Many women live with daily exhaustion, dizziness, brain fog, and deep neck and shoulder pain, but struggle to get clear answers. For some, these symptoms may be part of something called POTS, or Postural Orthostatic Tachycardia Syndrome.
It’s a form of dysautonomia, meaning the body’s automatic systems, like heart rate, blood pressure, and circulation, don’t regulate properly when you stand up. It’s not “just anxiety” or low fitness. It’s a physiological condition that predominantly affects women, often starting in adolescence or early adulthood (though it can appear later too).
Recognising the Signs of POTS
When you move from lying to standing, gravity pulls blood down into your legs. In most people, the nervous system quickly compensates, tightening blood vessels and keeping blood flowing to your heart and brain.
In POTS, this system doesn’t adjust efficiently, so your heart rate shoots up (by 30 beats per minute or more within 10 minutes of standing), and blood flow to your brain and upper body may drop.
Common symptoms include:
- Racing heart when you stand up
- Lightheadedness, dizziness, or near-fainting
- Fatigue and weakness — even from simple daily activities
- Brain fog — that feeling of mental fuzziness or forgetfulness
- Blood pooling in the legs (purplish or mottled appearance)
- Nausea, bloating, or digestive discomfort
- Sensitivity to heat or worsened symptoms in hot weather
- Headaches or neck and shoulder pain — especially a deep, aching pain that worsens when upright
The “Coat-Hanger” Pain — A Key Clue
One of the most characteristic (and misunderstood) symptoms is what’s known as “coat-hanger pain.”
This describes a band-like aching or tightness across the neck, shoulders, and upper back, as though a coat hanger were pressing across that area. The pain often worsens when sitting or standing, and eases when you lie down.
Why? Because when you’re upright, blood pools in your lower body, meaning less blood and oxygen reach the neck and shoulder muscles. This leads to fatigue, aching, and cramping in that region, not unlike a muscle trying to function with too little fuel.
This pain isn’t “just tension” or posture, it’s circulatory. It’s your body signalling that blood flow to those muscles is reduced. Understanding that difference can be life-changing.
Supporting and Managing POTS (and Coat-Hanger Pain)
There’s no single cure, but with the right support, symptoms can be managed beautifully. Women often do best with a holistic, multidisciplinary approach combining lifestyle, movement, hydration, and gentle medical support.
Lifestyle & Self-Help Strategies
- Stay hydrated and increase salt (under guidance) to expand blood volume
- Wear compression stockings or abdominal binders to support blood return to the heart
- Use postural pacing — lie down or elevate your legs during the day to relieve symptoms
- Use heat therapy (like a warm compress across shoulders) to improve circulation
- Gentle massage or myofascial release can ease muscle tension and enhance flow
- Begin gentle, reclined exercise (like Pilates on your back, swimming, or recumbent cycling), gradually progressing as your tolerance improves
- Avoid long periods of standing and rise slowly from sitting or lying positions
Medical Management
Some women may benefit from medication prescribed by an autonomic or cardiology specialist, such as:
- Fludrocortisone to help the body retain sodium and fluid
- Midodrine to improve blood pressure
- Beta blockers to slow a racing heart
- Pyridostigmine or ivabradine in certain cases
Holistic & Supportive Therapies
- Gentle yoga, breathwork, and meditation to calm the nervous system
- Acupressure and energy-based therapies for relaxation
- Nutritional support (magnesium, electrolytes, balanced meals)
- Scar or fascial therapy if post-surgical or connective tissue issues are present
- Relaxation rituals, restorative rest, and body awareness practices
A Note for Women
Many women with POTS are told for years that their symptoms are “just stress” or “in their head.” But the truth is, POTS is a real physiological condition — and recognising it early can change everything.
If your neck and shoulder pain worsens when upright but improves when lying down, if your heart races when you stand, or if fatigue feels constant despite rest — it’s worth exploring.
Ask your GP for autonomic testing or a tilt-table test, and consider tracking your symptoms (heart rate, posture, time of day, triggers). With compassionate care and a balanced plan, it is absolutely possible to live well and thrive with POTS.
Gentle Reminder
Your body is not failing you, it’s communicating. When blood doesn’t return efficiently, when your heart races, when pain flares across your shoulders — it’s your nervous system asking for balance and support. With understanding, pacing, and the right guidance, you can find that balance again.
