PoTS: postural tachycardia syndrome affects 5 times more women than men, but what exactly is it?

light-headed woman leaning against a wall

Credit: Getty

Strong Women


PoTS: postural tachycardia syndrome affects 5 times more women than men, but what exactly is it?

By Anna Bartter

Updated 2 years ago

5 min read

PoTS is a little-understood condition that most commonly affects women between the ages of 15 and 50 – but it’s rarely discussed and remains underdiagnosed. 


You know that light-headed feeling you get when you’ve stood up too quickly? It usually passes within a few seconds, right? Well, imagine getting that every time you move from sitting to standing, often passing out as a result of everyday activities like getting dressed or taking a shower.

It sounds horrible, but fainting on standing is one of the main symptoms of postural tachycardia syndrome, also known as PoTS. 

If you’ve never heard of it, you’re not alone – it’s notoriously misunderstood and underdiagnosed – and the sufferers are largely young women. We chatted with some experts and PoTS sufferers to get a better understanding of this debilitating condition.


What is PoTS?

According to the charity PoTS UK, postural tachycardia syndrome is “an abnormality of the functioning of the autonomic nervous system”. Broken down, it means the position of the body (“postural”) causes a faster-than-normal heart rate (“tachycardia”) alongside a combination of other symptoms.

Dr Lesley Kavi, visiting professor at the University of Birmingham, has been the charity’s chair since 2017. She explains: “When a healthy person stands up, blood vessels narrow and heart rate increases slightly to maintain blood supply to heart and brain. In PoTS, this automatic adjustment to upright posture is not working correctly, resulting in an excessive rise in heart rate, increased norepinephrine (a chemical produced by our fight or flight response) in the blood and altered blood flow to the brain.”

PoTS is something 35-year-old Emily Pomroy-Smith, a small business owner, knows all about. “The main symptoms of PoTS are caused by changes in blood pressure and heart rate when moving from sitting to standing or with sudden changes of temperature. So that feeling you get when you stand up to quickly, like a head rush, but on steroids. It can cause dizziness, fainting, blood pooling in the extremities, palpitations and fatigue.”

What are the symptoms of PoTS?

Symptoms of PoTS will vary from person to person, but the most common symptoms according to the NHS are: 

  • dizziness or light-headedness
  • fainting or almost fainting
  • noticeable heartbeats (heart palpitations)
  • chest pain
  • shortness of breath
  • shaking and sweating

Other symptoms can include problems with digestion (feeling sick, constipation and bloating), extreme tiredness, headaches and vision problems and trouble concentrating, among others.

What causes PoTS?

Technically, PoTS is caused by an abnormality in the functioning of the blood vessels of the limbs and abdomen, but what causes this is largely unknown, with sufferers reporting numerous triggers.

“It is likely that there are a variety of causes of PoTS,” explains Dr Kavi. “It is often triggered by a viral infection, such as glandular fever, Covid-19 or a bacterial infection, and it’s commonly associated with hypermobile Ehlers-Danlos syndrome, multiple allergies and autoimmune conditions, among other factors.”

Why does PoTS affect more women than men? 

It’s unclear why the syndrome affects women up to five times more than men, but this fact could go some way to explaining why it’s so often under-diagnosed (hello, gender health gap). 

Research suggests that 70–80% of PoTS sufferers are female, but no one knows why. “It is not fully understood why women are more commonly affected than men,” acknowledges Dr Kavi. “There are hypotheses that include oestrogen making blood vessels more stretchy or that women are more prone to autoimmune diseases than men (some PoTS subtypes are likely to have an autoimmune mechanism).”

It’s notoriously hard to get a diagnosis for the issue, with women seeing an average of seven doctors over a period of four years before PoTS is recognised. According to PoTS UK, many healthcare professionals are still unaware of the condition – something Pomroy-Smith has experienced first-hand.

“I’m constantly having to explain to and educate medical professionals who don’t fully understand the condition,” she says. “While being an expert on your own condition is great, it can be frustrating. I would love it if more GPs were aware of it.”

What are the side effects of PoTS?

A PoTS diagnosis can significantly impact quality of life, and it’s a cruel twist that it most often affects young, previously active women.

“Due to my PoTS symptoms I have to be very careful with everyday tasks such as dressing and bathing,” says Pomroy-Smith. “I also need to be mindful of how quickly I get up from sitting and avoid certain exercises – especially anything that involves changing position rapidly. For long days out I use a wheelchair to manage my symptoms and fatigue.”

Even everyday tasks such as getting dressed and washed can become difficult for sufferers, but there are things you can do to ease your symptoms.

Woman relaxing in the bath PoTS treatments

Credit: Getty

“I have had to adapt and a lot of things I do without conscious thought, for example, having to sit down to get dressed, needing assistance when raising my arms above my head (passing out with a bodycon dress over your head is no fun),” explains Pomroy-Smith.

“Bathing is also challenging, and I won’t do it if I am on my own in the house in case I faint. It’s tricky because my pain is helped by heat, but hot baths and showers aggravate my PoTS symptoms. One of my tricks in the shower is to gradually lower the water temperature so that I don’t have a sudden change from hot to cold.”

Can PoTS be treated or cured? 

There are drug treatments available for PoTS, but the main treatments are lifestyle-related. 

If you do find yourself with a PoTS diagnosis, one of the questions you’ll likely want answered is whether you’ll be dealing with the symptoms for the rest of your life. Unfortunately, there isn’t a straightforward answer, and it will vary from person to person.

“Since the underlying causes of PoTS mostly can’t be removed, some people gradually improve but others will need treatment for years or for life,” says Dr Kavi. “Patients with inherited conditions in particular are likely to need ongoing medical treatment.”

While the type of PoTS that Pomroy-Smith has won’t go away, she does find some days easier than others.

“I have to manage my symptoms on a daily basis, and some days are better than others,” she tells Strong Women. “In particular, I’m concerned about increasingly hot summers since the temperatures last year were unbearable and made it impossible for me to function normally.”

Tips and advice for coping with PoTS

Dr Kavi recommends staying well hydrated and maintaining an adequate salt intake to start with, along with regular exercise, eating little and often and the use of compression garments to ease symptoms.

There are a number of resources on the PoTS UK charity website, and it can help to reach out to fellow sufferers. As always, if you’re at all concerned about any symptoms or if you suspect you might have PoTS, go and see your GP. 


Images: Getty

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