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Understanding the Connection: POTS, May-Thurner Syndrome, PCS, and Ehlers-Danlos Syndrome

Mar 19, 2025
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Certain vascular and connective tissue disorders may occur simultaneously. When POTS, May-Thurner Syndrome, PCS, or Ehlers-Danlos Syndrome develops along with another condition, doctors must coordinate treatment to address the underlying causes of all associated conditions to prevent a worsening of symptoms and improve patient outcomes in pain relief and quality of life.

Sometimes, medical conditions intersect in ways that make symptoms more severe and harder to treat. This is especially true for vascular and connective tissue disorders, which often overlap. Conditions like Postural Orthostatic Tachycardia Syndrome (POTS), May-Thurner Syndrome (MTS), Pelvic Congestion Syndrome (PCS) (or pelvic venous insufficiency), and Ehlers-Danlos Syndrome (EDS) frequently occur together, interacting symbiotically to worsen both the symptoms and the conditions themselves. However, treating the underlying causes of one may help improve any other coexisting conditions.

At CardioVascular Health Clinic, our team recognizes how these conditions can coincide or even be linked and they work together to address multiple conditions at the same time. Our vascular and cardiovascular specialists deliver national-caliber expertise in diagnosing and treating a range of vascular conditions, even for rare or underdiagnosed ones. By combining an integrative, patient-centric approach to care with state-of-the-art diagnostic tools, a multidisciplinary team of experts, and decades of experience, our team provides comprehensive, personalized treatment plans that can address multiple conditions at once and lead to significant improvements in symptoms and overall quality of life.

Postural Orthostatic Tachycardia Syndrome (POTS)

Overview of POTS

POTS is a condition that affects how the body controls your heart rate when standing up. Normally, the body adjusts your blood pressure and heart rate to keep both steady and prevent spikes when you move from sitting to standing. With POTS, your body struggles to regulate your heart rate properly when you stand up, which can cause a sudden increase in how fast your heart is beating. This can leave you feeling tired and drained, making even everyday tasks feel overwhelming. 

POTS is often linked to nervous system issues and is more common in people with connective tissue disorders like Ehlers-Danlos Syndrome. Doctors and researchers are also exploring a possible link between POTS and PCS.

Symptoms of POTS

POTS can be particularly difficult to diagnose properly or accurately because many of the symptoms overlap with other conditions. However, some of the most common symptoms include:

  • Rapid heart rate when standing. Your heart rate can suddenly jump by 30 beats per minute or more.
  • Dizziness or lightheadedness, which you may start to notice more often, especially after standing up.
  • Fatigue. Even mild activities can leave you feeling drained.
  • Brain fog. Fatigue can make it difficult to concentrate or think clearly.
  • Fainting spells. Some people may even pass out when they stand and their heart rate spikes.

Causes of POTS

While it is unclear exactly what causes POTS, there are significant links between the condition and:

  • Nervous system dysfunction, which prevents the autonomic nervous system from properly regulating the heart rate..
  • Connective tissue disorders, including conditions like Ehlers-Danlos Syndrome, which can contribute to weak blood vessels.
  • Blood volume issues, as well as low blood pressure or poor blood circulation, since low blood volume can make symptoms worse.
  • Viral infections, which can trigger an autoimmune response and could interfere with the autonomic nervous system

Treatment for POTS

There is currently no cure for POTS, but it is a manageable condition, via methods such as:

  • Lifestyle changes. Staying hydrated and wearing compression stockings can help.
  • Medications. Beta-blockers, salt tablets, or medications to boost blood pressure.
  • Physical therapy. Gradual exercise programs to build tolerance and strength.

May-Thurner Syndrome (MTS)

Overview of May-Thurner Syndrome

May-Thurner Syndrome (MTS) occurs when the right iliac artery crosses the left iliac vein and presses against it. This compression restricts proper blood flow and increases the risk of deep vein thrombosis (DVT), a dangerous blood clot. MTS often goes undiagnosed until a blood clot forms, but early detection and treatment can prevent complications. I

MTS is more common in women and people with connective tissue disorders like EDS.

Symptoms of May-Thurner Syndrome

Symptoms of May-Thurner Syndrome may include:

  • Swelling in the left leg, including persistent or worsening swelling.
  • Leg pain, heaviness, or discomfort in the legs, especially after standing for long periods.
  • Visible varicose veins, which are enlarged, twisted veins on the leg.
  • Blood clots. People with MTS have an increased risk of developing DVT.

Causes of May-Thurner Syndrome

There is no clear connection to the development of May-Thurner Syndrome. However, certain factors can increase your likelihood of developing the condition, such as:

  • Anatomical compression, as the right iliac artery presses on the left iliac vein.
  • Connective tissue disorders like EDS, which can contribute to vein and artery misalignment.

Treatment of May-Thurner Syndrome

Diagnosing and treating May-Thurner Syndrome typically requires a cardiovascular specialist. Treatment often focuses on relieving pressure on the iliac vein, improving blood flow, preventing blood clot formation, and long-term management, and can include:

  • Angioplasty and stenting, opening the vein and placing a stent to keep it open.
  • Blood thinners to prevent or treat blood clots.
  • Minimally invasive procedures, such as effective options for restoring blood flow and relieving symptoms.

Pelvic Congestion Syndrome (PCS)

Overview of PCS

Pelvic Congestion Syndrome (PCS), or pelvic venous insufficiency, is a long-term condition where varicose veins develop in the pelvic area and don’t drain blood properly from the area. These veins become enlarged, leading to a dull, aching pain that often gets worse when you're standing or active. 

PCS is frequently linked to vein compression disorders like May-Thurner Syndrome and it tends to affect women more commonly, especially those with connective tissue disorders like Ehlers-Danlos Syndrome.

Symptoms of PCS

The symptoms of POTS are primarily the result of inflammation and an inefficient return of blood to the heart, and can include:

  • Chronic pelvic pain, such as aching or dull pain that gets worse when standing.
  • Pain during intercourse, especially discomfort that lingers after intimacy.
  • Leg pain or swelling. Similar to May-Thurner Syndrome, there may be leg swelling or pain.
  • Visible varicose veins, particularly in the pelvic area or thighs.
  • Painful periods.

Causes of PCS

  • Poor blood flow in pelvic veins, which causes veins in the pelvis to become enlarged and twisted.
  • Compression syndromes like MTS, which compress the pelvic veins, can contribute to PCS.
  • Connective tissue disorders like EDS, which increase the risk of vein problems.

Treatment of PCS

Treatment of PCS focuses on improving blood flow in the pelvic area by relieving strain on the circulatory system via methods like:

  • Embolization procedures, which block off problematic veins to reduce pain.
  • Pain management like medications and therapies to manage discomfort.
  • Lifestyle adjustments, including exercise and movement to help improve blood flow and relieve pain.

Ehlers-Danlos Syndrome (EDS)

Overview of EDS

Ehlers-Danlos Syndrome (EDS) refers to a group of inherited disorders that weaken connective tissues that support the skin, joints, and blood vessels. Those with EDS often have overly flexible joints, delicate skin that bruises easily, and issues with blood vessels functioning properly. 

EDS can make other conditions, like POTS, May-Thurner Syndrome, and PCS, more likely because of the body’s weakened connective tissues.

Symptoms of EDS

  • Hypermobile joints that are very flexible and move beyond the normal range.
  • Fragile skin that may bruise, tear, or scar easily and be slow to heal.
  • Joint dislocations and slips that may occur frequently because of loose connections.
  • Chronic pain, such as persistent pain in joints and muscles.
  • Fatigue and feeling tired or weak due to joint instability and pain.

Causes of EDS

  • Genetic mutations that can affect the body’s collagen production.
  • Inherited conditions that are passed down through families from one or both parents.

Treatment of EDS

Treating EDS primarily focuses on preventing complications; managing pain and skeletal and joint difficulties; and reducing stress to the aorta and other arteries by lowering blood pressure and/or cholesterol levels. Treatment of EDS can include:

  • Physical therapy, such as activities help to strengthen muscles and stabilize joints.
  • Pain management through over-the-counter pain relievers, prescription pain medication, and/or cognitive behavioral therapy (CBT)
  • Cardiovascular care to monitor and manage vascular complications.

How POTS, May-Thurner Syndrome, PCS, and Ehlers-Danlos Syndrome Intersect

When dealing with POTS, May-Thurner Syndrome, PCS, and Ehlers-Danlos Syndrome, it becomes clear that, often, these conditions don’t just coexist — they are interconnected in symbiotic ways that can make each other worse. Recognizing how these conditions overlap and intersect is crucial for accurate diagnoses and effective treatment.

Here are the 2 primary ways in which these conditions are related:

  1. They can exacerbate each other.

There is typically a correlation between one condition and another (or more), so if you have one, you’re more likely to either have or develop another.

Ehlers-Danlos Syndrome, for instance, weakens connective tissues, making veins more likely to compress, as seen in May-Thurner Syndrome and PCS. When blood flow is restricted because of these compressions, it can worsen the symptoms of POTS, like dizziness and fatigue when standing. On top of that, the chronic pain and exhaustion from EDS can heighten the discomfort caused by PCS and MTS. This interconnected nature often creates a cycle where each condition aggravates the others, making everyday life more challenging.

Treating just the symptoms of one condition–instead of the root cause–might help, but it often doesn’t provide complete relief. For example, managing POTS by regulating your heart rate can help with some symptoms. However, if poor blood flow from MTS or PCS isn’t addressed, symptoms may linger. Likewise, if EDS is causing joint instability and weak veins, treatments that don’t account for this underlying issue may fall short.

  1. Treating the cause of one condition may help improve the others.

Treatment plans for these conditions often overlap, so addressing the underlying causes of one may have a ripple effect and improve a related condition.

For example, placing a stent to correct May-Thurner Syndrome can enhance blood flow and reduce the pelvic pain associated with PCS. Similarly, physical therapy to stabilize joints for EDS can lessen the strain on veins, which might ease some POTS symptoms. Treating POTS by improving blood circulation with hydration and compression stockings can also benefit overall vascular health, making symptoms of MTS and PCS less severe.

Take the First Step Toward Comprehensive Relief with CardioVascular Health Clinic

Living with conditions like POTS, May-Thurner Syndrome, PCS, and Ehlers-Danlos Syndrome can be challenging, but you don’t have to navigate it alone. At CardioVascular Health Clinic, our team focuses on understanding how these conditions are connected and treating them with a comprehensive, multifaceted approach to care. By tackling multiple issues at once, we aim to improve your overall well-being and help you find lasting relief.

The specialists at CardioVascular Health Clinic have developed a highly collaborative methodology to diagnosing and treating conditions like POTS, MTS, PCS, and EDS, working together to address all related conditions at the same time to help break the cycle of worsening symptoms so you can feel better and enjoy a better quality of life.If you’re experiencing symptoms that could be related to any of these conditions, schedule an appointment today with CardioVascular Health Clinic and take the first step toward better health.

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