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If menstrual irregularities cause significant distress or interfere with quality of life, healthcare providers may consider several approaches

(2003) Randomized, placebo-controlled trial of intramuscular vitamin B12 for the treatment of hyperhomocysteinaemia in dialysis patients

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Reduced cobalamin availability leads to: Impaired enterocyte regeneration Villous atrophy and barrier dysfunction Increased intestinal permeability Secondary dysbiosis and chronic inflammation Clinically, this manifests as: Persistent anorexia Weight loss Chronic diarrhea Poor response to standard GI or pancreatitis therapy Low vitamin B12 concentrations have also been associated with increased disease severity and poorer prognosis in dogs with chronic enteropathy and inflammatory bowel disease