POTS syndrome is not just dizziness when standing up
Everyone knows it – you get up quickly from a chair or bed and for a moment your head spins. Usually it lasts only a second or two and then everything is back to normal. But what if this dizziness when standing up doesn't pass? What if it's accompanied by a racing heart, blurred vision, extreme fatigue and the feeling that you're about to faint at any moment? For thousands of people – and statistically, most often young women – this scenario is an everyday reality. Behind it lies a condition called POTS syndrome, or postural orthostatic tachycardia.
POTS syndrome is one of those insidious conditions that goes unnoticed, dismissed or mistaken for anxiety, anaemia or simple sleep deprivation for a long time. The path to diagnosis takes an average of several years, during which patients visit a whole range of specialists and leave without a clear answer. Yet it is a fairly widespread condition – estimated to affect approximately one to three million people in the United States alone, with Dysautonomia International reporting that up to 80% of diagnosed patients are women between the ages of 15 and 50.
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What is actually happening in the body with POTS syndrome
To understand why dizziness when standing up in POTS syndrome is not just "ordinary dizziness", it is worth pausing for a moment to consider how a healthy body responds to a change in position. When a healthy person stands up, the autonomic nervous system responds immediately – blood vessels in the lower part of the body contract to prevent gravity from "stealing" too much blood into the legs and abdomen, and the heart speeds up slightly to maintain adequate blood supply to the brain. This entire process takes place within a few seconds and the person doesn't notice it at all.
In people with POTS syndrome, this mechanism doesn't work properly. When they stand up, blood pools in the lower parts of the body and the brain receives less oxygen than it needs. The body tries to compensate by dramatically increasing the heart rate – by more than 30 beats per minute within the first ten minutes of standing, and in younger patients by more than 40 beats per minute. This pathological acceleration of the heart without a corresponding increase in blood pressure is the fundamental diagnostic feature of POTS syndrome. The result is dizziness, a racing heart, weakness, a feeling of faintness and a whole range of other symptoms that can be truly exhausting.
Behind this failure of regulation lies dysfunction of the autonomic nervous system – the part of the nervous system that controls involuntary bodily functions such as breathing, digestion, or precisely the regulation of blood pressure and heart rate. POTS syndrome thus belongs to a broader group of conditions called dysautonomia. The exact causes are not always clear, but researchers have identified several factors that may play a role: genetic predisposition, autoimmune processes, a previous viral infection (which has become a very topical issue in connection with long COVID), previous trauma or surgery, and also pregnancy.
The symptoms, moreover, are not just about dizziness when standing. People with POTS syndrome describe chronic fatigue that does not respond to rest, problems with concentration and memory (so-called brain fog), headaches, nausea, sleep disorders, sensitivity to heat and, last but not least, anxiety. This anxiety is itself a paradox – doctors sometimes mistakenly consider it the cause of the problems, when in reality it is their consequence. A racing heart and dizziness logically trigger fear, not the other way around.
Why POTS syndrome primarily affects young women
The question of why young women are so significantly more affected than men is fascinating and still not fully answered. Researchers are putting forward several hypotheses that likely complement one another.
One of the key factors is sex hormones, particularly oestrogen and progesterone. These hormones influence vascular tone, fluid regulation in the body and the function of the autonomic nervous system. Many women with POTS syndrome describe a worsening of symptoms at certain phases of the menstrual cycle, during pregnancy or conversely after childbirth. Oestrogen can reduce the ability of blood vessels to contract properly in response to a change in position, contributing to the pooling of blood in the lower limbs.
Another factor is anatomy. Women generally have a lower total blood volume and a smaller heart relative to body size. This means that any fluctuation in blood distribution has a greater impact on them than on men. Studies published in the specialist journal Journal of the American College of Cardiology also suggest that women may have different autonomic nervous system reactivity, which may make them more susceptible to dysautonomia in general.
It is also impossible to overlook the fact that POTS syndrome very often develops during puberty or shortly after – that is, during a period of fundamental hormonal changes when the body is undergoing rapid growth. Sometimes a relatively short illness, stress or surgery is enough to trigger the entire chain of symptoms in a genetically predisposed girl.
It is a sad truth that conditions that predominantly affect women – especially young women – have historically been less funded and less researched. As Dr. Svetlana Blitshteyn, a leading American neurologist specialising in dysautonomia, has noted: "Patients with POTS are too often dismissed as anxious or hysterical, rather than receiving appropriate medical care." This systemic bias means that the average time from first symptoms to diagnosis is around four to six years – which is absolutely devastating for young women in the most productive years of their lives.
Imagine, for example, an eighteen-year-old student who, over the summer before starting university, begins to feel inexplicably tired, her head spins when she gets out of bed and her heart races so much that she has to wait a moment before she is able to go to the bathroom. Doctors first rule out anaemia, then the thyroid, then refer her to a psychiatrist. It takes years before anyone mentions the word POTS. In the meantime, she misses her school-leaving exams, misses her university entrance exams, loses her social life. This story is unfortunately not exceptional – it is typical.
How POTS syndrome is diagnosed and treated
Diagnosis of POTS syndrome requires a so-called tilt-table test. The patient lies strapped to a special table that slowly tilts to an upright position, while heart rate and blood pressure are continuously measured. If there is a significant increase in heart rate without a corresponding drop in blood pressure, the diagnosis is confirmed. Alternatively, a simpler so-called active orthostatic test can be performed directly in the doctor's office.
Treatment of POTS syndrome is complex and highly individual, because the causes and manifestations differ in each patient. There is no single universal solution, but a combination of approaches can significantly improve quality of life. Generally recommended measures include:
- Increased fluid and salt intake – helps increase the volume of circulating blood and stabilise blood pressure
- Compression stockings or leggings – mechanically prevent blood from pooling in the lower limbs
- Gradual exercise – particularly in a horizontal position (swimming, rowing, exercising while lying down), which strengthens the cardiovascular system without the risk of worsening symptoms
- Dietary adjustments – smaller and more frequent meals, limiting simple sugars, adequate electrolytes
- Pharmacological treatment – doctors may prescribe various medications depending on the specific mechanism of POTS, for example beta-blockers, fludrocortisone or midodrine
An important part of care is also psychological support, because living with a chronic condition that is not visible at first glance is psychologically very demanding. Patients with POTS syndrome face a lack of understanding from those around them, sometimes even from family members or employers, because they appear healthy on the outside.
Great hope is brought by the growing interest of the scientific community in dysautonomia in the context of long COVID. Many patients after COVID-19 developed symptoms very similar to POTS syndrome, which led to a significant increase in research funding and greater awareness among doctors. Organisations such as Dysautonomia International or Czech patient communities help people navigate the system, share experiences and find specialists who are familiar with and treat POTS syndrome.
Dizziness when standing up does not have to be just a harmless trifle. If it persists, is accompanied by a rapid heartbeat, fatigue or brain fog and has been troubling you for a long time, it is definitely worth visiting a doctor and mentioning the possibility of POTS syndrome. The sooner the condition is diagnosed, the sooner treatment can begin and the greater the chance of returning to a full life. Young women who are struggling with these symptoms should not be dismissed with the words "it's just nerves" or "it will pass" – they deserve to be heard and properly examined.
