Episode #137: LH Levels and PCOS: What You Need to Know

Welcome back to the PCOS Repair Podcast! Today, we’re going to talk about one of the most important hormones in our cycle, especially when trying to understand irregular cycles, ovulation timing, or fertility. This hormone plays a crucial role, and that is LH, or luteinizing hormone.

LH is a key reproductive hormone found in both men and women. In men, it stimulates testosterone production. In women, it helps regulate estrogen and progesterone levels, facilitating the cyclical hormone shifts that drive the different phases of the menstrual cycle.

How LH Functions in a Healthy Cycle

As a quick recap, we’ve discussed this in previous episodes, but essentially, LH levels are low at the beginning of the cycle. During this phase, estrogen is rising, helping to mature a follicle in the ovaries that will hopefully release an egg during ovulation. As estrogen increases, LH also gradually rises until it surges sharply—about 24 to 48 hours before ovulation. This LH surge signals the mature follicle to release the egg, enabling fertilization.

If pregnancy occurs, the fertilized egg implants in the uterine lining, and the body sustains progesterone levels. If pregnancy does not occur, progesterone levels drop, triggering menstruation and starting the cycle over again.

If you’ve ever taken progestin, a synthetic form of progesterone, to induce a period, it works by mimicking this natural progesterone drop. However, unlike natural progesterone, progestin doesn’t regulate the full hormonal symphony of rising and falling hormone levels. Instead, it simply signals the body to bleed. Some women find that after taking progestin, their body naturally resumes cycling, but others do not. This distinction is important to understand.

LH Imbalances in PCOS

One of the most common LH imbalances in PCOS relates to the LH-to-FSH (follicle-stimulating hormone) ratio. Ideally, LH and FSH should be at a 1:1 ratio throughout the cycle. However, testing LH and FSH can be challenging when cycles are irregular since timing is crucial.

In PCOS, we often see an LH-to-FSH ratio of 2:1 or 3:1, where LH levels are elevated compared to FSH. This disrupts the natural hormone pattern. Instead of the expected gradual LH rise, sharp surge, and decline, LH remains chronically elevated, which:

• Interferes with estrogen and progesterone regulation
• Fails to trigger ovulation properly
• Leads to immature follicles that don’t fully develop or release an egg

This lack of proper ovulation creates a cycle where multiple follicles partially mature but never release, leading to cystic ovaries, a hallmark of PCOS. Instead of fully completing the cycle, the process stalls, leaving undeveloped follicles lingering in the ovaries.

Why Ovulation Predictor Kits (OPKs) Are Unreliable for PCOS

Many women with PCOS turn to ovulation predictor kits (OPKs) to track ovulation. However, these tests often provide misleading results due to chronically elevated LH levels.

Popular OPKs, such as Clearblue digital tests, display:

• A blank circle (no LH detected)
• A smiley face (moderate LH detected)
• A blinking smiley face (LH surge detected)

Since PCOS often causes consistently high LH levels, these tests may display multiple positive results in a row, creating confusion. Women may assume they’ve ovulated or missed their fertile window when, in reality, ovulation may not have occurred at all.

Another common OPK method uses test strips that darken in color based on LH levels. Women with PCOS may see fluctuating or persistently dark results, leading to false confidence in ovulation timing.

Tracking Ovulation More Accurately

For women with PCOS, alternative tracking methods are often more reliable than OPKs, including:

1. Basal Body Temperature (BBT) – Tracking waking temperature can help confirm ovulation after it happens.
2. Mira Fertility Tracker – Provides quantitative hormone levels, tracking LH, estrogen, and progesterone more accurately.
3. Bloodwork from a Doctor – Measuring hormone levels through lab tests can give more precise data, though it’s difficult to time with irregular cycles.

Understanding PCOS and LH Dysfunction

So, what causes elevated LH levels in PCOS? The primary driver is high testosterone levels.

Testosterone plays a key role in raising LH, which disrupts ovulation and menstrual cycle regularity. Women with high testosterone may also experience:

• Acne
• Facial hair growth (hirsutism)
• Male-pattern hair thinning

To reduce testosterone levels, we need to address the underlying root causes of PCOS, including:

1. Insulin Resistance

• High insulin levels stimulate the ovaries to produce excess testosterone.
• Snacking frequently, consuming high-sugar foods, and a high-glycemic diet can lead to increased insulin production, worsening the hormonal imbalance.

2. Chronic Stress and High Cortisol

• Stress triggers cortisol, which increases insulin levels, further exacerbating high testosterone.
• Psychological stress, poor sleep, and over-exercising can all contribute.

3. Inflammation

• Chronic inflammation can directly stimulate androgen (testosterone) production in the ovaries.
• Anti-inflammatory lifestyle changes, such as a nutrient-dense diet, stress reduction, and balanced exercise, can help.

How to Improve LH Balance and Regulate Cycles

Since LH is at the top of the hormone pyramid, directly lowering LH isn’t straightforward. Instead, we must address the root causes affecting testosterone and insulin. Here’s where to start:

1. Identify Your PCOS Root Cause – Determine if insulin resistance, inflammation, stress, or a combination is driving your symptoms.
2. Track Your Cycle – Chart symptoms, BBT, and hormone levels over several months to identify patterns.
3. Improve Diet and Lifestyle –
• Balance carbohydrates with protein and healthy fats to stabilize insulin.
• Manage stress through self-care and quality sleep.
• Incorporate regular movement to improve metabolism and hormone balance.
4. Use Tracking Tools Wisely – OPKs can be misleading, but Mira, BBT tracking, and lab testing provide more useful data.

Final Thoughts

LH dysfunction in PCOS is a complex but manageable issue. By identifying the underlying causes, making lifestyle adjustments, and tracking progress, we can improve hormone balance, restore ovulation, and enhance fertility.

If you’d like to dive deeper into this topic, check out my PCOS Period Repair Manual at PCOSRepair.com. This guide covers:

• How the menstrual cycle works
• What’s happening in PCOS
• How to repair hormonal imbalances

You can also reach out to me on Instagram (@NourishedToHealthy)—that’s where I chat with most of my listeners. Feel free to send me a message if you have any questions!

And don’t forget to subscribe so you never miss an episode. Until next time, bye for now!