What Is POTS?
Postural Orthostatic Tachycardia Syndrome or Postural Tachycardia Syndrome, commonly called POTS, is a disorder of the autonomic nervous system. This part of the nervous system controls “automatic” body functions such as heart rate, blood pressure, digestion, and temperature regulation.
In people with POTS, the body has trouble adjusting to upright posture. When standing, instead of blood flowing smoothly back to the heart and brain, it tends to pool in the lower body. To compensate, the heart races — often rising 30 beats per minute or more within 10 minutes of standing. This sudden jump can cause symptoms such as:
- Dizziness or lightheadedness
- Palpitations (racing or pounding heartbeat)
- Fatigue and weakness
- “Brain fog” or trouble concentrating
- Nausea or digestive upset
- Blurred vision
- Sometimes fainting
- Headache
- Anxiety
- Difficulty breathing
These symptoms typically improve when lying down.
Why Are More People Developing POTS?
Even before 2020, POTS was underrecognized but not rare — affecting an estimated 1 to 3 million people in the United States. Since the COVID-19 pandemic, cases have increased significantly.
Many people develop POTS after recovering from a COVID infection, while others notice their symptoms as part of what’s now called “long COVID.” The exact reason isn’t fully known, but several theories include:
- Immune system changes: Viral infections may trigger the immune system to mistakenly affect the body’s own nerves or blood vessels.
- Inflammation or nerve injury: COVID may damage small nerve fibers that help control circulation.
- Unmasking hidden tendencies: Some people may have had mild or unnoticed symptoms before, and COVID tipped them into more obvious POTS.
Research is ongoing, but doctors agree the rise in POTS after COVID is real.
The Influence of Hormones
POTS is diagnosed much more often in women than in men, and symptoms often fluctuate with hormonal changes. Many women notice worsening before a period, around ovulation, or during perimenopause.
Hormones like estrogen and progesterone affect blood volume and how blood vessels tighten or relax. These shifts can amplify the circulatory challenges already present in POTS. Recognizing this pattern can help patients and providers plan around symptom flares.
Why Diagnosis Often Takes So Long
Getting diagnosed with POTS can be frustrating. Many people go months or years before getting the right answer. Reasons include:
- Overlapping symptoms: Fatigue, palpitations, and dizziness also occur with anxiety, thyroid disease, heart rhythm problems, and many other conditions.
- Normal test results: Standard labs, heart ultrasounds, or EKGs may look normal, making doctors think nothing is wrong.
- Limited awareness: Not all providers are familiar with POTS, and specialized autonomic testing isn’t available everywhere.
The good news is that awareness is growing, and more providers now recognize the signs.
How POTS Is Diagnosed
We typically look at several factors:
- Heart rate increase: A rise of 30 beats per minute (40 in patients under 20 years old) within 10 minutes of standing, without a big drop in blood pressure.
- Chronic symptoms: Symptoms must be present for at least three months.
- Ruling out other causes: Conditions like dehydration, anemia, or thyroid disease need to be excluded.
Testing may include:
- Active stand test: Heart rate and blood pressure are checked lying down and again after standing.
- Tilt-table test: The patient is strapped to a table that tilts upright while vital signs are monitored.
- Laboratory tests: To check for thyroid issues, anemia, adrenal insufficiency or other contributing factors.
- ECG or echocardiogram: To rule out heart disease.
First Steps in Managing POTS
There’s no single cure, but many people find meaningful improvement with lifestyle changes. Some of the simplest, most effective first steps include:
1. Increase Fluids and Salt
- Aim for 2–3 liters of water per day.
- Boost salt intake (about 1–2 teaspoons per day, or as directed by a provider) through food, salt tablets, or electrolyte drinks.
This helps the body hold onto more fluid, supporting blood pressure and circulation.
2. Avoid Triggers
- Heat: Hot showers, saunas, or summer heat often worsen symptoms.
- Prolonged standing: Waiting in long lines or standing still can trigger dizziness.
- Large meals: These can cause blood to pool in the stomach. Eating smaller, more frequent meals may help.
- Overexertion: Pushing too hard with activity can cause setbacks.
3. Use Compression
Waist-high compression stockings or abdominal binders help prevent blood from pooling in the legs and abdomen.
4. Exercise Smartly
Although exercise may feel impossible at first, a gradual approach helps:
- Start with reclined activities like rowing, recumbent cycling, or swimming.
- Slowly increase endurance and strength over weeks to months.
- Focus on lower-body and core strength to help blood circulation.
As always, it’s important to talk with your provider before making any changes.
Living with POTS
For many, POTS is a long-term condition, but symptoms often improve over time with the right strategies. Some people need medications in addition to lifestyle changes, such as low-dose beta blockers or drugs that help raise blood pressure, though these are usually added under the care of a specialist.
POTS is often associated with conditions like Ehlers-Danlos syndrome (EDS) and can share similar symptoms with Chiari malformation, Mast cell activation syndrome (MCAS), and panic disorder, so it’s important to discuss these possibilities with your provider and consider further evaluation if symptoms overlap.
Keeping a symptom diary, tracking fluid and salt intake, and learning personal triggers can all help people with POTS feel more in control. Other tools can include botanical medicine, homeopathy, and craniosacral therapy.
Outlook
The surge in POTS after COVID has brought much-needed attention to a condition that used to fly under the radar. While research continues, there is now greater recognition that POTS is real, manageable, and worthy of care. Unfortunately, like many women’s health issues, it remains underfunded and under-researched, which means there is still so much we don’t yet understand.
At our clinic, we’ve been aware of POTS for several years, even before COVID, and have been honored to walk alongside patients on their POTS journey, helping them feel more like themselves again.
For people living with POTS, early diagnosis and simple daily strategies, like hydration, electrolytes, avoiding heat, and pacing activity, can be life-changing. And for clinicians, increasing awareness means fewer people will be left searching for answers in the years to come.
For those who want to learn more, an excellent resource is Dysautonomia International.
