An older woman's heart races and flutters. Is it a sign of cardiovascular problems or is it maybe a symptom of menopause?

New research shows that the palpitations are a distressing problem for roughly 25% of women during menopause, but those feelings of a pounding heart or skipped heartbeat have been the subject of very little research, said study author Janet Carpenter. She's an associate dean of research at Indiana University School of Nursing, in Indianapolis.

"We're not really sure what they are. We're not sure if they really need a cardiac workup when they're experiencing the palpitations, and that is something that we hope to learn a little bit more about," Carpenter said.

The purpose of Carpenter's study was to investigate menopausal palpitation distress in women by analyzing data from clinical trials on menopausal health.

In the new study, Carpenter's team recorded palpitation distress if a woman reported any distress related to heart racing or pounding over the previous two weeks. The odds of a woman reporting palpitation distress was higher among women who suffered from insomnia, depression, and stress. In that subgroup, nearly 34% reported heart palpitations.

It's not clear whether these palpitations reflect changes that could be seen on an electrocardiogram, if these are cardiac arrhythmias or if they are just passing sensations, Carpenter said.

"I think if they didn't have a relation to quality of life and they weren't related to some of these other symptoms, and it was only a quarter of the women, we might say, 'Oh, well, you know, maybe this is no big deal.' But I think based on our findings, I think the findings in this article are really spurring us on to do more research," Carpenter said.

The report was published online recently in the Journal of Women's Health.

"I feel like it's an area where we might really find out something that could make a difference for women," Carpenter said.

Women can track their heart palpitations and talk with a healthcare provider about them, Carpenter suggested, paying attention to other symptoms that may be related to arrhythmias, such as dizziness or shortness of breath.

Women can experience a range of symptoms during menopause, including sleep disturbances, mood issues and joint aches. Hot flashes and night sweats happen because of changes in the central and peripheral nervous systems, said Dr. Stephanie Faubion, medical director of the North American Menopause Society.

That could also be the cause of palpitations, Faubion noted. Anxiety symptoms are fairly common in menopause and can contribute to these sensations. Most of the time, doctors don't see a woman with palpitations in isolation, but along with other symptoms, she said.

"We don't necessarily assume it's all for menopause. We do often work these women up for heart disease because of these symptoms. I think we do women a disservice when we just say it's related to anxiety or blow it off in some way," Faubion said.

"I think it is manageable and once we make sure there's no structural heart disease or arrhythmias that are going on, these are treatable symptoms and often do respond," Faubion said. "We don't know if hormone therapy addresses this symptom specifically, but it does tend to address menopause symptoms globally. So often you will see them anecdotally go away when we put women on hormone therapy."

Women considering the use of hormone replacement therapy should talk with their doctors because it has been tied to health risks in previous research.

But, Faubion said, lifestyle changes — including avoiding weight gain, maintaining a healthy diet and regular exercise, and avoiding too much alcohol or caffeine — can also help treat menopause symptoms.

She referenced an American Heart Association report published in November that featured menopause as a cardiovascular risk.

This "is the first time that a major organization like the American Heart Association has acknowledged that menopause and loss of estrogen convey cardiovascular risks," Faubion said. "I think it's really important that women understand that this is a time when their risk really goes up and they really need to be taking action to reduce their risk."