The body loves balance. In biology we call this “homeostasis” which means the body likes to be in the “same state”. If you become stressed (physically or emotionally) the balance is affected as your body gets ready for action. The body releases hormones such as adrenaline and cortisol which allow you to have a “fight or flight” response. The fight or flight response occurs when those hormones speak to the “autonomic nervous system”.

The autonomic nervous system controls actions which you don’t usually have to think about which include:

• heart rate
• body temperature
• digestion
• sweating
• widening or narrowing of blood vessels (which affect blood pressure)

When you see how much of the body the autonomic nervous system controls it’s hardly surprising that anything which upsets it can result in lots of symptoms. If we take another look at the list above it means that symptoms can include:

• Palpitations due to change in heart rate (which can be linked to standing upright)
• Difficult to control body temperature
• Change in bowels
• Increased sweating
• Light-headedness or dizziness due to blood pressure changes (which can be linked to standing upright)
• There are many other symptoms including fatigue and brain fog.

Some things which cause damage or imbalance in the autonomic nervous system can lead to a long term change in the way it works. If this happens we call it “autonomic dysfunction” or “dysautonomia”. We know that many viruses including the virus which causes COVID-19 can lead to dysautonomia. It can be a feature of Post COVID-19 syndrome.

One of the commonest problems in Post COVID-19 syndrome is orthostatic intolerance. This means that symptoms develop when you stand or sit up. They often often improve when you lie down. This is because the autonomic nervous system struggles to regulate the heart rate and blood pressure in response to gravity. It results in low blood pressure or a fast heart rate (Postural Orthostatic Tachycardia Syndrome, or PoTS for short).

Standing up can trigger a number of symptoms including light-headedness/dizziness, palpitations, fatigue, breathlessness, chest pain, sweating, headaches, sweating, brain fog, fainting, shaking, gut problems, visual greying and difficulty exercising.

The natural body balance has been upset. It has led to changes in hormones such as cortisol and adrenaline. Resetting the body balance is really important to help control these hormones and the autonomic nervous system. There are a number of lifestyle measures we can do to help with this. It is important to aim to improve the way we manage our:

• Posture
• Fatigue
• Sleep
• Nutrition
• Emotions
• Breathing

You can read more about how to do this on the other pages on our website.

Are there any good resources for more advice around dysautonomia?

Yes there are good resources. If you have PoTS, the one we particularly recommend is the PoTS UK website.

If you believe you have PoTS then it’s worth chatting with your GP to see whether or not you may require further tests to support the diagnosis, or an onward referral to a PoTS specialist (which can be found on the PoTS UK website).

This seven minute video from PoTS UK helps us to understand what it can feel like to live with PoTS.

The PoTS UK website also contains information on managing low blood pressure.

Women often notice that symptoms of PoTS are worse around periods. Symptoms can also be more noticeable in the peri-menopuase or menopause. Preventing periods by using contraception such as the combined oral contraceptive pill (or mini pill in people unable to take the combined pill) does appear to improve symptoms in many people. However, there is not good research currently available to confirm this and the contraceptive pill is not licenced for use in these circumstances.

Fewer women develop PoTS after the menopause. There may be a role for hormone replacement therapy (HRT) in those people who are suffering from PoTS and menopause/perimenopause. Once again, medical evidence is lacking for this use and not all doctors may be happy to prescribe HRT in these circumstances.