were balanced with chasteberry, her stress-buffering serotonin didn’t plummet as violently and her palpitations stopped. Fortunately, all this occurred before she was wheeled into the operating room.

Why Does My Heart Feeling Like it is Doing Hurdles?


I’m 46 years old, healthy and have never, ever had any heart trouble. However, three times in the last six months I’ve had to go to Emergency because my heart starts jumping and racing and I feel like I could black out. I’ve now seen two cardiologists who think they should do surgery to cut the electrical channels in my heart. But I’m young and healthy–my periods are even regular but I’m getting night sweats now and having much worse premenstrual symptoms, cramps and heavy periods. Please help! I’m scared.


Thank you for your question. First of all, I understand how scary this can be. When I was perimenopausal I had spells where my heart was beating strangely and once I ended up in Emergency too. It happened one calm evening after supper (probably watching a nature programme on Knowledge Network) so not under any stress. I felt the peculiar jumping feeling in my chest (called palpitations). Curious, I started tracking my heart beat by feeling the pulse in my wrist-every third beat was too early and followed by a long pause. I felt fine otherwise.
My partner saw that I was counting my pulse, asked what the matter was and insisted I go to the hospital. There they took an electrocardiogram (ECG), did some blood tests and kept track of my heart beat. They eventually sent me home with vague assurances that everything tested normal but without any explanation for what was going on.
What you are describing could well be perimenopausal heart symptoms-they have not yet been well studied. Sometimes it is not just the palpitations from the heart’s skipping beats or going too fast (arrhythmia) but also chest pain that bothers midlife women. At this point, no one has a clear idea why these heart symptoms are occurring to healthy women in their 40s or 50s, what’s causing them and how, or even if, perimenopausal arrhythmias and chest pain are related to an increased risk of heart attack.
The good news is that I’ve known a dozen women who described palpitations and arrhythmia experiences like yours (but probably less intense). The ones I’ve known over many years (including myself!) have not ended up with any hint of early heart disease. So I can reassure you about that!
Recently I learned something new about heart rhythms and women’s ovarian hormones, estrogen and progesterone. The heart uses electrical impulses to trigger each heart beat. We can see these on the electrocardiogram (ECG) as a sequence of bumps, spikes and dips. The main cluster of a beat is called the QRS complex (the Q wave is downward, the R is up and the S is down again) followed by a flat line and then a low hill called a T wave.

How fast we go from a Q wave to a T wave depends on lots of things, but most of all it is related to stress hormones like adrenalin. Some drugs (given for many reasons) also cause a lengthening of the QT interval. It turns out there are some people who are born with or who develop a condition called a “Long QT Interval”. These people are at increased risk for arrhythmias but rarely also at risk for fast and uncontrolled heart beats. Sometimes these arrhythmias can cause sudden death. Although heart disease is not as common in women as in men, half of the women with heart disease who die because of it, have sudden death.
Recently a couple of very large studies have shown that menopausal women who report taking estrogen have a longer QT interval than women who haven’t taken any hormone therapy or women who are taking estrogen with progesterone or a progestin (synthetic form of progesterone). There is now a lot of information to show that estrogen lengthens the QT interval and progesterone shortens it. In addition, some scientists have taken heart muscle from guinea pigs and stimulated it while adding estrogen and shown the QT interval gets longer. What is really exciting and important is that studies in rabbits with a genetic risk for long QT showed that treating with progesterone made the QT interval shorter. So far, there are no controlled trials of progesterone therapy for women with Long QT Intervals.
So-back to you and your hurdling heart. I think that the higher estrogen levels in perimenopause are likely lengthening your QT interval and may be causing your funny heart beats. Remember that on average perimenopausal estrogen levels are about a third higher than in younger women. However, in perimenopausal women with symptoms, like you, estrogen levels are usually double-high. (Your premenstrual symptoms, heavy flow and increased cramps are all evidence for higher estrogen levels.)
In addition, perimenopause is a time when cycles are less likely to be ovulatory and release an egg (thus lower progesterone levels) and even cycles that are ovulatory have less progesterone than normal. Therefore progesterone is not able to shorten your QT interval and prevent your irregular heart beat episodes.
What do I suggest?
As you already know, if you have a fast heart beat that lasts and you feel faint, you need to get help from the medical system. In addition, I’ve made a few suggestions below:

  1. As with any fast heart beat, take away the things that normally make the heart beat too fast. This means to decrease caffeine (coffee, tea, coke or stimulant drinks) to less than one or none a day, get a half hour of walking every day and get at least eight hours of sleep.
  2. You need to have a thyroid test to make sure that your thyroid is not making too much hormone-that means measuring thyroid stimulating hormone (TSH) and free T4 levels.
  3. Because there are some new relationships between an abnormal QT interval and risks for diabetes and the associated higher blood sugar levels, eat three healthy meals a day with lots of whole grains, fruits and vegetables. Avoid plain sugar, candy or very sweet desserts or drinks.
  4. Ask your pharmacist to be sure that you are not taking any medicines could make your QT interval longer.
  5. Ask for an ECG test when your heart is “behaving”, plus ask your cardiologist to measure your QT interval on that and all the ECG tests you have had done to see if you have a longer than normal QT interval. If you have another episode, ask them to measure your estrogen and progesterone levels at the time of rapid heart beat.
  6. Finally, because of what we now know, I’d suggest that you take oral micronized progesterone (Prometrium, 300 mg at bedtime daily) for six months as a kind of a trial and before you have any surgery. I know it is likely to help with night sweats (we are currently doing a controlled trial to test this), and that it will make heavy flow, premenstrual symptoms and cramps better. Given your three Emergency visits in six months, we can see if progesterone is associated with less serious palpitations and funny-fast heart beat episodes and if it shortens your QT interval on an ECG taken after six months.

I would be happy to talk with your family doctor and both of your cardiologists to share the scientific references I’ve found about long QT intervals and estrogen and how progesterone may help.
Hope this is helpful for you,
All the best,

Life Phase: Perimenopause Updated Date: Tuesday, November 19, 2013 – 11:15

Polycystic Ovarian Syndrome: How Your Ovaries Can Affect Your Heart

As if all that isn’t enough, now doctors are saying women with PCOS need to think about their heart health as well, says Erin Michos, M.D. , associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease .

“Women worry about infertility, acne and weight gain but might not be thinking of high blood pressure and type 2 diabetes . It’s important to know that they’re at an increased risk and how important diet and exercise is,” says Michos.

The Heart’s Connection to Diabetes and the Ovaries

Many women with PCOS are insulin resistant, meaning that insulin can build up in the body, making it difficult to maintain normal blood glucose levels. This is a risk factor for diabetes, so women with PCOS are especially at risk for developing diabetes as well. In fact, 35 percent of women with PCOS have prediabetes and 10 percent go on to develop diabetes by age 40. Higher androgen levels also increase the risk of diabetes.

Because excess insulin can cause weight gain, women with PCOS also tend to be overweight or obese, particularly in the abdomen area. This belly fat, called visceral fat, can lead to higher triglycerides and lower levels of HDL, or “good” cholesterol.

Heart Disease Risk Factors and PCOS

PCOS risk factors, like being overweight or having insulin-resistant diabetes or higher blood pressure, are associated with cardiovascular disease, says Michos.

“Studies suggest that women with PCOS have a twice as likely risk of a future cardiovascular event, like a heart attack or stroke,” she says.

Diabetes Risk Factors and PCOS

The connection between PCOS and diabetes is not fully understood, but women with PCOS are more likely to develop diabetes if they have these risk factors:

  • A family history of diabetes
  • Higher blood pressure
  • Obesity
  • African-American or Hispanic heritage

Healthy Lifestyle Choices to Help Control PCOS

Being diagnosed with PCOS can be daunting, but take heart: You can manage this condition with a healthy lifestyle, says Michos. She urges women who have PCOS to be vigilant about diet and exercise to reduce the risk of diabetes and heart disease.

“Everyone should follow a healthy lifestyle, but especially these women because they’re at greater risk. In general, young women exercise less than young men. They’re not thinking of their heart health; infertility and irregular menstruation are on their minds,” Michos says. “These women need to be extra vigilant.”

If You Have PCOS, Are you More Likely to Develop Heart Disease?

With Lubna Pal, MBBS, FACOG

For decades, if you were diagnosed with polycystic ovarian syndrome (PCOS), you were considered to be at increased risk of developing heart disease, too.1-3 Despite the rising rate of cardiovascular disease in women,4 there is reason to believe that this association between PCOS and heart disease may not be as strong as previously thought.5

This should come as good news to the estimated 10-15% of reproductive-age women who have been diagnosed with polycystic ovary syndrome.6

A woman’s risk of heart disease increases with a diagnosis of diabetes or obesity but not because she has PCOS, two experts say.

Why Heart Disease Has Been Labeled a Risk Factor for PCOS?

Elevated cholesterol, high blood pressure, increased insulin levels, and glucose intolerance are common occurrences in women with PCOS, all of which escalate the risk of developing diabetes and heart disease in affected individuals.7 For this reason, doctors and researchers alike have believed women with PCOS are more likely to develop heart problems.5

“espite having these and other risk factors…there is no credible evidence that there is greater morbidity in all women with PCOS,” wrote the authors, Enrico Carmina, MD, professor of endocrinology at Palermo University in Argentina, and Rogerio A. Lobo, MD, professor of obstetrics & gynecology at Columbia University Medical Center in New York City. They shared against this commonly held belief but did not respond to several requests for comment.

While women are more readily diagnosed as having PCOS based on reproductive abnormalities, there are equally compelling endocrine- and metabolic-related disruptions related to this complex condition,7 leading these reproductive endocrinologists to take a closer look at the presumed relationship between PCOS and heart disease.5

Dr. Carmina and Dr. Lobo identified and reviewed published studies involving women who were diagnosed with PCOS to see if there was a notable pattern or association with heart problems.5

Simply put, they found no apparent connection, meaning women with polycystic ovary syndrome have no greater risk of developing cardiovascular disease than women who do not have PCOS.5 “These data have led us to challenge the notion of increased events in all women with PCOS,” the authors report

However, according to these experts, most of the available studies were poorly designed.5 For example, the studies were inconsistent in how women were diagnosed as having PCOS. Sometimes, women were labeled as having PCOS simply because they indicated having irregular periods, and other times, other symptoms were used in making the diagnosis.

In addition, many of the women followed in the selected studies had conditions, such as diabetes or obesity, which have a direct relationship with increased risk of heart disease, even in the absence of PCOS,5 making the ability to detect any pattern with PCOS alone much more difficult.

Obesity and Diabetes Present Direct Concern for Heart Health

Type 2 diabetes and obesity are commonly experienced in women with PCOS, and both conditions increase the lifetime risk of developing heart disease.5

Two well-designed retrospective studies suggested cause for concern. One study showed an increase in heart-related mortality amongst women with PCOS who also had diabetes.8 The other study showed an increase in cardiovascular events, including heart attacks.9

“…ifestyle management, which should be a key feature of care of all women with PCOS, is particularly important to prevent obesity and diabetes. Early identification of glucose intolerance in women with PCOS is of paramount importance,”5 the authors write.

A related article you might like: PCOS Diet

We approached Lubna Pal, MBBS, FACOG, professor of obstetrics, gynecology, and reproductive sciences and director of the Polycystic Ovary Syndrome Program at Yale School of Medicine in New Haven, Connecticut, for her expert opinion on this topic.

“The challenge here is that we have such little longitudinal data in terms of cardiovascular outcomes that for us to say there is harm or there is protection is just hypothesis generation at this point,” she tells EndocrineWeb, meaning there isn’t enough evidence for a clear answer.

Another obstacle that arises in studying PCOS, Dr. Pal says, is that there is no one agreed upon definition for what constitutes polycystic ovary syndrome in clinical trials, nor is this syndrome a standard set of symptoms or simple to diagnose.

“It’s like a fruit basket—The PCOS diagnostic criteria are so varied that it’s like having to choose from apples, oranges, strawberries, grapes, and plums all in one basket. When we want to know how quickly the fruit might deteriorate, there’s no easy answer because each of the different entities has an influence in the freshness of the basket, Dr. Pal says, so we need to separate out the fruit into like groups to tease out a valid answer.”

It is In the Patient’s Best Interest to Take Control of Her Health

You may wonder in light of all of this information, what your individual concerns regarding heart disease should be? Dr. Pal provided her insights on what she would like patients to know.

Certainly, women who have PCOS, as well as T2D or obesity, might be recognized as having greater cause for concern about their heart health due to these related conditions but no greater risk as a resulting of the polycystic ovary syndrome.

“We can approach concerns about heart disease by focusing on optimizing wellness rather than worrying about being unwell,” she says. In women with PCOS, the goal is not to try to prevent cardiovascular disease; rather, we are trying to help you achieve the best heart health.

To do this, Dr. Pal advises all of her patients to take action and make the necessary adjustments when they learn they may have an increased risk for heart disease. These risks include: high blood cholesterol as well as high triglycerides, elevated high density lipoprotein (LDL) levels or low high density lipoprotein (HDL), or high blood pressure.

When my patients—the younger the better— respond to our suggestions by making the necessary lifestyle changes particularly as it concerns diet and physical activity, they see the benefits as their risk for heart disease decreases.

“Nothing drastic is happening while you are still young, but there is room for you to improve based on all this data collected in other populations,” she said. “What we can say clearly is that young women who present with an at-risk profile at a young age should be reassured that these potentially concerning conditions can be abated.

Last updated on 12/14/2018 Continue Reading Do I Have PCOS? 2-Min PCOS Symptoms Quiz View Sources

Talbott EO, Guzick DS, Sutton-Tyrrell K, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol. 2000; 20: 2414–2421.
Zhao L , Zhu Z , Lou H , et al. Polycystic ovary syndrome (PCOS) and the risk of coronary heart disease (CHD): a meta-analysis. Oncotarget. 2016;7(23):33715-33721
Zhou Y, Wang X, Jiang Y, et al. Association between polycystic ovary syndrome and the risk of stroke and all-cause mortality: insights from a meta-analysis. Gynecol Endocrinol. 2017;33(12):904-910.
Centers for Disease Control and Prevention. Heart Disease. Available at: https://www.cdc.gov/heartdisease/facts.htm. Accessed December 7, 2018.
Carmina E, Lobo RA. Is There Really Increased Cardiovascular Morbidity in Women with Polycystic Ovary Syndrome? J Womens Health. 2018;27(11):1385-1388.
Azziz R. Does the risk of diabetes and heart disease in women with polycystic ovary syndrome lessen with age? Fertil Steril. 2017;108(6):959-960.
Legro RS. Polycystic Ovary Syndrome and Cardiovascular Disease: A Premature Assocation? Endocr Rev. 2003; 24(3): 302-312.
Pierpoint T, McKeigue PM, Isaacs AJ, Wild SH, Jacobs HS. Mortality of woman with polycystic ovary syndrome at long term follow up. J Clin Epidemiol. 1998; 51: 581–586.
Mani H, Levy MJ, Davies MJ, et al. Diabetes and cardiovascular events in women with polycystic ovary syndrome: A 20-year retrospective cohort study. Clin Endocrinol. 2013; 78: 926–934.

PCOS (Polycystic Ovary Syndrome) and Diabetes

More than half of women with PCOS develop type 2 diabetes by age 40.

Ever heard of polycystic ovary syndrome (PCOS)? If you’re a woman who has had trouble getting pregnant, you might have. Just about everyone else? Probably not.

What is PCOS?

PCOS is one of the most common causes of female infertility, affecting 6% to 12% (as many as 5 million) of US women of reproductive age. But it’s a lot more than that. PCOS is a lifelong health condition that continues far beyond the child-bearing years.

Women with PCOS are often insulin resistant; their bodies can make insulin but can’t use it effectively, increasing their risk for type 2 diabetes. Women with PCOS have higher levels of androgens (male hormones that females also have), which can stop eggs from being released (ovulation) and cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body.

Women with PCOS can develop serious health problems, especially if they are overweight:

  • Diabetes—more than half of women with PCOS develop type 2 diabetes by age 40
  • Gestational diabetes (diabetes when pregnant)—which puts the pregnancy and baby at risk and can lead to type 2 diabetes later in life for both mother and child
  • Heart disease—women with PCOS are at higher risk, and risk increases with age
  • High blood pressure—which can damage the heart, brain, and kidneys
  • High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol—increasing the risk for heart disease
  • Sleep apneaexternal icon—a disorder that causes breathing to stop during sleep and raises the risk for heart disease and type 2 diabetes
  • Stroke—plaque (cholesterol and white blood cells) clogging blood vessels can lead to blood clots that in turn can cause a stroke

PCOS is also linked to depression and anxiety, though the connection is not fully understood.

What Causes PCOS?

The exact causes of PCOS aren’t known at this time, but androgen levels that are higher than normal play an important part. Excess weight and family history—which are in turn related to insulin resistance—can also contribute to PCOS.


Does being overweight cause PCOSexternal icon? Does PCOS make you overweight? The relationship is complicated and not well understood. Being overweight is associated with PCOS, but many women of normal weight have PCOS, and many overweight women don’t.

Family History…

PCOS tends to run in families. Women whose mother or sister has PCOS or type 2 diabetes are more likely to develop PCOS.

…and Insulin Resistance

Lifestyle can have a big impact on insulin resistance, especially if a woman is overweight because of an unhealthy diet and lack of physical activity. Insulin resistance also runs in families. Losing weight will often help improve symptoms no matter what caused the insulin resistance.

Do You Have PCOS?

Sometimes PCOS symptoms are clear, and sometimes they’re less obvious. You may visit a dermatologist (skin doctor) for acne, hair growth, or darkening of the skin in body creases and folds such as the back of the neck (acanthosis nigricans), a gynecologist (doctor who treats medical conditions that affect women and female reproductive organs) for irregular monthly periods, and your family doctor for weight gain, not realizing these symptoms are all part of PCOS. Some women with PCOS will have just one symptom; others will have them all. Women of every race and ethnicity can have PCOS.

It’s common for women to find out they have PCOS when they have trouble getting pregnant, but it often begins soon after the first menstrual period, as young as age 11 or 12. It can also develop in the 20s or 30s.

To determine if you have PCOS, your doctor will check that you have at least 2 of these 3 symptoms:

  1. Irregular periods or no periods, caused from lack of ovulation
  2. Higher than normal levels of male hormones that may result in excess hair on the face and body, acne, or thinning scalp hair
  3. Multiple small cysts on the ovaries

Just having ovarian cysts isn’t enough for a PCOS diagnosis. Lots of women without PCOS have cysts on their ovaries and lots of women with PCOS don’t have cysts.

Treatment for PCOS

See your health care provider if you have irregular monthly periods, are having trouble getting pregnant, or have excess acne or hair growth. If you’re told you have PCOS, ask about getting tested for type 2 diabetes and how to manage the condition if you have it. Making healthy changes such as losing weight if you’re overweight and increasing physical activity can lower your risk for type 2 diabetes, help you better manage diabetes, and prevent or delay other health problems.

There are also medicines that can help you ovulate, as well as reduce acne and hair growth. Make sure to talk with your health care provider about all your treatment options.

Find Out More

CDC’s Division of Diabetes Translation
PCOS Fact Sheetexternal icon
Common Reproductive Health Concerns for Women
Infertility in Women
Being Physically Active
Diabetes Features & Spotlights
CDC Diabetes on Facebook
@CDCDiabetes on Twitter

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