What treatment is recommended for hormonal fluctuations causing dizziness and heart palpitations?

Treatment for Hormonal Fluctuations Causing Dizziness and Heart Palpitations

Beta-blockers such as metoprolol are the first-line treatment for hormonal fluctuation-related dizziness and heart palpitations, particularly when symptoms are moderate to severe. 1, 2

Diagnostic Approach

When evaluating hormonal fluctuations causing dizziness and palpitations, consider:

• Laboratory testing: Complete blood count, electrolytes, glucose, and thyroid function tests 1
• Cardiovascular assessment: 12-lead ECG to assess for arrhythmias 1
• Timing of symptoms: Relationship to menstrual cycle, pregnancy, or perimenopausal status 3

Treatment Algorithm Based on Severity

Mild Symptoms

• Lifestyle modifications:
  • Avoid triggers (caffeine, alcohol, nicotine)
  • Adequate hydration
  • Regular meals to maintain stable blood glucose
  • Avoid excessive heat exposure 1
• Paracetamol (acetaminophen) for symptomatic relief 1

Moderate to Severe Symptoms

1. Beta-blockers:

   • Metoprolol or propranolol are first-line medications for arrhythmia-related dizziness 1, 2
   • Dosing should start low and be titrated based on symptom control
   • Monitor for side effects including fatigue, cold extremities, and bradycardia 2

2. Hormone therapy considerations:

   • For perimenopausal women: Consider hormone therapy if symptoms are clearly related to hormonal fluctuations 4
   • For women with menstrual cycle-related symptoms: Evaluate for potential benefit of hormonal regulation 3

3. Treatment of underlying endocrinopathies:

   • Thyroid disorders: Thyroxine replacement for hypothyroidism 5
   • Other endocrine disorders: Address electrolyte imbalances and treat the underlying endocrinopathy 5

Special Considerations

Pregnancy

• Beta-1 selective blockers (metoprolol) may be used with caution for arrhythmia-related dizziness 1
• Manual therapy of cervical and thoracic spine may be considered 1
• Avoid activities with risk of falling 1

Perimenopause

• Symptoms are usually benign and related to increased sympathetic activity 3, 4
• Beta-blockers can effectively manage palpitations and associated dizziness 1, 2

Red Flags Requiring Immediate Attention

• Severe symptoms with hemodynamic instability
• Dizziness with neurological symptoms
• Persistent symptoms despite treatment
• Dizziness with significant cardiac symptoms 1

Monitoring and Follow-up

• Patients with moderate symptoms should have follow-up within 1-2 weeks 1
• ECG monitoring may be necessary if symptoms persist despite treatment 6
• Consider ambulatory ECG monitoring (Holter or event monitor) for patients with frequent but unpredictable episodes 6

Pitfalls to Avoid

• Don't attribute all symptoms to hormonal fluctuations without ruling out structural heart disease or arrhythmias 5, 6
• Avoid prescribing class I or III antiarrhythmic drugs without documented arrhythmia due to proarrhythmic risk 5
• Don't overlook thyroid dysfunction, which can cause both palpitations and dizziness 5
• Remember that palpitations may be perceived differently by each patient and may not correlate with actual arrhythmias 6

Beta-blockers remain the cornerstone of treatment for these symptoms, providing relief by reducing sympathetic tone and controlling heart rate, which addresses both the palpitations and associated dizziness.