The endometriosis-POTS connection: A retrospective analysis

Adeline Y. Chin, Chin AY, Ryan G. Rilinger, Rilinger RG, Mackaleigh Levine, Levine M, Nowacki AS, Amy S. Nowacki, Brant AR, Ashley R. Brant, Cheryl Cameron, Cameron C, Gubbels A, Ashley Gubbels, Robert Wilson, Wilson R
Autonomic neuroscience : basic & clinical · 2026 · vol. 267 , pp. 103469 · doi:10.1016/j.autneu.2026.103469 · PMID:42641290 · W7204092752
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This retrospective analysis found that endometriosis is significantly more prevalent in female patients with postural orthostatic tachycardia syndrome than in the general population, with endometriosis typically diagnosed before POTS.

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Abstract

OBJECTIVE: To report the prevalence of endometriosis among female patients with postural orthostatic tachycardia syndrome (POTS) and determine which condition is more commonly diagnosed first. METHODS: In a retrospective case-control analysis, we reviewed medical records for patients with POTS who presented to our autonomic center from 2018 to 2024. POTS was defined by symptoms of orthostatic intolerance accompanied by a heart rate increase of ≥30 beats per minute within the first 10 min of head-up tilt table testing. Endometriosis diagnoses were determined using surgical pathology when available or clinical documentation by a gynecologic specialist. RESULTS: Among 1322 female patients with POTS, 229 (17.3%) had a diagnosis of endometriosis, a prevalence significantly higher than the prevalence of 10% observed in the general female population (p < 0.001) and higher than the prevalence of 10.2% observed in our tilt-negative cohort (p < 0.001). For patients with both diagnoses, endometriosis was diagnosed before POTS in 156 patients (68%), and POTS was diagnosed first in 73 patients (32%). CONCLUSION: Endometriosis is significantly more prevalent in female patients with POTS than in the general population, with endometriosis more likely to be diagnosed first. Clinicians should be aware of the high co-occurrence and consider further workup for endometriosis in patients with POTS presenting with pelvic pain or dysmenorrhea, and vice versa.

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