What do studies show about the association between hypermobility and POTS?
POTS and hypermobility disorders coexist in some cohorts, but the figures vary and do not demonstrate causation.
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4min read
✓Clinical review
Verified9 November 2026
Key points
Some people with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) also have orthostatic intolerance or POTS; this coexistence is described in clinical cohorts and reviews, but it does not apply to every patient [1].
A 2026 systematic review (30 studies; 8,421 EDS patients and 12,983 POTS patients), which covers EDS in general and was read from its abstract only, reports highly variable proportions: POTS in 17.5% to 92.7% of EDS patients, and EDS in 17.9% to 50% of POTS patients, depending on the populations studied [1].
These ranges are not general-population prevalence figures: the studies differ in their populations, criteria and recruitment [1].
In a retrospective study of 100 young POTS patients followed at a pediatric cardiology practice, the proportion with a hypermobility disorder ranged from 13% (hEDS, strict criteria) to 34% (HSD criteria): the result depends heavily on the definitions used [2].
The proposed mechanisms remain hypotheses; coexistence does not prove that one condition causes the other [4, 1].
Useful definitions
POTS (postural orthostatic tachycardia syndrome) is an orthostatic intolerance syndrome whose diagnostic criteria and evaluation are presented in the dossiers devoted to POTS. hEDS and HSD are diagnoses within the hypermobility spectrum. This page deals only with their coexistence.
Kwok CS, Hagger G, Gillespie D, Hall M, Nazari B, Chong D, Hinton J, Qureshi AI, Raj SR. The co-existence of Ehlers-Danlos syndrome and postural orthostatic tachycardia syndrome: A systematic review of the literature. Autonomic Neuroscience, 267:103453 2026. DOI: 10.1016/j.autneu.2026.103453. PMID: 42398445.(evidence synthesis)
Limitations: 30 studies (8,421 EDS patients, 12,983 POTS patients) with very different populations and definitions; proportions presented as ranges. Read: abstract.
Declared conflicts of interest: Not reviewed in the part of the source that was read
Yao L, Subramaniam K, Raja KM et al. Association of postural orthostatic tachycardia syndrome, hypermobility spectrum disorders, and mast cell activation syndrome in young patients; prevalence, overlap and response to therapy depends on the definition. Frontiers in Neurology, 16:1513199 2025. DOI: 10.3389/fneur.2025.1513199. PMID: 40352770.(observational study)
Limitations: Retrospective, single-center (pediatric cardiology practice, California); 100 young POTS patients aged 9.6 to 25 years, 80% female, 86% Caucasian. Read: full text (PMC12063504).
Declared conflicts of interest: The authors declare no commercial or financial relationships that could constitute a conflict of interest
Tofts LJ, Simmonds J, Schwartz SB et al. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet Journal of Rare Diseases, 18(1):104 2023. DOI: 10.1186/s13023-023-02717-2. PMID: 37143135.(guideline or consensus)
Limitations: Pediatric consensus framework; cites specialist POTS/hypermobility cohorts. Read: full text (PMC10157984).
Declared conflicts of interest: The authors declare no conflict of interest
Carroll MB. Hypermobility spectrum disorders: A review. Rheumatology and Immunology Research, 4(2):60–68 2023. DOI: 10.2478/rir-2023-0010. PMID: 37637226.(evidence synthesis)
Limitations: Narrative, non-systematic review; possible causes of dysautonomia are listed without ranking by level of evidence. Read: full text (PMC10457547).
Declared conflicts of interest: The author declares no conflict of interest
Miller AJ, Stiles LE, Sheehan T, et al. Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome. Autonomic Neuroscience 2020. DOI: 10.1016/j.autneu.2020.102637. PMID: 31954224.(observational study)
Limitations: 91 participants recruited in a specialist setting, no control group.
Written by
AI-assisted literature research (ChatGPT) and AI-assisted writing (Claude)
Editor
Jean Viry-Babel
Review status
Clinical review: Dr Françoise Charmoillaux (anesthesiologist)
Approved on
9 November 2026
Literature search
8 November 2026
Last verified
9 November 2026
Geographic scope
international, United States, France
Audience
everyone
Conflicts of interest
No known financial ties. Separately, the publisher is developing a personal approach to these conditions under the name Connected Conditions, which is not cited here (see the legal notice).
Limitations of this page
Describes coexistence observed in selected populations: the page cannot be used to estimate an individual risk or to conclude that one condition causes the other. The 2026 systematic review was read from its abstract only. Page not reviewed by a rheumatologist or geneticist.