@ymv the Tymlos educator (and maybe your doctor) are constrained by what studies were based on, and also on the idea that Tymlos can be left out of the refrigerator. The Tymlos specialty pharmacy wouldn't even give me more needles to extend use past 30 days.

My doc is a top endo and said it is fine to use past 30 days until the pen is empty. I think a good middle ground is to toss the pen after an extra 14 days, as long as it has been refrigerated.

Ramping up is going to pose this question since the 30 days is based on full doses.

Make sure the pen isn't cloudy. If side effects stop entirely, maybe consider it isn't working!!!!