photo credit: @wildsoulmagsyogi via Unsplash
TL;DR: The echocardiogram and the Zio patch came back normal. Who is surprised? But I’ve had two episodes since the last update and I still don’t know what triggered them. Both episodes were like the first one in May: 15-20 minutes long, started with a racing heart and lightheadedness and ended with chills/shaking before my nervous system returned to normal.
Here’s finally an update on my health situation. As a quick reminder, I had an episode of heart palpitations and lightheadedness back in May, but had a normal ECG and troponin test a couple of days later. My heart seemed fine. The doctor I saw for a follow up in June still recommended an echocardiogram, and a Zio patch (14-day EKG patch) to further eliminate any possible heart issues.
I had my next follow up appointment at the end of July. I was scheduled with Dr. H, who I had seen in June, but when I checked in at the practice, I was told that my appointment was canceled because Dr. H was out.
Apparently, she had called in sick in the morning or something, with no time to inform me beforehand (I had the first appointment at 8 a.m.), but luckily, I was able to be rescheduled for an appointment with Dr. J at 8:20 a.m. I wasn’t necessarily thrilled to see yet another doctor, but I also didn’t want to have come in vain, and it turned out that Dr. J is one of the supervisory MDs, not another resident doctor, so that made me feel a little better.
The bad news: the results of the Zio patch had not come back yet even though I sent the patch back 3 (!) weeks prior). So we couldn’t take a look at it.
The good news: Dr. J discussed the results of the echocardiogram with me and said that everything looked great and that there is nothing structurally wrong with my heart.
I had already looked at the results in MyChart prior to my appointment, and the only thing that was noted in the report was “sinus bradycardia” (slow heartbeat) and mild dilation of the left and right atrium (upper chambers of the heart), which is not uncommon in endurance athletes. (Thanks again, Sarah, for reaching out and inquiring about the heart monitor results. I appreciated your insights!)
Dr. J was also enthusiastic about all my other test results – they were all great and he thought I was taking excellent care of my health. Blood pressure 111/69, HR 55 bpm, all other blood values in the normal range. I mean, I would be lying if I said that I was NOT happy that all the test were negative… I would just like to know why I have these symptoms occasionally, and more importantly, how to prevent them.
That was my next question to Dr. J: if all tests come back negative, what then?
He said we should wait for the results of the Zio patch to really rule out any cardiac arrhythmia, and if that comes back normal, we can talk about other scenarios.
The Zio Patch results came in a week later and I received a message from Dr. H that the readings did not capture any signs of heart rhythm irregularities (surprise!) and that this most likely means that the palpitations were due to other causes (no sh*t, Sherlock). But I did mention to her that I had had another episode just before wearing the Zio Patch at the end of June, and then again at the beginning of August.
Dr. H thinks we need more information before we make any more moves. She asked me to keep a log of these episodes (which I’ve been doing already!), in particular, date of occurrence, what I was doing prior, how long they last, any other associated symptoms, anything I was doing out of the ordinary/any new changes to my environment, stress level, and anything else I think is relevant.
A NEW THEORY
So, what is a(n impatient) girl to do? Of course I scrutinized my current symptom log, looked at the patterns, and came up with a new theory.
Could this be something like reactive (postprandial) hypoglycemia (blood sugar drops below normal levels, usually 2-4 hours after eating) possibly triggered by perimenopausal hormone fluctuations? Classic symptoms for hypoglycemia are dizziness, chills, a pounding heart, and shaking — exactly what I’ve been experiencing. The episodes were always between lunch time and late afternoon.
I was also able to track both recent episodes to my luteal phase, because they happened about 3-7 days before my period (though there was one skipped cycle in between). So what if erratic hormones are to blame? Do you think that could be a reasonable explanation? Just because my blood work looks normal and I don’t have the classic perimenopausal symptoms like weight gain, insomnia, or hot flashes, it doesn’t mean that there are not a gazillion other symptoms that can be related to the hormonal changes in women’s bodies.
I don’t want to blame things on perimenopause just because, but since I don’t have any other explanation yet, isn’t it something to consider? And why hasn’t any doctor thought of it yet?
Interestingly, every time I have brought this up with a doctor, they instantly dismissed any connection with hormonal changes, which is really surprising to me. They haven’t even considered it. But how would they know if they haven’t even tested my hormones? Basic gynecological care is done in my primary care clinic, but maybe the doctors there are not educated enough about perimenopause and maybe it’s time to see a OBGYN who knows a bit more about these matters! It feels like perimenopause is still such an insufficiently researched field, although I am glad things are improving now that women are finally talking more about it and do not suffer in silence.
So, I am just over here trying to fit the puzzle pieces of my particular situation together, but as you can tell, I am still poking in the dark here. The most scary scenarios (heart-related issues) seem to have been ruled out, which is obviously a big relief. But maybe I now should consider a glucose monitor and/or a hormone test.
Because of my newest theory, I’ve been more mindful with my eating habits, caffeine, and water intake and I carry around Dextro Energy Glucose Tablets, just in case. I am happy to say that I have not had any symptoms for the last 3 weeks. Encouraging, of course, but I’ll still be carefully logging any new or recurring symptoms, especially since I am in my luteal phase again. If I end up not having any symptoms this cycle, I think I’ll still message Dr. H and share the information about my two most recent episodes, and see what she says. I am not very keen on waiting for new episodes to occur (they’re not fun) just to gather more information, if something – anything – else can be checked or ruled out now.
I know some of you have talked about (peri)menopausal symptoms and HRT before. I’d like to know more about which symptoms you were experiencing and how you connected them to your cycle.
Also, stay tuned for more updates.
Anne
September 1, 2026 at 9:04 amJumping in early on comments (so unlike me) to say yes yes yes. Please keep track of what you are eating and drinking, in addition to everything else you are tracking. And yes, please consider seeing a women’s health (or menopause) specialist. There should be someone in your area, given that it’s relatively large and metropolitan. Finally, perhaps consider eating on a schedule, rather than waiting until you’re ravenous.
I can’t speak to HRT and perimenopause symptoms, but I know others have that experience and expertise.
Boo
September 1, 2026 at 9:24 amHello! I am a nurse midwife who does a lot of prescribing for HRT. I think your thinking on perimenopause is very sound- while HRT is only FDA approved for treatment of vasomotor symptoms (like hot flashes or night sweats) often it help with a whole bunch of other complaints, since we have estrogen receptors all over our bodies. I don’t recommend hormone testing, because during perimenopause our hormones are so up and down that it’s not a reliable way of gauging what’s happening (it’s more like a snapshot of that particular momment, which may be falsely high or low). I think finding a menopause specialist who is open to doing a HRT trial is smart- it can take 6+ weeks for HRT to take effect and then longer to find the right dose. And if it’s not right for you, it’s also okay to stop it! I also love the idea of a continuous glucose monitor- hopefully you could even get one covered by insurance, although it might require a prior authorization. Good luck and I hope you get answers and feel better soon!
coco
September 2, 2026 at 12:40 amI like your Sherlock’s approach, exactly what I did when my knee one day started to complain and what triggered me to inquire about HRT. I would say if you really what to know where you are in the process of perimenaupause, get tested with a knowledgeable doctor. heart palpitations is one of the symptoms. I didn’t have any of other usual symptoms, but my tendons and joints were more sensitive than before when everything else stayed the same. So definitely inquire more to understand your physiology, and maybe a solution for prevention.
Sarah
September 2, 2026 at 3:13 amI definitely had episodes of racing heart before I started HRT.
Elisabeth
September 2, 2026 at 7:01 amFirst, I LOVE the tl;dr! That was helpful so I had some context going into reading the rest of your post.
Ugh. I know this is beating a proverbial dead horse (WHICH IS SUCH A HORRIBLE IDIOM), but if men had hormone changes like women did, there would be so much more information and research.
You are taking control of your health in such an important way, San, and I am so happy you’re advocating for yourself AND tracking things independently.
Thanks for taking the time to provide the update and I hope you have an easing of symptoms, concrete answers, and a clear path forward.
Michelle G.
September 2, 2026 at 4:57 pmSan, I’m SO happy that your heart test came back good, and now you can put that worry behind you. It would be interesting to try a Continuous Glucose Monitor. I think you can try a Stelo (over-the-counter) for around $90/month. There are several different options. It’s what I use to help with my Diabetes, and it’s really interesting to see how exercise affects my blood glucose. It’s totally painless to attach it. If nothing else, it’s a cool experiment, especially since you like those kinds of stats! Anyway, wonderful news about your echocardiogram. Thank you for the update!
ernie
September 2, 2026 at 8:40 pmUgh. This sounds so frustrating. I’m relived there seems to be nothing wrong with your heart. I wonder if you’re on to something with hormone issues. I had hot flashes but nothing else that was off the charts like this. I hope they are able to pinpoint something soon and can help you prevent the episodes from happening. They sound so unpleasant.
Anya
September 3, 2026 at 4:53 amI have a hormonal IUD so there’s no tracking my cycles. What I will say is, my worst symptoms were VERY poor sleep and insane sweating at night. My sleep has been bad the past few years, along with the night sweats, but it got even worse last fall. A year prior, I had my old gyno test my hormones and everything seemed fine. Another doctor encouraged me to see a gyno who deals with HRT, so that’s exactly what I did and ended up adding Estradiol (I’m already getting progesterone through the IUD). My sleep is mostly back to normal – it’s still not great but it’s not like it was last fall, and enough to get through the day, and the night sweats have mostly stopped. I was talking to my mom recently about this and at my age, she had breast cancer and was put into menopause through medication; these were her exact symptoms, so now I’m convinced it’s peri.
Nicole MacPherson
September 3, 2026 at 8:36 amIt sure could be perimenopause related. I had racing heart and elevated HRH, along with other symptoms. It’s worth an investigation for sure. My doctor did NOT test my blood for hormone levels. She said that it was a useless test because I was still getting my period, and so my hormones would be all over the place depending on the time of month that the blood was taken. So she just – wait for it – BELIEVED ME about my symptoms and immediately prescribed a low-dose HRT. And it has been life changing! I feel SO much better.
Another thing to consider is stress/ anxiety. Sometimes stress sneaks up on it, even if we think we are doing well at managing it. The body keeps the score as they say.
Hope you get it all figured out, what a journey.
Stephany
September 4, 2026 at 8:24 amI basically had the same experience as you with my heart problems! I *do* think mine were steroid-related because a lot of the issues resolved as I lowered my steroid dose, so that helps. And now every time I think I’m having chest pain, I remind myself that my echo was fine and the cardiologist isn’t worried about my heart! That helps with my health anxiety, lol.
That’s an interesting theory about perimenopause. I just bought The New Perimenopause book because I’m probably still a few years (at least) away from perimenopause but I’d like to be prepared! Might be helpful for you!
J
September 4, 2026 at 9:02 pmI remember years ago having a racing heart, and not having any idea why. It was my only symptom and it wasn’t as severe as yours, so I never talked to anyone about it, other than to write a blog post about how I couldn’t settle sometimes and I didn’t know why. Looking back, I am sure it was perimenopause. I’m so glad there is so much more information about it now. I think adding a mid afternoon snack to your day when you are in that part of your cycle sounds really smart. I’m talking to my doctor about HRT, wondering if I missed my window or not, and when I asked about hormone testing, I got the same answer others have mentioned…it’s too much of a snapshot (even at 60) of a moment, not your overall hormones. Which makes me wonder why they bother testing it at all.
Tobia | craftaliciousme
September 5, 2026 at 12:39 amThis is frustrating to see some patterns and yet no results. At least your heart is healthy and that is great.
When I read your first article I immediately thought of perimenopause. I had recently read a piece where someone mentioned similar things. Unfortunately I didnt save it and I didn’t want to spread any half knowledge but now I do mention it. It was also from a study or a scientist this much I remember. Maybe I had seen it at the IG account of Dr. Mary Claire Haver.
Hope you find some answers.