Hypermobile Ehlers-Danlos syndrome (hEDS) affects collagen, the protein that gives your joints, skin, blood vessels and gut their structure. Estrogen and progesterone influence how that tissue behaves, so hormonal shifts can change how hEDS feels.

The research backs up what many women notice:

• In a study of 386 women with hEDS, more than one-third had symptoms that flared around every period, and about half said puberty made their symptoms worse (Hugon-Rodin et al., 2016).

• In the same study, symptoms worsened after childbirth for 38% of women, another major hormonal transition.

• Heavy periods (76%) and painful periods (72%) were very common, and many women had pain with sex.

• Women with joint hypermobility had lower bone density and 1.8 times the risk of low bone mass, even before menopause (Gulbahar et al., 2006). Bone loss speeds up after menopause, so this matters for long-term planning.

Menopause affects everyone with hEDS differently. In that 386-woman study, about 1 in 5 postmenopausal women said their symptoms improved after menopause, while others did not. Since symptoms track with hormonal swings, perimenopause, when hormones rise and fall unpredictably, can be an especially rough stretch. That's why care should be individualized, not a standard protocol.

The trifecta: hEDS, POTS and MCAS

Hypermobile EDS rarely shows up alone. Two conditions travel with it so often that patients call the three "the trifecta":

• POTS (postural orthostatic tachycardia syndrome): your heart races and you feel dizzy, foggy or faint when you stand up.

• MCAS (mast cell activation syndrome): immune cells called mast cells overreact, causing flushing, hives, itching, food or medication reactions, and gut symptoms.

How often they overlap:

• In a 2025 survey of 84 women with hEDS or hypermobility spectrum disorder, 58% reported POTS, 32% reported MCAS, and 1 in 4 had all three (Blitshteyn et al., Autonomic Neuroscience, 2025).

• About 1 in 4 people with POTS also have hEDS, and in a large dataset, almost 1 in 3 people with MCAS also had hEDS, as summarized in a 2024 review (Quigley et al., 2024).

Where hormones come in

• POTS: women with POTS feel more lightheaded than other women at every phase of the menstrual cycle, and most of all during their period (Peggs et al., 2012).

• MCAS: mast cells carry estrogen and progesterone receptors. In lab studies, estradiol can trigger mast cells to release their contents, which may help explain why some women's reactions flare around their cycle (Zierau et al., 2012).

• hEDS: as covered above, joint and pain symptoms often track with hormonal shifts.

When perimenopause makes hormones less predictable, all three can flare at once, and it's easy to blame each symptom on the wrong cause. Research on this cluster is still young, so care has to be built around your own pattern rather than a one-size-fits-all protocol.

Does this sound familiar?

Women with hEDS or hypermobility often tell me that in their late 30s and 40s:

• Joint pain, subluxations or new injuries became more frequent

• Fatigue and brain fog got harder to push through

• POTS symptoms, like dizziness or a racing heart, flared

• Food reactions, flushing or other mast cell symptoms seemed to come out of nowhere

• Gut symptoms such as bloating, reflux or irregularity got worse

• Periods got heavier, more painful or more unpredictable

• Sleep fell apart, and anxiety or mood swings showed up

• Sex became painful or desire disappeared

You were probably told it was stress, aging, or "just your EDS." Some of it may be. But hormones are a piece of the puzzle that's often left out, and it's one we can treat.

I've been where you are

Before I became a women's health clinician, I was a professional acrobat. I was always flexible and always getting hurt. Then everyday movements started causing serious injuries: a shoulder dislocation from reaching down, a back injury from a sneeze. Even as a healthcare provider, I was dismissed by colleagues and specialists for years. It took a hip injury and surgery before someone finally said "hypermobile Ehlers-Danlos."

That diagnosis changed everything, and it's why I built Bold Wellness. I'm a board-certified nurse practitioner, a Menopause Society Certified Practitioner, and a member of The Ehlers-Danlos Society. I understand both sides of this: the connective tissue and the hormones.