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Contact your healthcare provider if you experience: Absent periods (amenorrhea): Missing three or more consecutive menstrual cycles if previously regular, or six or more months if previously irregular Heavy bleeding (menorrhagia): Soaking through a pad or tampon every hour for several consecutive hours, or periods lasting longer than seven days Severe pain: New or worsening menstrual cramping not relieved by over-the-counter medications Intermenstrual bleeding: Bleeding or spotting between periods that persists beyond initial treatment months Pregnancy possibility: Any missed period when pregnancy is possible, as tirzepatide is not recommended during pregnancy Urgent warning signs: Heavy bleeding with dizziness, fainting, rapid heartbeat, or severe weakness requires emergency evaluation Your healthcare provider may recommend specific investigations to evaluate persistent menstrual irregularities

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Although HLA-DR2 has been identified as a major genetic risk factor for MS its direct association with Cbl deficiency remains uncertain