How to Improve Heart Rate Variability (HRV) in Perimenopause

Heart rate variability (HRV) is a powerful marker of nervous system health, stress resilience, and cardiovascular function. It measures the variation in time between heartbeats, giving insight into how well your body adapts to stress and recovers.

For those of us in perimenopause, hormonal shifts—especially fluctuating estrogen levels—can lower HRV, making it harder to handle stress, sleep well, and maintain heart health. A lower HRV is linked to more intense perimenopausal symptoms like hot flashes, anxiety, and poor sleep, all of which can further impact overall well-being. The good news? You can improve HRV naturally with a few key lifestyle shifts.

Why HRV Matters in Perimenopause

Your autonomic nervous system (ANS) controls HRV, balancing between the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) responses. Ideally, your body can switch between these states as needed, but chronic stress, poor sleep, and hormonal changes can keep you stuck in high alert mode—lowering HRV and making you feel wired yet exhausted.

Boosting HRV helps your body become more adaptable, promoting better sleep, a calmer mind, and improved heart health. Here’s how to do it:

8 Ways to Improve HRV in Perimenopause

1. Prioritize Quality Sleep

Sleep disruptions are common in perimenopause, and poor sleep tanks HRV. To improve sleep:

• Set a consistent bedtime and wake-up time (yes, even on weekends).

• Keep your room cool, dark, and quiet. A temperature around 65°F (18°C) is ideal.

• Limit blue light exposure before bed. Reduce screen time at least an hour before sleep and wear blue light blocking glasses if you need to be on a screen later in the day.

• Support melatonin production naturally. Dim the lights in the evening, get morning sunlight exposure, and avoid caffeine from mid day on.

• Regulate your blood sugar at night. A small protein-based snack before bed may help prevent blood sugar dips that wake you up.

• Address nighttime cortisol spikes. If you wake up between 2-4 AM feeling wired, try magnesium glycinate or an adaptogenic herb like ashwagandha to support your stress response.

• Any amount of alcohol can disrupt your sleep.

2. Move Your Body Daily

Regular exercise is one of the best ways to increase HRV and support hormone balance. Focus on:

• Strength training 2-3 times a week to build muscle and support metabolism.

• Walking or light movement daily to avoid long periods of sitting.

• Low-intensity activities like yoga or Pilates to stimulate the parasympathetic nervous system.

3. Practice Breathwork & Relaxation

Deep, controlled breathing increases HRV by activating the vagus nerve, which promotes relaxation. Try:

• Box breathing: Inhale for 4 seconds, hold for 4, exhale for 4, hold for 4. Repeat.

• Extended exhales: Breathe in for 4 seconds, out for 6-8 seconds.

• Single nostril breathing: Close one nostril and breathe deeply through the other, switching sides after a few breaths. This can calm the nervous system and balance energy.

• Heart-centered breathing: Inhale deeply while focusing on gratitude or calmness.

4. Manage Stress (Instead of Letting It Manage You)

Chronic stress lowers HRV, so building daily stress management habits is key. A few options:

• Morning sunlight exposure to regulate cortisol and circadian rhythm.

• Journaling or gratitude practice to shift your mindset.

• Cold exposure (like a cold shower or splash of cold water on your face) to stimulate/improve the tone of the vagus nerve. (Gargling, humming and singing can also do this.)

• Epsom salt baths in the evening to promote muscle relaxation and nervous system recovery.

• Lymphatic support: Dry brushing or rebounding (jumping on a mini-trampoline) can help move stagnant energy and reduce stress buildup.

• Boundaries and saying no to extra things.

Learning to conserve energy is a huge factor in nervous system regulation during perimenopause.

5. Eat for Blood Sugar Balance

Fluctuating blood sugar levels can negatively impact HRV and energy. To support stable blood sugar:

• Prioritize protein and healthy fats at every meal (yes, breakfast too!)

• Don’t eat carbs without protein, fat or veggies.

• Reduce processed foods and sugar.

• Time your eating window (intermittent fasting) to align with your body’s needs and best fit for your lifestyle.

6. Stay Hydrated

Dehydration can lower HRV and increase stress on the body. Aim for at least half your body weight (lbs) in ounces (8 oz = 1cup = 250ml) of filtered water per day and add electrolytes if needed, especially if you’re active or fasting.

7. Reduce or Eliminate Alcohol

Alcohol and nicotine both decrease HRV by increasing stress on the nervous system. Even occasional alcohol consumption can interfere with HRV, sleep quality, and recovery. (1 glass of wine has been shown to negatively effect your sleep for up to 3 days.)

8. Track & Monitor HRV

Wearable devices like the Oura Ring (my fav) can help you track HRV trends and see how your habits impact your nervous system over time. Keep in mind: HRV is personal, and trends matter more than daily fluctuations.

The Bottom Line

Your body is incredibly adaptable, and by making small, consistent changes, you can improve HRV, support heart health, and reduce perimenopausal symptoms. Prioritize recovery, movement, sleep, and stress management, and your nervous system (and hormones) will thank you.

Check in with your perimenopause healthcare practitioner before you make major changes in your lifestyle. The information in this article is not direct medical advice.

References:

• Understanding the Connection Between Menopause and Heart Rate Changes

• Heart Rate Variability and Perimenopause: A Research Perspective

• Tracking HRV in Perimenopause: The Oura Ring Report