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1989;570 (1): 514-517.PMID 14223080

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Key warning signs requiring urgent evaluation include: Postmenopausal bleeding (any vaginal bleeding occurring more than 12 months after the last menstrual period) Bleeding accompanied by fever, unusual vaginal discharge, or pelvic pain suggesting infection Bleeding associated with pregnancy or suspected pregnancy Recurrent spotting that persists for more than two to three menstrual cycles Patients taking tirzepatide who develop abnormal bleeding should undergo a comprehensive gynecological assessment, including detailed menstrual history, pelvic examination, and pregnancy testing for all reproductive-age women regardless of contraceptive use

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