Understanding Insulin and Blood Sugar in Functional Hypothalamic Amenorrhea (HA)
Before we dive in, we want to give credit to the author. This was written by Cat, a graduate of our Holistic HA Practitioner (HHAP) Certification Program. Cat brings a deep understanding of the root causes of HA and is passionate about supporting women on the path to recovery through education, empowerment, and holistic strategies.
Insulin and Functional Hypothalamic Amenorrhea: What’s the Connection?
If you’ve been diagnosed with functional hypothalamic amenorrhea (FHA), you may have noticed low fasting insulin levels in your blood work—or perhaps you’ve experienced symptoms of low blood sugar (hypoglycemia) like shakiness, fatigue, or dizziness. These are common in HA and are often the result of the body adapting to chronic energy deficiency, elevated cortisol, and increased physical activity.¹
On the other end of the spectrum you may have experienced consistent high glucose levels—another phenomenon in HA, often the result of low estrogen levels. While abnormal glucose and insulin levels can feel overwhelming or even concerning. By understanding how these play a role in HA and what it means for your health, can help you make empowered decisions in your recovery and take the right steps to achieve hormonal balance.
Let’s explore what insulin does, how it connects to HA, and what all of this means for your recovery from amenorrhea.
What Is Insulin—and How Is It Related to Functional Hypothalamic Amenorrhea?
Insulin is a hormone produced by the pancreas in response to food—especially carbohydrates. Its main role is to move glucose (sugar) from your bloodstream into your cells for energy.² But insulin also acts as a signal to your brain that your body is nourished and can support reproductive functions like menstruation and ovulation.²
This is where the connection to HA comes in. HA is a condition triggered by chronic energy deficiency—when your body doesn’t have enough fuel coming in to meet its needs. This often happens through a combination of under-eating, over-exercising, and psychological stress. When this continues over time, the body downregulates functions that aren’t essential for immediate survival—like your menstrual cycle. ¹,³.
Insulin is closely tied to this process. In HA, low insulin levels are both a contributor to and a consequence of energy deficiency.
How Low Insulin Contributes to Amenorrhea Symptoms
In HA, as overall food intake decreases—particularly carbohydrates—insulin secretion drops. Glucose is the main trigger for insulin release, so when glucose levels are low, insulin naturally declines. But beyond blood sugar regulation, insulin also plays a key role in reproductive hormone signaling.
Insulin acts as an energy signal to the brain. ²,³ Specifically, it helps stimulate the hypothalamus (a brain region that controls reproduction) to release gonadotropin-releasing hormone (GnRH). GnRH kickstarts the hormonal cascade that leads to ovulation and menstruation by signaling the pituitary gland to produce LH (luteinizing hormone) and FSH (follicle-stimulating hormone).⁴ Low insulin means weaker GnRH signals and, ultimately, reduced LH and FSH levels—resulting in a lack of ovulation and amenorrhea.
Insulin works hand-in-hand with another hormone called leptin, which is produced by fat cells. Leptin also signals to the brain that energy stores are adequate. Together, insulin and leptin activate kisspeptin neurons, which are critical for maintaining reproductive hormone signaling. ²,⁴ When both insulin and leptin are low—common in HA due to undernutrition and low body fat—the brain essentially gets the message that the environment is unsafe for reproduction, therefore contributing to the onset of HA. ²,⁴
How HA Suppresses Insulin Production Over Time
The relationship between HA and insulin is bi-directional: low insulin can lead to HA, and once HA sets in, it can keep insulin levels low.
This happens because your body adapts to chronic energy shortage by slowing down your metabolism. ¹,⁵ When carbohydrate intake is reduced, less glucose enters the bloodstream. With less glucose to manage, your pancreas produces less insulin. ⁶ At the same time, your body begins conserving energy by breaking down stored fat and muscle and shifting into a fuel-rationing mode. Over time, this adaptive response keeps insulin levels low—even if you’re not actively trying to restrict food.
Estrogen, Cortisol, and Their Role in Blood Sugar & Insulin
Two key hormones—estrogen and cortisol—play a major role in the relationship between insulin regulation and HA. Estrogen, particularly in the form of estradiol, is essential for maintaining the health and function of pancreatic beta cells, which are responsible for producing and releasing insulin.⁸ When estradiol levels drop, as they often do in HA, this protective support is lost, and beta cell function can become impaired—resulting in reduced insulin output.⁹
At the same time, low estrogen affects how the body uses glucose. Estradiol normally improves insulin sensitivity, helping tissues like muscle and fat efficiently absorb glucose.⁹ When estrogen is low, this sensitivity decreases, and tissues become less responsive to insulin, potentially leading to slightly elevated blood glucose levels.⁹
Under normal circumstances, the body might compensate for this reduced insulin sensitivity by producing more insulin. However, in HA, the pancreas often does not respond with increased insulin secretion. This could be due to the combined effects of low estrogen and elevated cortisol—both of which suppress insulin production.
Cortisol, the body’s primary stress hormone, directly inhibits insulin synthesis by downregulating the expression of genes necessary for insulin production in beta cells.¹⁰ In addition, cortisol promotes a catabolic state by stimulating the liver to produce more glucose (gluconeogenesis) and by increasing the breakdown of fat and muscle tissue to provide energy.¹¹ These metabolic shifts seem to occur as the body attempts to prioritize energy release over energy storage while in a state of low energy availability, further reducing the body’s need—and capacity—for insulin.
This coordinated hormonal response reflects the body’s broader goal in HA: to conserve energy and prioritize survival over growth, repair, and reproduction. As a result, individuals with HA may experience slightly elevated blood glucose levels without a corresponding rise in insulin—not because the body isn’t aware of the change, but because its ability to produce insulin is fundamentally compromised by the surrounding hormonal environment.
Understanding Why Insulin and Glucose Levels May be Abnormal in HA
Understanding the connection between insulin, glucose and HA helps highlight just how smart your body is. In a well-fed state, insulin encourages your body to store nutrients and support reproduction. But in times of stress or food scarcity, your body prioritizes survival. Insulin promotes the storage of glucose, but when energy is scarce, the body wants to keep glucose circulating for essential organs like the brain.¹² So, while measures of insulin and glucose in HA may be abnormal, it is for a reason—your body is ensuring that vital tissues get the fuel they need.¹³ It’s an amazing example of how your body protects you during hard times—even though it can come at the cost of your cycle and hormones.
What This Means for Your Missing Period
Recovery from HA is the foundation for restoring healthy glucose regulation and insulin production. When the body is consistently fueled with adequate energy—through balanced meals that include complex carbohydrates, proteins, and fats—insulin and glucose levels can begin to normalize.¹²-¹⁴ Protein and fat are KEY in this context as they help slow glucose absorption and stabilize blood sugar levels, while also supporting the rebuilding of hormones like estrogen.¹⁵ As nutritional intake improves and the body receives sufficient rest, insulin secretion gradually increases and blood glucose fluctuations become more stable and less extreme. Leptin levels also begin to increase (signaling energy sufficiency), GnRH kicks in, estrogen rises and the hypothalamic-pituitary-ovarian (HPO) axis can resume normal communication. Together, these changes help restore reproductive function and support the normalization of glucose metabolism and insulin production.¹⁴
Wondering if blood sugar and insulin are playing a role in your missing period?
If you’re seeing signs like fatigue, dizziness, or irregular glucose levels—and your period is missing due to functional hypothalamic amenorrhea (HA)—you’re not alone. Navigating the hormonal shifts of recovery can be complex, especially when insulin, estrogen, and cortisol are all involved. That’s why our 1:1 coaching and group coaching programs are designed to help you fuel your body, regulate your hormones, and get your period back—without the guesswork.
At The HA Society, we combine science-backed education, compassionate coaching, and a supportive community to help you move from uncertainty to confidence. Whether you’re working through the realities of HA or guiding others through it, we’re here to walk with you every step of the way.
Want to dive deeper into the science of insulin, energy availability, and hormones—or become the kind of practitioner who truly understands the physiology of HA? Explore our Holistic HA Practitioner Certification Program, where students like Cat learn how to support cycle restoration and whole-person healing from the inside out.
Keep Reading:
What is Hypothalamic Amenorrhea?
What Labs to Request if You Suspect Functional Hypothalamic Amenorrhea (HA)
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