Why POTS Often Emerges Around Puberty, and How Rehabilitation Gives Young Women Their Days Back
Part of the Femina PT POTS & Orthostatic Intolerance Series | Complete Guide: POTS & Orthostatic Intolerance Physical Therapy in Los Angeles
A teenager who used to be active is suddenly dizzy every time she stands, wiped out by half a school day, and heart racing for no clear reason, and too often she is told it is anxiety, growing pains, or not trying hard enough. If that is your daughter, or you, this is worth reading. POTS in teens and young women is common and physiological, and it responds to the right kind of rehabilitation.
Why POTS often shows up in the teen years
POTS is common in kids and teens, and it often starts around puberty[1]. There’s no single cause. In this age group it tends to come from a mix of things, which can include changes in blood volume, an off-balance autonomic nervous system (the part that runs automatic functions like heart rate), a body running high on adrenaline, leg muscles that aren’t pushing blood back up well, mast cell activity, low iron, and immune-related factors. Many young people have more than one of these going on at once[1].
The timing isn’t random. Teenage girls tend to handle standing less well and develop POTS more often, and the hormonal changes of puberty are one proposed reason they’re more prone to it[2]. We look at the hormonal and menstrual-cycle thread in more detail here.
It is not “just anxiety,” and it is not a lack of effort
This deserves saying plainly, because so many young women are told otherwise. The exhaustion and the racing heart come from a circulatory system that is not keeping up well when she is upright, a physical problem, documented on tilt-table and standing tests (which track heart rate and blood pressure as she stands)[1]. In children and teens, the heart-rate rise used to diagnose POTS is higher than in adults: at least 40 beats per minute on standing[1]. The barrier a teenager with POTS runs into is not motivational. Diagnosis is a medical process led by a physician, often a children’s heart doctor (pediatric cardiologist) or an autonomic specialist, and treating the symptoms as a character flaw only adds harm to an already hard experience.
How rehabilitation works for young women
The good news is that the same graded, recumbent-first exercise approach with the strongest evidence in POTS[3][4] applies here, adapted for a younger person and coordinated with their medical team. It directly targets the loss of fitness from inactivity (deconditioning), which research links to the same changes seen after long bed rest[5]. That loop spins fast when illness and inactivity collide with school stress. At Femina Physical Therapy, care for adolescents and young women is patient-led and family-involved: a thorough evaluation, a short, monitored exercise portion that respects a limited energy supply (their ‘energy envelope’), progression driven by their response rather than a calendar, and practical pacing strategies for getting through a school day. Physical therapy supports the medical plan and school accommodations; it does not replace their physician. The goal is to rebuild tolerance gently and give a teen or young woman their days back.
“The exhaustion and the racing heart are not a character flaw. They are physiological, and they respond to rehabilitation.”
📍 Femina Physical Therapy treats POTS and orthostatic intolerance across Los Angeles, with offices in Sherman Oaks, Pasadena, and Beverly Hills. Telehealth and Coaching consultations are available for patients whose symptoms make travel difficult.
FAQ — PEOPLE ALSO ASK
A: POTS commonly emerges around puberty and is multifactorial: blood volume, autonomic reflexes, a hyperadrenergic state, the muscle pump, and other factors can all contribute, often together. Pubertal hormonal changes are one proposed reason young females are more susceptible, though no single cause explains every case.
A: No. POTS is a physiological problem with the circulatory response to standing, documented on tilt-table and standing tests, and it is frequently misattributed to anxiety. Anxiety can coexist, but the racing heart and exhaustion are not a character flaw or a lack of effort, and diagnosis is a medical process.
A: Yes, adapted for a younger person and coordinated with their physician. The graded, recumbent-first approach with the strongest evidence in POTS applies across ages. The fitness portion of each session is kept short and monitored, progression follows their response, and pacing is built around the demands of a school day.
A: The course is variable. Some young people improve substantially over time, but there is no guarantee and no fixed timeline, so we avoid promising it. What rehabilitation can do in the meantime is meaningfully improve function and quality of life by rebuilding tolerance and breaking the deconditioning cycle.
>> Living with POTS in Los Angeles? We would like to help a young woman get her days back. Book your evaluation at Femina Physical Therapy.
References (Peer-Reviewed Sources)
[1] (Class C) Postural tachycardia syndrome in children and adolescents: pathophysiology and clinical management. (PMC7468430) [ncbi.nlm.nih.gov/pmc/articles/PMC7468430]
[2] (Class C) Pubertal hormonal changes and the autonomic nervous system: potential role in pediatric orthostatic intolerance. (PMC6861527) [ncbi.nlm.nih.gov/pmc/articles/PMC6861527]
[3] (Class A) Fu Q, VanGundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension. 2011;58(2):167-175. [pubmed.ncbi.nlm.nih.gov/21690484]
[4] (Class A) Semi-supervised exercise training program more effective for individuals with POTS in a randomized controlled trial. (PMC10751269) [ncbi.nlm.nih.gov/pmc/articles/PMC10751269]
[5] (Class C) Joyner MJ, Masuki S. POTS versus deconditioning: the same or different? Clin Auton Res. 2008;18(6):300-307. [pmc.ncbi.nlm.nih.gov/articles/PMC3770293]
Related Reading: POTS & Orthostatic Intolerance at Femina Physical Therapy
→ Hormonal and menstrual-cycle influences on POTS
→ How a POTS exercise program is structured, recumbent to upright
→ Complete Guide: POTS & Orthostatic Intolerance Physical Therapy in Los Angeles (Pillar)
Medical disclaimer: This article is for informational purposes only and is not intended as medical advice. Always consult your medical doctor before beginning this or any program that may affect your health. Reading this article does not create a patient relationship with Femina Physical Therapy. If you are under 18, please review this information with a parent or guardian and your physician.