Some women with endometriosis have noticed their heartbeat races when they stand up after sitting or lying down. They can also feel dizzy or lightheaded, and these symptoms seem more pronounced during their periods. “Has anyone had any issues with tachycardia (rapid heart rate) either before starting a period or during a flare?” one MyEndometriosisTeam member asked. This can be a sign of postural orthostatic tachycardia syndrome (POTS), a condition that affects blood flow in the body.
The symptoms of postural orthostatic tachycardia syndrome are usually experienced when people stand up after a period of sitting or lying down. The primary POTS symptom is an increased heart rate of up to 30 beats per minute higher than the baseline heart rate after standing up. Other symptoms include fainting, dizziness, fatigue, high or low blood pressure, chest pain, and feeling like your heart is racing.
In most people, these symptoms feel like low blood volume, but improve or go away after sitting or lying back down — an effect known as an orthostatic intolerance. It’s estimated that between 1 million and 3 million Americans between the ages of 15 and 50 have POTS. Symptoms may occur frequently, occasionally, or rarely.
There are many reasons people may experience a rapid heart rate, but with POTS, some women may notice they have more symptoms before or during their menstrual period.
When most of us stand up after lying down, our bodies have to accomodate for the change in position so our blood doesn’t just pool in our legs due to gravity. Usually our bodies do this quickly and without us noticing. For people with POTS, the body has difficulty adjusting to the change in position, and it struggles to keep the blood circulating. As a result, people with POTS can feel their heartbeat rapidly increase when they stand up. This causes physical symptoms when standing, like feeling lightheaded or faint. They may also feel their heart is pounding rapidly.
The cause of POTS is unknown. Health events such as major surgery, trauma, and viral illness may trigger POTS. Pregnancy and the days before menstration are also times when POTS symptoms can occur.
“Recently I was taken to the hospital for increased heart rate (160 bpm) and palpitations,” one MyEndometriosisTeam member said. “I left with no diagnosis or reason for it, and was told by someone to look into POTS.”
A connection between endometriosis and POTS is unclear. One small study of 160 participants showed that women with POTS were more likely to also have endometriosis, but the study was questionnaire-based and hasn’t been repeated. There isn’t enough evidence right now to determine a connection.
POTS and endometriosis tend to affect women in the same age range. While POTS can affect anyone, it’s most commonly diagnosed in women ages 15 to 50. Endometriosis may affect more than 11 percent of women ages 15 to 44. Researchers aren’t certain why more women than men experience POTS. One theory is, generally speaking, women tend to have smaller hearts, and the combination of a small heart and reduced blood volume can cause POTS.
“I have POTS and endometriosis. For me, they developed around the same time,” one MyEndometriosisTeam member said. It’s certainly possible to have both POTS and endometriosis, even if they aren’t directly connected. It’s a good idea to talk with your doctor about POTS if you’re noticing symptoms of irregular heart rate or lightheadedness after some minutes of standing.
There’s a simple test for POTS called a tilt table test. Since POTS is caused by changing position, the tilt table tilts you back and forth while your heart rate and blood pressure are measured. Your health care provider or cardiologist might also do blood tests to see if something else is causing your symptoms.
POTS is not life threatening, but the symptoms can be unpleasant. There are various treatments available, including adding more salt to the diet, increasing fluid intake, exercising, or taking medication. Physical therapy in combination with home exercise is often effective.
If you feel you have symptoms that could be from POTS, the first step is to make an appointment to talk with your doctor. Before your appointment, you may want to keep track of your symptoms on a calendar and record your pulse every time you feel it racing when you stand up. A normal resting heart rate for adults is 60 to 100 beats per minute. (You can learn more about how to take your pulse.) Also track your menstrual cycle, as some women report an increase in POTS symptoms around their period.
Although having POTS and endometriosis isn’t easy, there are good treatments for POTS. Exercise may help both conditions, so talk with your doctor to see if creating an exercise plan is right for you. POTS is very treatable. Most patients have a reduction in symptoms after a year of treatment, and one study found a third of participants no longer had symptoms at all.
Have you been diagnosed with POTS or experienced symptoms of racing heartbeat or dizziness after standing? Do your symptoms change with your menstrual cycle? Comment below or join the conversation at MyEndometriosisTeam.