B12 deficiency in perimenopause and menopause: Signs and symptoms

Eileen Durward
Ask Eileen

03 June 2024

What is B12 needed for?

It's very common to get nutritional deficiencies in the perimenopause and menopause. A lot of it has to do with all the physical, emotional, and hormonal changes that are going on, increasing your nutritional needs. Certain nutrients are really essential for our well-being and our health and one of them is vitamin B12.

Vitamin B12 is what's called a water-soluble vitamin, which is crucial for various body functions. It's one  of the eight B vitamins. There's a ‘family’ of B vitamins that are all essential to the proper functioning of the nervous system, for red blood cell production, for DNA synthesis, for energy metabolism, and also various psychological processes in the body.

What can affect B12 absorption during perimenopause and menopause?

Here are several factors that can affect your absorption and cause or contribute to B12 deficiency during perimenopause and menopause:

Age: The problem is that as we get older, our ability to absorb B12 from food decreases, so the deficiency of B12 risk increases.

Digestive changes: So many women going through perimenopause and menopause find they get digestive problems. One of the important things for vitamin B12 absorption is having enough stomach acid. So, if your production of stomach acid decreases, then your absorption of B12 is going to decrease, and that is going to give you a risk of vitamin B12 deficiency. We also know that gut flora (the balance of friendly bacteria in the gut) can have an impact on vitamin B12.

Dietary factors: If you're vegetarian or vegan, you're not going to get good sources of B12 from meat, so that's a really important one. If you're in this category, it's really important to understand the risk of B12 deficiency.

Excessive alcohol consumption: Drinking alcohol can affect how your body absorbs B12.

Medication: Some medications can also affect your B12 levels. I will go into one particular class of medication later in this article.

Signs and Symptoms of low B12

Some of the common signs and symptoms of a vitamin B12 deficiency include:

Fatigue and general weakness: You feel that you're so tired all the time or you don’t seem to have enough 'get up and go', and it seems to be a constant feeling. Vitamin B12 is crucial for energy production. So, if you're low in B12, then fatigue and general weakness are going to be one of the main symptoms.

Shortness of breath and dizziness: This can be due to the decrease in red blood cells, because one of the other things vitamin B12 does is help with the production of red blood cells. Our red blood cells carry oxygen to all parts of the body. So, if you're low in B12, if your red blood cell count is low, then you can end up with a lack of oxygen. That's going to cause shortness of breath, dizziness, and it could also affect things like brain function, which I will go into later in this article.

Tingling and numbness: B12 is essential for nerve function. So, if you're low in B12, you're going to get nerve-tingling. You're going to get numbness, pins and needles, and very often the hands and feet are the main areas where you will feel this.

Difficulty walking or balance problems: Nerve damage caused by B12 deficiency can lead to difficulty walking, balance problems, and even muscle weakness.

Cognitive Issues: It can be experienced as cognitive issues, as I mentioned before. So again, if you're not getting enough blood cells and oxygen to the brain, you're going to have memory loss. You're going to have the brain fog. You're going to have confusion, and your concentration levels can decrease as well.

Mood changes: Low B12 can also cause symptoms such as depression, irritability, and mood changes; and it can contribute to anxiety as well.

Vision problems: In some cases, a B12 deficiency can cause vision changes. It can cause vision disturbances, or it could lead to optic nerve damage.

B12 deficiency symptoms vs menopause symptoms

So, the problem here is that all those symptoms that I've just mentioned, don't they sound just like menopause ones? What can happen in menopause is that many people don't know much about B12 deficiency, so all of these symptoms can then be blamed on menopause. You take menopause remedies. You might end up going on HRT. You might do other things to help with hormonal balance, and you find that nothing helps; and that's because the symptoms may be associated with vitamin B12 deficiency rather than the hormonal changes associated with perimenopause and menopause.

So, it's really important to know the signs and symptoms of B12 deficiency. I always advise that when you start to get any of these symptoms in any combination, you go and ask your doctor to get your vitamin B12 levels checked. It's so easy to remedy, and it can make a difference really, really quickly.

How to increase your vitamin B12 intake

If you are deficient, it's more than likely that you'll end up having to get regular injections. But if you're maybe on the borderline or you just want to try and do something to help yourself to start with, there are a few things that can help:

One of the main ways to boost your vitamin B12 intake is through your diet. For those of you who eat meat, really good-quality red meat is an excellent option - liver in particular is very high in B12.

For those of you who are vegetarian or vegan, it's really important to supplement because there are very few vegetables and other vegan food options that will contain enough vitamin B12 in consistent quantities to make a difference for you.

The other thing that you can do is to get a vitamin B sublingual spray. You can also get what's called a vitamin B complex. I tend to recommend the complex because the B vitamins work in harmony with each other. Rather than taking a high dose of one single one on its own, it's better to take a good combination. Your local health food shop or pharmacy should be able to advise you on a good quality product that's high strength enough.

The recommended daily allowance at the minute in the UK is about 2.4 micrograms, but these things do change over time, so always keep an eye on that.

B12 and stomach acid medication

Now, one of the things I mentioned before was certain medications. So many women tell me that going through menopause, they end up with gastric reflux or indigestion, so they go to the doctors and get prescribed medications that bring down stomach acid. Quite a few of these medications do mention vitamin B12 deficiency on their side effects list, especially if they are taken long-term. So, if you're on any of these medications and you've been on them for more than a few months, check the patient information leaflet. Also, have a chat with your pharmacist. Maybe ask them if they do B12 tests as well, just to make sure that the medication is not part of the problem for you.

So, I hope you found this one helpful. It's quite a big factor. I'm finding now, as time goes on, that more and more women are being diagnosed with vitamin B12 deficiency in perimenopause and menopause, so just be aware of this one.

Don't always blame menopause for all your symptoms, because as we've just seen today, it might not be. So, if any of you have had experience of vitamin B12 deficiency, what happened? What symptoms did you get? What have you done to remedy it? What tips do you have for everyone else out there? Because, as always, I love to read your stories.

Until next time, take care and have a lovely week.

You may also find these topics helpful:

5 common vitamin & mineral deficiencies in menopause?

What is the best vitamin for menopause?

Menopause and your increased nutritional needs

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