Postural Orthostatic Tachycardia Syndrome (POTS) is a condition associated with a low blood volume that causes dizziness and fainting episodes when standing up or changing position. POTS affects females more than males with 80% of all patients diagnosed with POTS being female. The typical age of diagnosis is between 13-19 years old. For many of these young female patients, their symptoms may be exacerbated during menstruation. This is thought to be partly due to the already decreased blood volume as well as something called the renin-angiotensin-aldosterone system (RAAS). RAAS is a hormonal regulation mechanism in the body that helps to control blood plasma volume and hemodynamic homeostasis. Hemodynamic homeostasis is the steady state control of blood flow and delivery throughout the body. Since there are fluctuations in hormone levels throughout the menstrual cycle, RAAS is disturbed during this time and patients will see an increase in fatigue, dizziness, and other POTS symptoms.
While POTS was not found to be caused by fluctuations in sex hormone levels, there were physiologic changes found in response to this. Patients were less able to tolerate prolonged standing and experienced more frequent episodes of tachycardia. A study performed at the Autonomic Function Clinic in Dallas, Texas looked at potential strategies to help reduce this flare in symptoms. One strategy studied investigated the timing of medication dosage to help modulate hormone levels at specific points in the menstrual cycle. Their findings were positive, but they reported that more research should be conducted before this could be recommended to patients. Another strategy that was discussed was increasing salt intake in the diet prior to the onset of menstruation to encourage blood and fluid volumes to increase. Overall, patients with POTS who are menstruating will most likely experience a flare in their symptoms, so it is important to speak with your managing physician to find the best strategy to minimize this.
Fu, Qi, et al. “Menstrual Cycle Affects Renal-Adrenal and Hemodynamic Responses During Prolonged Standing in the Postural Orthostatic Tachycardia Syndrome.” Hypertension, vol. 56, no. 1, July 2010, pp. 82–90., doi:10.1161/hypertensionaha.110.151787.