POTS: What is it and why is it “Trending” Among Young Women?

Written by: Eleanor McKown

Edited by: Amanda Benneh, Wajiha Moin, Anusha Raghunathan, and Alanna Xue

Illustrated by: Teniola Obayomi

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Introduction to POTS

For some people, what seems like a simple movement, going from sitting to standing, can trigger a wave of dizziness, a sudden rush of heat, or a pulse that feels like it is sprinting. Many do not know that this everyday struggle has a name. Postural Orthostatic Tachycardia Syndrome (POTS) is defined as an autonomic disorder that affects the ability of one's body to adjust to an upright position. When someone with this syndrome stands, their heart rate increases by more than 30 beats per minute within five minutes of standing, without a decrease in blood pressure [1]. This is a syndrome of dysautonomia, meaning dysfunction of the autonomic nervous system, the part of your body that regulates automatic functions like heart rate, blood pressure, and digestion. This causes a variety of symptoms, including dizziness, palpitations, fatigue, fainting, brain fog, etc.

Once considered rare, POTS is now recognized as a common cause of chronic dizziness and fatigue among young women. In fact, around 80% of POTS cases are in young women. The condition most frequently affects individuals between 15 and 45 years old, with an estimated prevalence of 0.2–1% of the global population [4]. The term “POTS” was first introduced in 1993 by Schondorf and Low from the Mayo Clinic to describe a sudden-onset form of idiopathic dysautonomia with hyperadrenergic symptoms and abnormal heart rate acceleration [1].  Since then, the once obscure diagnosis has grown into what some might call a “trending” diagnosis, especially in the aftermath of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. 

Following the COVID pandemic, it has been found that between 2–-14% of individuals who get COVID develop POTS and 9-61% experience similar symptoms [4]. In addition, women experience extreme diagnostic delays and dismissal compared to men. One study found that female patients wait on average seven years for a corrected diagnosis, while men wait 3.8 years on average [4]. Women are also likely to have their symptoms dismissed as psychological; they are 2.6 times more likely to be placed on a mental health treatment plan [4]. This combination of gender bias and post-viral infection onset has made POTS a medical and social issue that reveals the inequities in the women's health system.

Mechanisms and Symptoms

POTS is fundamentally a disorder of orthostatic intolerance, meaning that a person cannot remain upright without developing symptoms [2]. When a healthy person stands, gravity causes blood to shift downward, and the autonomic nervous system quickly compensates by tightening blood vessels and increasing heart rate slightly. In someone with POTS, this compensation does not happen effectively because of the disruption of the autonomic nervous system. So, standing leads to an increase in heart rate, dizziness, lightheadedness, shortness of breath, nausea, and sometimes fainting. Other common symptoms for patients include fatigue and brain fog.

A contributor to these symptoms is a reduced blood volume, known as hypovolemia. Individuals with POTS tend to have lower blood volume circulating around the body, which limits the return of blood to the heart when standing [1]. Upon standing, the body tries to maintain blood pressure by increasing heart rate, leading to the many symptoms patients experience.

Another proposed mechanism of these symptoms is related to autoimmunity. After viral infections, including COVID, some people develop autoantibodies that target different receptors in the body. These receptors help regulate blood vessel contraction and heart rate, so when autoantibodies interfere with the receptors, they do not signal appropriately. This leads to blood vessels not tightening appropriately upon standing, forcing the heart to work harder. This proposed mechanism helps to explain why POTS often coexists with other immune-related conditions.

POTS symptoms are triggered by factors that people experience every day. Heat, including hot showers or even summer weather, dilates blood vessels within the body, leading to ineffective circulation and symptoms like blood pooling and dizziness. Dehydration lowers an individual's blood volume. Physical exertion causes dramatic jumps in heart rate. In the early morning, the circulating blood volume tends to be the lowest. In addition, fever and menstruation can also worsen symptoms. Each of these triggers causes worsening symptoms for people with POTS, making everyday unpredictable and even disabling. 

Management and Treatment

There is no “cure” for POTS, only symptom management. The main treatment involves lifestyle adjustments, including increasing fluid intake, consuming more salt, wearing compression garments, and gradually increasing physical activity. Medications like beta blockers are also used to control symptoms and regulate blood pressure [1].  Some patients find that getting regular saline infusions improves their symptoms. Outcomes of individuals vary; it has been found that half of patients recover from POTS symptoms within one to three years of diagnosis, but that is still half of those who are experiencing these chronic symptoms [1]. Beta-blockers are typically used for the treatment of arrhythmias, heart failure and coronary artery disease. But, their main mechanism is that they dilate blood vessels and doing so reduces heart rate, blood pressure, and the amount of work the heart has to do [7]. This can be effective for POTS patients in reducing the symptoms they experience upon standing.

Why POTS affects young women disproportionately

The gender gap in POTS can be attributed to distinct underlying biological factors. Women have lower blood volume, stroke volume, and vasoconstrictor capacity compared to men. This means that women have less blood moving around their body because there is less blood being pumped by the heart. This makes women more prone to blood pooling and compensatory tachycardia [4]. Hormones also play a role, estrogen is a hormone that can influence vascular tone and sympathetic nerve activity. This contributes to the lower arterial pressure and greater orthostatic intolerance that women with this syndrome experience [4].

Women with POTS frequently have overlapping comorbidities, including endometriosis, mast cell activation syndrome (MCAS), and Ehlers-Danlos syndrome (EDS) [4]. In addition, autoimmune conditions like Hashimoto’s thyroiditis, Sjögren’s syndrome, and rheumatoid arthritis occur more often in women and are reported to occur in 20-50% of POTS patients [4]. Around 58% of women with POTS report having one or more gynecological disorders, with 21.9% of those being endometriosis [4]. 

Women are disproportionately told their symptoms are psychological. The syndrome's symptoms, racing heart, dizziness, and shortness of breath, can mimic anxiety. But this leads to diagnostic delays and unnecessary psychiatric treatments. Patients with POTS experience significant distress from this disorder, with 70% reporting income loss, and 25% are unable to work because of chronic symptoms [4].

POTS and Covid Links

As seen by the surge in POTS diagnosis following COVID, viral infections and autonomic dysfunction are highly connected. In what's known as post-viral autonomic dysfunction, COVID can trigger autoimmune reactions, causing the body to produce antibodies that are involved in blood vessel control and heart rate regulation [3]. This is similar to the mechanisms associated with POTS, thus why they present so similarly. Long COVID and POTS also share many symptoms, including fatigue, tachycardia, exercise intolerance, and cognitive impairment. Researchers have identified several shared physiological disruptions: autoantibody formation, chronic hypovolemia, impaired baroreflex sensitivity, and increased sympathetic activation [4, 7]. These overlapping processes help explain why a significant portion of long-COVID patients fit the diagnostic criteria for POTS.

Conclusion

POTS is ultimately a condition that reflects the underplay of physiological vulnerability, post-viral immune response, and patterns of diagnosis that leave women disproportionately affected. As research continues to clarify the mechanisms behind POTS, it becomes increasingly important for clinicians to recognize the condition early and take patients’ symptoms seriously rather than attributing them to anxiety or stress. POTS is not a “trending” diagnosis but an overdue acknowledgment of a chronic and often disabling disorder that has been underrecognized for decades, particularly among women. Understanding the biological and social factors that shape this condition is essential for improving outcomes and reducing the inequities that many patients continue to face.

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References

[1] Carew, S., Connor, M. O., Cooke, J., Conway, R., Sheehy, C., Costelloe, A., & Lyons, D. (2008). A review of postural orthostatic tachycardia syndrome. Europace, 11(1), 18–25. https://doi.org/10.1093/europace/eun324

[2] Fedorowski, A. (2018). Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. Journal of Internal Medicine, 285(4), 352–366. https://doi.org/10.1111/joim.12852

[3] Ormiston, Cameron K., et al. “Postural Orthostatic Tachycardia Syndrome as a Sequela of COVID-19.” Heart Rhythm, vol. 19, no. 11, July 2022, https://doi.org/10.1016/j.hrthm.2022.07.014.

[4] Mallick, Deobrat, et al. “COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review.” Cureus, vol. 15, no. 3, 31 Mar. 2023, pmc.ncbi.nlm.nih.gov/articles/PMC10065129/, https://doi.org/10.7759/cureus.36955.

[5] Seeley, Marie-Claire, et al. “Biological Sex-Dependent Differences in Postural Orthostatic Tachycardia Syndrome (POTS).” European Journal of Cardiovascular Nursing, 26 Mar. 2025, academic.oup.com/eurjcn/advance-article/doi/10.1093/eurjcn/zvaf048/8095354, https://doi.org/10.1093/eurjcn/zvaf048.

[6] Fitzgibbon-Collins, L.K., et al. “Women, Orthostatic Tolerance, and POTS: A Narrative Review.” Autonomic Neuroscience, vol. 259, June 2025, p. 103284, https://doi.org/10.1016/j.autneu.2025.103284.

[7] Gorre, F., & Vandekerckhove, H. (2010). Beta-blockers: focus on mechanism of action Which beta-blocker, when and why? Acta Cardiologica, 65(5), 565–570. https://doi.org/10.1080/AC.65.5.2056244