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otherwise observation Breakthrough bleeding or spotting between periods: Likely mechanism: fluctuating estrogen levels during active weight loss Typical timeline: episodic during weeks 4 to 20 Associated findings: correlates with weeks of accelerated weight loss What it means: uterine lining is responding to unstable estrogen levels Management: usually benign

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Injections may provide more predictable absorption, particularly for those with digestive or absorption difficulties

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Traditionally viewed as a cytoprotective mechanism, autophagy, when excessive, can also instigate cell death and contribute to tumor suppression (120)