Menopause Medication Consultation: Addressing Heart Palpitations and Hormonal Changes

Q: Menopause Medication Consultation: Addressing Heart Palpitations and Hormonal Changes

Hello Ms. <br>Eva： If your palpitations are caused by hormone deficiency, you will see improvement after taking hormones. <br>If you take hormones but do not take cardiology medications and your palpitations do not improve, it indicates that the issue is purely cardiac. <br>In th

Menopausal medication consultation

Hello, Dr.
Huang.
Last September, I suddenly experienced palpitations all day, anxiety accompanied by panic, frequent urination, and insomnia (I was completely unable to sleep).
After a gynecological examination, I learned that I was in menopause (and indeed, I stopped menstruating the following month).
I also underwent a 24-hour Holter monitor and echocardiogram at the cardiology department, where the cardiologist diagnosed me with mild mitral valve prolapse and moderate tricuspid regurgitation.
Consequently, I was prescribed antiarrhythmic medication to take after each meal.
I have been on this regimen for three and a half months, taking one tablet of Concor in the morning and half a tablet in the evening, along with one antiarrhythmic tablet after each meal, and one tablet of Sitalopram before bed.

I would like to ask you:
1.
Is my all-day palpitations, which require me to take antiarrhythmic medication after each meal (with my heart rate exceeding 100 beats per minute if I miss a dose), caused by the mitral valve prolapse and moderate tricuspid regurgitation, or is it due to the lack of hormones in menopausal women? (I had no symptoms prior to menopause.)
2.
Will the symptoms of all-day palpitations improve after I continue hormone replacement therapy? (I forgot to ask the cardiologist during my last visit, so I am consulting you.)
3.
Currently, I have seen improvements in anxiety, panic, frequent urination, and insomnia due to the medications from the psychosomatic department.
How long should I continue hormone replacement therapy before I can gradually reduce and eventually stop the medications for these psychosomatic symptoms? Thank you!

eva, 40~49 year old female. Ask Date: 2017/01/10

Dr. Huang Yiwen reply Obstetrics and Gynecology

Hello Ms.
Eva: If your palpitations are caused by hormone deficiency, you will see improvement after taking hormones.
If you take hormones but do not take cardiology medications and your palpitations do not improve, it indicates that the issue is purely cardiac.
In that case, you should continue taking the cardiology medications.
It is also recommended that you take hormone therapy for about six months to a year, but for the medications related to mental health, you should work with a psychiatrist to see if you can discontinue them.
After all, symptoms of anxiety and panic sometimes do not have a direct correlation with menopause.

Reply Date: 2017/01/10

More Info

Hello! It sounds like you are experiencing a complex interplay of symptoms related to menopause, heart conditions, and possibly anxiety. Let's break down your questions and concerns regarding heart palpitations, hormonal changes, and medication management.

1. Heart Palpitations and Valve Issues: The palpitations you are experiencing could be attributed to several factors. Mitral valve prolapse (MVP) and moderate tricuspid regurgitation can indeed lead to palpitations, as these conditions can affect the heart's ability to pump blood effectively and may cause irregular heart rhythms. However, hormonal changes during menopause can also significantly impact heart function. The decrease in estrogen levels can lead to increased sympathetic nervous system activity, which may cause symptoms like palpitations, anxiety, and even panic attacks. Therefore, it is plausible that both your heart conditions and hormonal changes are contributing to your symptoms.
2. Impact of Hormone Replacement Therapy (HRT): As you continue with hormone replacement therapy, it is possible that your symptoms may improve. Estrogen has a protective effect on the cardiovascular system, and many women report a reduction in palpitations and anxiety symptoms after starting HRT. However, the response to HRT can vary from person to person. It may take some time to see significant changes, and it’s essential to have regular follow-ups with your healthcare provider to monitor your symptoms and adjust your treatment plan as necessary.

3. Duration of Hormone Therapy and Medication Management: Regarding the duration of hormone therapy and the potential tapering of your psychiatric medications, this is a nuanced topic. The timeline for reducing or stopping medications like those for anxiety and panic can depend on how well your symptoms are managed with hormone therapy. It is generally recommended to reassess the need for psychiatric medications after a few months of stable hormone levels and symptom improvement. Your healthcare provider will be the best resource for determining when and how to taper these medications safely. It is crucial to do this under medical supervision to avoid withdrawal symptoms or a resurgence of anxiety.

In summary, your heart palpitations are likely influenced by both your underlying heart conditions and the hormonal changes associated with menopause. Continuing with your prescribed medications and hormone therapy, while maintaining regular check-ups with your healthcare providers, is essential. They can help you navigate these changes and adjust your treatment plan as needed. If you notice any worsening of symptoms or new concerns, do not hesitate to reach out to your healthcare team for further evaluation and support.
Take care, and I hope you find relief from your symptoms soon!

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