Symptom Burden in Postural Orthostatic Tachycardia Syndrome (POTS) and Endometriosis: A Retrospective Cohort Study

The objective of this study is to evaluate differences in patient-reported symptom outcomes among individuals with postural orthostatic tachycardia syndrome (POTS) stratified by the presence or absence of co-occurring endometriosis. We conducted a retrospective cohort analysis of 458 POTS patients evaluated at our autonomic center between 2018 and 2024. POTS diagnosis required documented orthostatic intolerance with a heart rate elevation of ≥30 beats per minute during the initial 10 minutes of head-up tilt table testing. Endometriosis was confirmed through surgical pathology reports where available, or via clinical documentation from a gynecology specialist. Patient-reported outcome measures were then compared between those with and without concurrent endometriosis. Among 1,322 female POTS patients, 229 (17.3%) also carried a diagnosis of endometriosis. Those with concurrent endometriosis demonstrated greater autonomic symptom severity, evidenced by elevated Composite Autonomic Symptom Score 31 (COMPASS-31) scores across several domains. Although the prevalence of anxiety and depression did not differ significantly between groups, both cohorts exhibited substantially higher rates than the general population. Co-occurring endometriosis was associated with heightened autonomic dysfunction across several symptom domains, indicating that endometriosis may amplify the severity of POTS-related complaints. Both POTS groups demonstrated substantially elevated rates of anxiety and depression relative to the general population, revealing a considerable mental health burden irrespective of comorbid endometriosis. These results emphasize the need for thorough autonomic symptom evaluation and routine mental health screening in patients with POTS.