Changes to menstruation during B12 loading therapy?

[Beccy_123]

Hi, I just had my second consult with private consultant (recommended by PA Society and some good folk here) who seems up to speed with current B12 diagnosis and treatment. My symptoms (typically associated with B12 deficiency) have much reduced after 9 weeks of SI every other day. As a result he is confident with his diagnosis and has written t my GP to state he believes I have "immune-negative pernicious anaemia (B12 deficiency)" and that the problem is with my stomach, despite auto-immune tests being negative.

My periods have been more frequent this year and have always been fairly regular and often heavy but not unbearable. When I started B12 loading doses 9 weeks ago, my periods stopped altogether. I thought maybe this was a coincidence as I am 46 and around the time of pre-menapausal.

I forgot to inject over a week ago and missed a day. I had a period which lasted 4 days or so. I resumed back to normal every other day injections. At the weekend after no period for 2-3 days, I forgot to inject again and he next day, I bled again a little. This was Monday.

I told my consultant about this and he had no explanation. Due to my positive response to B12 therapy, he recommend trailing every 3rd day injections and emphasized this is a trail and is very much patient led and to keep an eye on my symptoms...

So today was my 2nd day without an injection and I bled again.

The questions I am asking myself are:

1. what is causing this and is it actually connected to B12 therapy and the frequency of injections

2. Therefore should I continue on every other day SI or try every 3rd day and observe what happens?

Does anyone have any advice or information to share please?🙏

[Gambit62 Administrator]

b12 deficiency can cause false menopause but I can't think of anything obvious that would make B12 cause menstration to start in the way you describe. My experience was one of periods becoming more regular and more manageable. I think progesterone can interfere with B12 absorption - some contraception interferes with uptake and I think it is progresterone - but I'm not aware of it working the other way round and that would , I think, be the wrong part of the menstral cycle anyway.

It could just be co-incidence and the way the perimenopause is affecting you or it could be co-incidence on something else.

[mabs79 in reply to Gambit62]

mmy GP is putting me on cerazette Progesterone pill will this mean that I will absorb even lessb12 ? My iron and ferretin are rock bottom we think due to heavy periods and I need to regulate my bleeding

[Gambit62 Administrator in reply to mabs79]

mabs79 if you are on injections it shouldn't be an issue

[Beccy_123 in reply to mabs79]

I have read that B12 deficiency can cause excess menstrual bleeding as it changes the lining of the uterus, and thus contribute to further anaemia. To my understanding, starting B12 therapy increased oestrogen which caused a thickening of the uterus and stopped bleeding. Reducing dosage frequency changed oestrogen levels and maybe thinned the uterus lining and caused some bleeding. After 4 doses at 3 days apart, I have no bleeding so I will report back in a few months on this. Are you on a loading dose B12 - injections?

[Dilly_blue]

Glad to hear you are generally feeling much better. I am not medically trained, so this is just my own personal opinion! B12 deficiency (and the impact on metabolite levels - MMA and homocysteine) can have a knock-on effect on the expression (and function) of a large number of genes/proteins within the body - which may then impact upon the function of other body systems - so this could be an example of a change in your B12 / MMA / homocysteine levels having a cascade effect and somehow impacting upon either your hormones or the physiological function of your uterus (it is largely muscle). If this is the case it may be very difficult to unpick, as very little is known about the effects of B12 Deficiency / MMA - and health professionals tend to be very unwilling to consider anything outside the envelope of current clinical knowledge.

Having said that, I would say that it is very important to monitor this, and track how it changes over the next month or so, and take it to a doctor if it continues / you are still concerned (I doubt that they will be able to give you a definitive answer, but they should be able to rule out anything sinister going on - there can be other reasons for bleeding between periods (which your B12 may be contributing to, or masking). And perimenopause itself can also be massively variable….).

A couple of things to note - I suspect that B12 Deficiency can contribute to infertility / subfertility… I understand you are 46, but is there any chance you might be pregnant? (Regular B12 injections may have indirectly given your reproductive system a bit of a boost). It might be worth buying a couple of over the counter pregnancy tests just to make sure - and may also be worth ensuring you use contraception consistently!! (Unplanned perimenopause pregnancies are on the increase - I had my last child in my 40s after 3-4 years of perimenopause…I thought it was the actual menopause! The endocrinologist I saw recently told me that there are more unplanned perimenopause pregnancies now than unplanned teenage pregnancies!). Good luck with it

[Beccy_123 in reply to Dilly_blue]

Thanks Dilly_Blue. I did read one published paper which touched upon a return of menstruation during B12 treatment but no real explanation given as to why. The human body largely remains a mystery!

I had to giggle when you mentioned pregnancy - I have had zero sex drive for well over a decade a and despite this being a common symptom of B12 deficiency and other things, I'm actually not concerned about this. So no, no chance of being pregnant

[Dilly_blue]

There have been posts on here (a couple of months ago?) with people reporting that previously grey hair has grown back with colour in, after getting regular B12 injections - so I am wondering whether part of the B12 cascade impacts upon aging effects / telomere length, and whether returning menstruation might also be part of this?! Yes - it is all a mystery!… and unfortunately (regarding B12) likely to remain so, as the big research bucks aren’t there…

Good luck with it all, Beccy - and hopefully (as your B12 treatment continues) you will start feeling perkier (in all aspects of life…!!!)