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N Engl J Med (2021) 385:50315

Fatty acids are utilized as an energy substrate in alltissues except the brain

Zaccardi F, Htike ZZ, Webb DR, Khunti K, Davies MJ

lighter or skipped periods suggest metabolic improvement in PCOS-pattern patients Cycle changes lasting beyond 6 months at stable weight or accompanied by severe pain, flooding, or clotting warrant gynecological evaluation, not just dose adjustment Direct answer (40-60 words) Zepbound (tirzepatide) disrupts menstrual cycles through rapid weight loss releasing stored estrogen from adipose tissue, improved insulin sensitivity changing ovulation patterns in metabolically compromised patients, and direct GLP-1 receptor activation affecting hypothalamic-pituitary-ovarian signaling