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Connection Between POTS and Your Menstrual Cycle

Updated: May 31, 2022

The transcript can be found under the video.

Have you noticed a connection between stages of your menstrual cycle and flare-ups and worsening of your symptoms?

You might notice that at various times of the month, you're more tired, more hungry for carbs, able to stand up for less, or have more palpitations, etc.

This leaves you wondering… "is this the worsening of my symptoms? A new flare-up? What could be the trigger?" Sometimes it could just be hormones.

The impact of hormones is significant. If you're trying to pace and rest more, or to follow a low-carb diet, or to incorporate more movement into your day-to-day life, you might find that more difficult at certain times of the month.

Much is still unknown about hormones and exactly how they influence and impact us. So far, there's been mostly small-scale studies done. It'll be interesting to see how this field develops over time. Our bodies are all unique.

Overview of the menstrual cycle

The menstrual cycle lasts approximately 28 days, but every woman is different. The menstrual cycle is split into two halves—the follicular and the luteal. In the middle is ovulation. The first day of your period marks the follicular phase.

The follicular phase is when the body produces more estrogen and prepares to release an egg. During ovulation, the body releases the mature egg down the fallopian tube. The luteal phase is where the lining of your uterus gets thicker to prepare for a possible pregnancy. If conception doesn't happen, the thickened womb lining sheds, which is when your next period starts.

Follicular phase

A research study looked at POTS symptoms in the follicular versus the luteal phase and compared that to markers in healthy women as a control group. In the control group, blood flow and blood pressure didn't really change in either of the phases. It was constant. For POTS women, blood pressure and heart rate were similar between the two phases. But they found that cardiac output, which is the amount of blood that your heart pumps each minute, was lower in the follicular phase than in the luteal phase.

They also discovered that during the follicular phase, POTS patients feel lightheaded, weak, and like they were going to pass out. This is more likely to occur two weeks after menstruation and around the time of your period. So what can be done at the moment?

It is important to get those fluids in through the foods you eat, salt and water, etc. If you're bleeding a lot, this can also make you weaker. Make sure that your iron levels are okay, or if not, supplement.

This might also be the toughest time to do cardio. Some people like to focus more on strength exercises during this time as they feel they have more strength.


According to certain research, women are more prone to injuries starting around week 3 because hormones cause ligaments and tendons to loosen. This is also something to consider if you have hypermobility, which is common in POTS patients. Focus on form and making sure workouts are done correctly to reduce the risk of injury.

Luteal Phase

Luteal phase, the high estrogen and progesterone levels are associated with greater increases in renal adrenal hormones, leading to more volume retention and the ability to stand longer and more easily. So, in week 3, you might find yourself being able to do more cardio or be upright a bit more.

You might be thinking to yourself: "you're saying that I should feel the least lightheaded and fainty in the two weeks before my period?" Yes, according to that one study. They found that the system that modulates the blood pressure and vasoconstriction is less affected during this time period.

Other people I speak with say that their symptoms are the worst right around ovulation and right before they get their period. This could be due to the drop in hormones. So, what physiological events occur around this time?

When you're in that luteal phase, your body temperature will increase. As a result, a warm or hot atmosphere may be more difficult than usual. So keep that in mind as well. Make better use of that cooling towel or vest. However, you may feel the most sluggish in week 4, the week before your period. It is best to do light stretching or yoga and be gentle to your body.

This is where you're also more likely to have cravings for high-carb and sweet foods, but many of these foods can also increase inflammation and make symptoms worse. High-carb foods can also exacerbate symptoms in POTS.

Don't ignore your cravings and what your body is asking (e.g. whole-grain bread and brown rice, which are complex carbs). Reach for complex carbs instead of simple carbs like chips, bread or pasta. Energy bites, honey, fruit, and smoothies can also hit the spot if you have a sweet tooth. Removing these foods can also help long-term with balancing hormones, increasing energy, and healing the gut.

If you're looking for more support with this, reach out to me for help with implementing some of these changes.

So other than the above-mentioned tips, what else can you do?

Why tracking is important?

In the beginning, tracking is really beneficial. Keep track of your flare days to see whether there's a link to your period. This can also assist you in being more kind to yourself on those days and weeks.

Don't be surprised if, during those days, things are harder. While you can't control what will happen, you can control some of the fear that arises, since you know that it's only a temporary thing. You can add more tools to your toolbox to manage everything. It does take a bit of time to see what is a random flare-up, but it's well worth the effort.

What trends have you noticed between your menstrual cycle and your symptoms?

I'd love to hear your biggest takeaway down in the comments below.


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