POTS: Postural Orthostatic Tachycardia Syndrome 


Have you ever stood up and felt your heart racing, your vision dimming, or like you might faint?


Perhaps you've been told you're anxious, unfit, dehydrated, or simply stressed. While these things can contribute, sometimes there's another explanation: your autonomic nervous system may be working harder than it should.


One condition that can cause these symptoms is Postural Orthostatic Tachycardia Syndrome (POTS).  And it is a condition I am becoming increasingly intrigued about.  Because... of course there is an association with hormones and blood pressure!!


What is POTS?


POTS is a condition where the body has difficulty adjusting to being upright. When most people stand, the nervous system automatically helps maintain blood flow to the brain and vital organs.


In people with POTS, this adjustment doesn't happen efficiently. To compensate, the heart speeds up significantly, often causing symptoms such as:

  • Racing heart or palpitations
  • Dizziness or lightheadedness
  • Brain fog
  • Fatigue
  • Nausea
  • Shortness of breath
  • Trembling or shakiness
  • Feeling faint
  • Exercise intolerance

Symptoms often improve when lying down.


A Simple Test Can Provide Clues


One of the simplest screening tools is an Active Stand Test (sometimes called a NASA Lean Test).


After resting flat for several minutes, heart rate and blood pressure are measured while lying down and then repeatedly over the next 10 minutes of standing.


A result may suggest POTS when:


✅ Heart rate increases by 30 beats per minute or more within 10 minutes of standing (40 bpm in adolescents)


✅ Blood pressure remains relatively stable


✅ Symptoms occur while upright


For example, a heart rate that rises from 65 bpm lying down to 100 bpm standing may be significant, particularly if accompanied by symptoms.


POTS Is More Than a Heart Problem


POTS is a nervous system condition, not simply a heart condition.


It can occur alongside:

  • Hypermobile Ehlers-Danlos Syndrome (hEDS)
  • Hypermobility Spectrum Disorders (HSD)
  • Hormonal transitions
  • Viral illnesses
  • Concussion
  • Autoimmune conditions
  • Mast cell activation disorders
  • Chronic stress or trauma

Many people notice symptoms fluctuate throughout the menstrual cycle, during perimenopause, after illness, or during times of increased stress.


A Positive Test Is Only One Piece of the Puzzle


An Active Stand Test doesn't diagnose POTS on its own.


Your clinician will also consider:

  • How long symptoms have been present
  • Medications
  • Hydration and nutrition
  • Iron levels
  • Thyroid function
  • Other medical conditions
  • Current 'fitness'

The goal isn't simply to label symptoms—it's to understand why they're happening.


The Good News


Many people experience significant improvement once the underlying pattern is recognised.


Strategies may include

  • Increasing fluids and salt (
  • Compression garments
  • Exercise and strength training programs
  • Addressing hormonal influences
  • Improving sleep and recovery
  • Managing associated conditions
  • Medications

Sometimes the biggest relief comes from finally understanding that what you've been experiencing is real—and that there may be a physiological explanation.


If standing up makes you feel worse, it's worth having a conversation with your healthcare professional. Your body may be trying to tell you something important.