Episode #169: Insulin, LH, and PCOS Hormonal Chaos: Understanding the Connection

Hi, and welcome back to the PCOS Repair Podcast, where today we’re going to be looking at a hormone that gets a lot of attention, especially when we’re concerned about ovulation and fertility, and that is luteinizing hormone, or LH. But we’re going to look at it from a slightly different angle—how it relates to insulin, and how insulin relates to LH—and the chaos that can ensue when we have PCOS.

If you’ve felt overwhelmed, unsure, or completely in the dark about what’s going on when you’re not ovulating, or when your cycle shifts—ovulating too early, too late, or your cycle gets longer or shorter—those symptoms often come down to LH being at the center of it all. Of course, we have a full symphony of hormones at play in ovulation and our menstrual cycle, but LH is the pinnacle, the hormone that spikes to trigger ovulation. So with that, let’s dive into what’s going on when we’re seeing chaos in the cycle—specifically, how insulin and LH play together.

First, let’s zoom in on insulin. This is at the root of PCOS for almost everyone, even if your primary root cause is inflammation or stress. Insulin still plays a critical role in whether your hormones are balanced or unbalanced. Insulin is the hormone that moves glucose—blood sugar—from your blood into your cells. When we eat, blood sugar enters the bloodstream. But for it to be used by our organs or muscles, it has to enter our cells, and insulin is what opens that door.

Many women with PCOS become insulin resistant. This means that the cells don’t respond to insulin as well, so the body has to produce more of it. Think of it like trying to get someone’s attention: at first, you speak normally, but if they don’t respond, you speak louder, then louder still. That’s what happens with insulin resistance. Over time, your body keeps producing more insulin to try to get a response from the cells. Eventually, the pancreas gets worn out and may stop producing enough insulin. That’s when we move into a type 2 diabetes diagnosis, and people may require insulin injections.

But even before reaching that point, PCOS becomes confusing because this insulin resistance spectrum exists—and even someone who is still insulin sensitive can experience problems if their daily insulin load is too high. The types of food we eat, the frequency, the portions, the timing—all influence how much insulin is secreted daily. When insulin is present in abundance—whether from resistance or diet—it does more than regulate blood sugar. It also tells the ovaries to produce testosterone, which in turn increases LH.

So, insulin helps with blood sugar, but high insulin levels also tell the ovaries to make androgens, primarily testosterone. High testosterone then raises LH. And that’s a problem for ovulation.

Here’s why. Day one of your cycle begins the follicular phase. Follicle Stimulating Hormone (FSH) starts maturing several ovarian follicles. Usually one becomes dominant, and it’s prepared for ovulation. But the egg isn’t released until an LH surge finishes that maturation process and triggers ovulation. The egg is then released and travels down the fallopian tube, ready for fertilization.

The problem is, if LH is already elevated throughout your cycle, you don’t get a proper surge. It’s like turning up the volume too early—you miss the spike that’s supposed to stand out. The body doesn’t notice the signal, and ovulation doesn’t happen. Over time, this results in cystic-looking ovaries filled with eggs that almost matured but were never released.

So we want to keep testosterone in check—not just because it raises LH, but because it causes many other PCOS symptoms. And in this episode, we’re zooming in on how elevated LH disrupts ovulation. The best way to improve LH is to address what’s elevating testosterone.

One major factor is diet. Dietary changes that help lower insulin include choosing lower glycemic index foods, ensuring enough protein and fiber, and incorporating healthy fats. Eating regularly—but not constantly—and being mindful of portion size also helps.

For those really wanting to understand their patterns, I highly recommend trying a CGM—a continuous glucose monitor. It’s a small device you wear on your arm for two weeks at a time. It’s easy to apply and doesn’t hurt, despite the loud “pop” it makes going in. It reads your interstitial blood sugar continuously and can give incredible insight into how your body responds to food and stress in real-time.

While it’s not meant to replace finger-prick glucose testing for those on medication, CGMs are great learning tools. They can show you how food choices and exercise affect your glucose spikes. For example, some people see a sharp spike followed by a crash, which indicates insulin resistance. CGMs also show how stress elevates blood sugar and how movement—like walking after a meal—can help manage it. You begin to see how simple habits lower the need for insulin.

I usually recommend wearing one for 4–6 weeks, using 2–3 sensors. The first few days, you just observe. Then, start making small changes and see how they affect your numbers. It takes a bit of experimenting to find what works best. CGMs are prescription-based in the U.S., but you can ask your doctor—family medicine or OB/GYN—for a script. I typically get a standing order with 2–3 refills when I get my labs done.

Besides food and tracking, the second way to lower insulin is exercise. Any activity lowers blood sugar a little, but Zone 2 exercise—such as a brisk walk after a meal—is especially effective. Just a 10–20 minute walk can significantly lower the glucose impact of a meal. The other long-term strategy is building muscle. The more muscle you have and the less fat, the more insulin sensitive you become. Strong, well-used muscle helps your body respond better to insulin.

Let me give you an example. Say I’m insulin sensitive and I eat an apple. My glucose spikes to 130, and my body sends over a “10” of insulin to bring it back to 100. But if I’m insulin resistant, the same apple might spike my glucose to 140. My body doesn’t listen to insulin well, so it sends a “40” to get the job done, and I crash down to 70. That big swing—high spike followed by a crash—creates fatigue, cravings, and more insulin issues. Now, if I go for a walk after that apple, I may not spike as high, and I’ll need less insulin to stabilize. Those small daily tweaks matter.

Weightlifting also helps. Not excessive muscle, but a healthy, well-used muscle mass makes you more insulin sensitive. It improves circulation and helps regulate blood sugar more efficiently.

Now, let’s talk about stress. This is a huge factor. When we’re stressed, cortisol goes up, and cortisol raises insulin. This is part of the fight-or-flight response: get glucose to the muscles in case you need to run. But when we live in constant stress, our cortisol and insulin stay elevated. Elevated insulin tells your body to hang onto fat and resist weight loss. It also disrupts hormones.

Finally, supplements can help. My favorite for improving LH and ovulation—once root causes are addressed—is inositol. Specifically, I like Ovasitol, which you can find in my PCOS supplement guide (linked in the show notes) and get a discount through my dispensary.

Magnesium is another one I recommend. It helps with blood sugar regulation, stress reduction, and sleep. Again, you can find my preferred magnesium options in my supplement guide with the discount.

So, stress, diet, exercise, and supplements all play a role in insulin management—which supports testosterone balance and ultimately helps regulate LH and improve ovulation.

I know this was a deep dive, but I hope it helped shed light on the chaos that happens with LH when ovulation isn’t working properly. LH is tricky to track, especially with over-the-counter ovulation kits, because women with PCOS often have elevated LH all the time. That makes it hard to detect the surge that signals ovulation. The tests get confusing, and many women feel lost trying to interpret them.

That’s why our lifestyle choices—nutrition, movement, stress management, and supportive supplements—are so important in managing PCOS and hormone health.

This episode doesn’t replace understanding your unique root cause, but it can help if you’re struggling with this specific hormone imbalance. If you haven’t already, take the PCOS Root Cause Quiz (linked below), and grab the full supplement guide at supplementsforpcos.com.

If you found this episode helpful, make sure to hit subscribe so you’re notified each week when a new episode becomes available. I’d also love to connect with you over on Instagram—come find me @nourishedtohealthy.

Until next time, bye for now!