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evaluation needed if bleeding is persistent (more than 14 days continuous) or heavy Cycle completely stops (amenorrhea): Multiple possible mechanisms: excessive caloric restriction, body fat percentage dropping below threshold for menstruation (typically under 18% to 20%), hypothalamic suppression, or pregnancy Typical timeline: if related to Zepbound, usually after 12+ weeks and significant weight loss (more than 15% of body weight) What it means: needs evaluation

Preuss CV, Kalava A, King KC