A Sinking Sensation in the Chest: The Truth Behind Palpitations That Worsen During the Climacteric

The palpitations experienced by women during the climacteric are not merely psychological; they are directly connected to complex biochemical changes occurring within the body. The primary driver is the sharp decline in the female sex hormone estrogen. Estrogen does not solely govern reproductive function, but also provides protective and regulatory support throughout the body, including the cardiovascular system. As estrogen declines, vascular flexibility diminishes and blood pressure regulation weakens, placing greater strain on the heart. An even more notable change is the disruption of the autonomic nervous system. The autonomic nervous system manages heart rate, blood pressure, digestion, and respiration independent of conscious control, divided between the sympathetic nerve engaged during tension and the parasympathetic nerve active during rest. Estrogen directly influences autonomic control regions such as the hypothalamus. When estrogen levels fall, this regulatory balance is disrupted, leading to sympathetic hyperactivity. Much like an emergency alarm sounding in error, the heart beats faster than needed, blood vessels constrict, and the body remains unnecessarily tense. This sympathetic surge brings about not only palpitations, but also anxiety, restlessness, and insomnia. Furthermore, the facial flushing and hot flashes common to the climacteric arise when an unstable thermoregulatory center leads to dilated blood vessels and a temporary increase in heart rate. Adrenaline release stimulated during this process can also trigger palpitations. In addition, falling estrogen levels disrupt neurotransmitters such as serotonin and norepinephrine, compounding feelings of anxiety and low mood, which in turn reactivates the autonomic nervous system in a continuous cycle. Donguibogam's description of heart fire flaring due to a deficiency in kidney water closely aligns with modern understandings of sympathetic hyperactivity driven by estrogen decline, in which the heart becomes overheated and unsettled. Reestablishing balance between body and mind remains essential.