Cardiovascular disease is the leading cause of death among women in Australia, and research shows that the risk increases after menopause. A recent Australian study found that women who experience menopause before the age of 45 face a higher likelihood of developing heart disease compared to those who go through menopause later. However, adopting a healthy lifestyle—avoiding smoking, staying active, maintaining a balanced diet, and getting enough sleep—can significantly lower this risk, regardless of when menopause occurs.
Now, new research suggests that up to one in four women develop an irregular heartbeat or atrial fibrillation after menopause. Stressful life events—such as divorce—and insomnia appear to be key contributors to this increased risk.
The study analysed data and found that women experiencing high levels of stress or poor sleep had a significantly higher likelihood of developing atrial fibrillation, a condition where the heart beats irregularly and often too fast. The researchers identified a “Stress Cluster,” linking factors like depressive symptoms, life stressors, and sleep disturbances to the development of heart rhythm disorders.
So, what does this mean for postmenopausal women, and how can they protect their heart health? Experts explain what women should know and the best ways to reduce their risk.
Why might someone develop an irregular heartbeat after menopause?
Research has already found that women have a “notable increase in the risk” for heart disease after menopause. It points out that “distinct patterns of sex hormone changes,” as well as changes in body composition and lipids (fatty compounds in the body), seem to play a role.
Cardiologist Dr David Slotwine says the drop in estrogen levels during menopause can have a direct impact on the cardiovascular system. “Oestrogen plays a role in regulating the autonomic nervous system which controls the heart rate and can affect the heart rhythm,” he explains. As estrogen levels go down, some women may have irregular heartbeats or feel like their heart is racing or fluttering, he says. This, Dr Slotwiner notes, “can be distressing and alarming,” especially for women who have never had them before.
But this study also found that stress—both mental and physical—seems to play a role, points out cardiac electrophysiologist and cardiologist Dr Sarina van der Zee.
“Stress in many forms is a known trigger for atrial fibrillation,” Dr van der Zee says. “The stress response, including hormonal activation and inflammation, impacts the cardiovascular system directly and affects other aspects of health, including sleep, weight and alcohol use, which are known to be atrial fibrillation risk factors.”
The link between insomnia and menopause isn’t new: Data from the National Institutes of Health (NIH) found that sleep disturbances like insomnia vary from 16% to 42% before menopause, from 39% to 47% during perimenopause (the period leading up to menopause) and from 35% to 60% after menopause. Researchers have theorised changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, lifestyle and other medical conditions may play a role.
“Hormones play a fundamental role in healthy and continuous sleep,” says neurologist and sleep medicine physician Dr W. Christopher Winter.
The study also notes online that being an older adult is a risk factor for atrial fibrillation but doesn’t specifically call out menopause as a reason.
Cardiologist Dr Susan X. Zhao says that she’s noticed in her patients that poor sleep and negative feelings can raise the risk of an irregular heartbeat in postmenopausal women, even if someone is in “very good physical health.”
Why is atrial fibrillation concerning?
Atrial fibrillation on its own may not always cause immediate harm, but it significantly increases the risk of serious health conditions, including:
- Stroke
- Heart failure
- Chronic fatigue
- Other heart rhythm problems
- Inconsistent blood supply
“Atrial fibrillation impacts both health and quality of life,” says Dr Zhao. “It also comes with significant healthcare costs due to the sheer number of people affected.”
What are the symptoms of atrial fibrillation?
Some people with AF may not experience noticeable symptoms. However, when symptoms do occur, they may include:
- A fast, fluttering or pounding heartbeat
- Chest pain or discomfort
- Dizziness
- Fatigue
- Lightheadedness
- Reduced ability to exercise
- Shortness of breath
- Weakness
AF can vary in severity. Some people experience episodes that last a few minutes or hours before resolving, while others may have a persistent irregular heartbeat requiring ongoing medical management.
How is AFib treated?
Treatment for atrial fibrillation varies depending on symptoms and underlying causes. It often involves a combination of lifestyle adjustments, medication and medical procedures.
Managing AF usually begins with heart-healthy habits. Regular physical activity, a balanced diet low in salt, saturated fats, trans fats and cholesterol and maintaining a healthy weight all support heart health. Controlling high blood pressure and cholesterol, reducing stress and limiting alcohol and caffeine intake are also recommended.
If lifestyle changes aren’t enough, medication may be needed. Beta blockers help slow the heart rate, calcium channel blockers regulate heart rhythm and blood thinners reduce the risk of stroke by preventing blood clots.
For some people, medical procedures may be necessary. Cardioversion, which uses controlled electrical shocks or medication, may help reset the heart’s rhythm, particularly for first-time episodes. Ablation therapy targets and removes the heart tissue responsible for irregular electrical signals, while surgical options such as a pacemaker implant or maze procedure may be considered in severe cases where other treatments are ineffective.
If symptoms like irregular heartbeats, dizziness, or shortness of breath occur, it’s important to see a doctor. Dr Slotwiner advises being prepared to discuss when symptoms happen, how long they last, and any other sensations that accompany them. A full evaluation will help determine the best approach for managing AF and reducing health risks.
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