The October Slide: Why Fall Is Harder When You Have hEDS, POTS, or MCAS
Every year around now, my body files a formal complaint.
Mid-September I'm doing great. The summer heat finally let go, I'm sleeping, I have a routine, I'm insufferable about it. And then somewhere in the second week of October the wheels come off and I spend three days going back through everything I ate and everything I did, looking for the mistake.
There's no mistake! October is just hard on bodies like ours, and knowing that in advance turns "what did I do wrong" into "oh. It's October."
We call it the October Slide. Nobody's writing it in your chart. It's a thing that happens to a LOT of you — people with hypermobile Ehlers-Danlos syndrome, hypermobility spectrum disorder, POTS and other forms of dysautonomia, MCAS, and honestly most complex chronic conditions — and I'd rather name it than let each of you sit alone with it every fall assuming you're the only one.
One note first, because you're not all where I am. I'm in New Hampshire, so October is my version of it. If you're in Melbourne or Cape Town or Buenos Aires, yours lands around April. If your seasons are wet and dry instead of warm and cold, yours shows up when the rains turn. So the month is wrong for a lot of you. The change isn't, and every single one of us gets one.
The body half: what a seasonal flare actually does
Barometric pressure, temperature swings, and hypermobile joints
The weather stops being able to make up its mind. Where I live, October can swing thirty degrees in a day, and the barometer goes up and down like a toddler on a trampoline.
Now, barometric pressure and pain. The research on that is genuinely a mess and I'm not going to pretend there's a clean study I can hand you. What I can tell you is I have never once been in a room full of hypermobile people where this was a controversial opinion. We knew before anybody gave us a diagnosis.
Temperature does a second thing on top of the pressure. Tissue gets stiffer, muscles guard harder, and guarding around already-loose joints is how you end up sore in places that weren't even involved. There's a wrinkle here I love: plenty of POTS people feel BETTER once it cools off. So you can be less dizzy and more wrecked at the same time. Cool. Great. Thanks, body.
Shorter days, worse sleep, lower pain threshold
The light changes, fast. This one depends on how far you live from the equator, and the further out you are the more brutal it gets. Where I am we lose close to three hours of daylight between the start of September and Halloween.
Your circadian rhythm notices even when you don't, sleep goes strange, and sleep is the load-bearing wall under all of it: pain threshold, fog, gut, mood. You don't need a seasonal depression diagnosis for this to land on you.
Indoor air, furnace dust, and MCAS triggers
The building climate changes. For half of you that's the first furnace run of the season, which is a dust event, and if you have mast cell activation syndrome your house has quietly become a different house.
For the rest of you it's the AC coming on, or the windows finally opening after months shut, or the damp arriving. Same principle! The air you're breathing sixteen hours a day just changed composition and nobody sends a memo about it.
Virus season, and why a cold isn't just a cold
The school term starts and everything becomes a petri dish. Wherever school just went back, virus season went with it.
And for a lot of us a regular cold isn't a regular cold. It's a week of being sick and then three weeks of being flattened, which nobody warns you about and everybody around you keeps forgetting. If you have dysautonomia or mast cell involvement, post-viral recovery is its own separate event with its own separate timeline.
The calendar half: the part nobody accounts for
And then there's the part that has nothing to do with your body at all.
Summer is loose. Autumn is not. School is in full swing, the activity schedules are real, whatever holidays your family does are suddenly visible on the horizon, and right about now almost every single one of you starts making the same quiet trade: I'll deal with me in January.
Tell me you haven't moved your own appointment to make room for somebody else's. I'll wait. (Psssst, I'm guilty of this, too. I literally just rescheduled an MRI for the new year because nobody has time for that.)
So the two halves land on top of each other. Your body gets harder to run at the exact moment your calendar gives you the least room to do anything about it, and then February shows up and you've been white-knuckling it for four months. That's the slide.
What actually helps with a fall flare
I won't insult you by insisting any of this will cure you. We all know it won't. But it WILL help.
Front-load. Don't back-load. Whatever care you know you need over the next few months, get it on the books now, while you still have the executive function to do it. December-you is not making that phone call. I say this with love and from experience.
Pace against the weather, not the calendar. When the pressure is doing something stupid, take the rest day. You didn't fail at anything, you read the weather correctly.
Don't drop your salt and fluids just because it got cold. Everybody's diligent in July and quietly stops in October, then wonders why they're lightheaded in a dry house with the heat blasting. Heated indoor air dehydrates you too. This one matters most if you have POTS.
Deal with your filters and your dust before the system runs. Boring. Works. Do it this weekend!
Get outside into morning light. Ten minutes early in the day does more for your sleep than most of what's in your supplement drawer. I'm fully aware of how that sounds. Do it anyway.
Move something, gently, most days. Not "exercise," not a program, not a whole thing. Stiffness feeds guarding and guarding feeds pain, and ten minutes of anything interrupts that loop.
Say something before the crash, not after. It's a much shorter conversation in October than it is in February, I promise you.
That's it, that's the whole post. If you're reading this in the second week of it wondering what you broke — nothing! It's the season. Go drink some water and put your feet up.
Sincerely,
Lauren
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Questions we get about seasonal flares
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Falling barometric pressure and dropping temperatures both affect connective tissue and muscle guarding. The research is genuinely inconsistent, but it's close to universal in the hypermobile community. Cold also stiffens tissue and increases guarding around already-unstable joints, which produces pain in places that weren't the original problem.
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Yes, and not always in one direction. Plenty of people with POTS feel better once the heat breaks, because heat is a major trigger for orthostatic symptoms. At the same time, heated indoor air is dehydrating and people tend to reduce salt and fluid intake once it's no longer hot out. You can improve and get worse at the same time.
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The first furnace run of the season stirs up months of settled dust, and switching between open windows and closed climate control changes your indoor air composition entirely. For anyone with mast cell activation syndrome, that shift alone can be enough.
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For many people with hEDS, dysautonomia, or mast cell involvement, the acute infection is the short part. Post-viral recovery can run three to four weeks past the point where everyone around you assumes you're better.
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No — the month doesn't. The seasonal transition does. In the Southern Hemisphere it lands around April. In places with wet and dry seasons rather than warm and cold, it arrives when the rains turn.
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Get care scheduled before you need it, maintain salt and fluids through the cold months, change your furnace filter before the heat runs, get morning light, and move gently most days. Most of it is boring. Most of it works.
