Symptoms of Vitamin B12 Deficiency in Women

Symptoms of Vitamin B12 Deficiency

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Here, we’ll address common symptoms of B12 deficiency, as well as other health-related information on vitamin B12. Vitamin B12, also known as cobalamin, is essential to the health and well-being of women of all ages. It plays a crucial role in numerous bodily functions including DNA formation, red blood cell formation, and nerve maintenance. It also plays an important part in turning food into energy.

A vitamin B12 deficiency can disrupt several systems in the body, causing fatigue, dizziness, shortness of breath, confusion, vision loss, and even depression. It can also lead to nerve damage. Learning to recognize the signs of a B12 deficiency can be life-changing for women who have otherwise been stumped determining the cause of one or more of these symptoms.

Signs of Vitamin B12 Deficiency

This list of symptoms of Vitamin B12 deficiency is long but reveals the importance of maintaining adequate levels of B12 for overall well-being.

A thorough list of consequences of inadequate B12 consumption follows.

Anemia-Related Symptoms

  • Fatigue
  • Weakness
  • Muscle weakness
  • Pale/yellowed skin
  • Rapid heartbeat
  • Heart palpitations
  • Shortness of breath
  • Swollen/sore/smooth tongue
  • Headaches
  • Nausea
  • Diarrhea
  • Indigestion
  • Incontinence
  • Appetite problems
  • Weight gain or weight loss
  • Dizziness or faint feeling

Nerve-Related Symptoms

  • Nerve problems, such as tingling or numbness
  • Mental health issues, such as depression
  • Memory loss
  • Dizziness
  • Confusion
  • Dementia
  • Imbalance/trouble walking or standing
  • Irritability
  • Vision loss

What Causes B12 Deficiency?

For women experiencing B12 deficiency, it is important to determine the underlying cause, so levels of B12 can be replenished. There are several possible causes of vitamin B12 deficiency.

Inadequate Absorption

The body requires certain conditions to properly facilitate the absorption of vitamin B12 from food. Stomach acid and a protein called intrinsic factor, which is produced in the stomach, must be present for B12 to be absorbed from food. Many conditions can lead to the body’s inability to absorb vitamin B12.

Pernicious Anemia

The most common cause of vitamin B12 deficiency is decreased or missing intrinsic factors. Cells in the lining of the stomach produce intrinsic factors, and if these cells are damaged or if the stomach is otherwise unable to produce it, vitamin B12 absorption can be impaired. This can lead to pernicious anemia.

Pernicious anemia is a type of anemia that is caused by a deficiency in vitamin B12. It is called “pernicious” because it was once considered a fatal disease before effective treatments were developed. Pernicious anemia occurs when the body is unable to absorb enough vitamin B12 from the diet due to a lack of intrinsic factor; thus, there is no absorption of B12.

Gastrointestinal Issues

Additionally, when an individual suffers from an illness or procedure such as chronic gastritis or various gastrointestinal surgery procedures, it can interfere with the absorption of vitamin B12.

A list of common conditions besides pernicious anemia associated with a B12 deficiency includes the following:

  • Crohn’s disease
  • Celiac disease
  • Atrophic gastritis, otherwise known as a thinning of the stomach lining
  • Bacteria or parasites in the intestines
  • Immune system disorders, including Graves’ disease and lupus
  • Inflammatory bowel disease (IBD)


Medications can also interfere with B12 absorption, such as some heartburn medicines and proton pump inhibitors prescribed to diabetics.

Some medications associated with B12 deficiency are listed below.

  • H2 blockers like Pepcid AC
  • Heartburn medications like Nexium, Prevacid, Prilosec OTC, Protonix, and Acipher
  • Diabetes medications like Metformin


Furthermore, age can play a role in the body’s lack of ability to absorb B12 adequately. As with other areas of women’s health, when women get older, changes in the body affect their ability to absorb B12 adequately. Thus, it is important to ensure efficient levels of B12 are maintained within the body as women get older.

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Vitamin B12 is primarily found in animal products, so individuals following a vegetarian or vegan diet may be at risk of vitamin B12 deficiency if they do not consume fortified foods or supplements. It is especially important for people who do not consume B12-rich foods in their diets to supplement with fortified foods and be mindful of the potential consequences of low B12 levels. Foods that are fortified with added B12 will indicate how much of the vitamin it includes on the nutrition label.

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Pregnancy and Breastfeeding

Certain conditions like pregnancy and breastfeeding may increase the need for vitamin B12. An adequate amount of B12 and vitamin B9 (folate) in pregnancy is important to prevent certain developmental defects. In particular, B12 and B9 deficiencies can cause neural tube defects, which can prevent the spinal cord or brain from developing properly. Neural tube defects like spina bifida and anencephaly can be devastating or fatal to a baby.

In addition, women must continue to consume adequate amounts of B12 while breastfeeding. If a breastfeeding baby does not receive enough B12 in the breast milk, it can lead to slow weight gain, delayed development, or even anemia.

Diagnosis and Treatment for B12 Deficiency

Diagnosing a B12 deficiency can be done via a blood test. Additional tests and medical history information are sometimes required to further investigate the cause of B12 deficiency.

Treatment for vitamin B12 deficiency typically involves vitamin B12 supplementation, either through injections or oral supplements. Injections may be used to quickly and effectively restore B12 levels, particularly in cases where malabsorption is a concern. A nasal spray is also available but is not considered the best treatment for severe deficiency because B12 is not absorbed as well as it is via injection.

Oral supplements, such as B12-fortified foods or vitamin B12 supplements, may also be used to treat vitamin B12 deficiency. These are particularly useful for individuals who are only mild to moderately deficient. In addition to supplementation, diet changes may be recommended.

Who Is Most at Risk for Vitamin B12 Deficiency?

Most US residents get enough of vitamin B12 in their regular diet, but certain groups should be extra mindful of their risk for B12 deficiency and know to keep an eye out for signs and symptoms.

Groups who are at higher risk of developing a B12 deficiency include the following:

  • Vegetarians
  • Vegans
  • Pregnant women
  • Breastfeeding women
  • Older women
  • Those who have had gastric bypass surgery or another surgery in which part of the stomach was removed
  • Those who drink alcohol excessively
  • Those taking and of the drugs listed previously such as Metformin

How Much B12 Is Enough?

How Much B12 Is Enough

The amount of B12 an individual needs primarily depends on their age group. Adults aged 18 and up need at least 2.4 micrograms per day. Pregnant women need to consume more B12 each day, and should get at least 2.6 micrograms. Breastfeeding women should consume still more, at 2.8 micrograms per day.

Since the body does not make its own B12, it must be obtained through foods that are rich in B12. However, the body stores B12 reserves in the liver for as long as five years. Still, deficiencies can occur after these reserves are used.

Here’s how to get more B12:

  • Eat Animal Products – Consumption of animal products such as meat, fish, poultry, eggs, milk, and cheese provide the highest amounts of B12 naturally. Some of the richest sources of vitamin B12 are liver, beef, sardines, and clams.
  • Eat Fortified Foods – Some foods are also fortified with B12 such as breakfast cereals, fortified tofu, and fortified plant-based milks, as well as nutritional yeast. Eating these fortified foods can be an effective way to boost B12 levels.
  • Take Oral Supplements – Supplements are available as over the counter (OTC) medications and often B12 is included in multivitamins along with other vitamins and minerals or in B complex multivitamins. B12 supplements are readily available in oral tablets, oral solutions, mouth sprays, and under-the-tongue tablets, and they range in dosage amounts from 5 mcg to 5,000 mcg depending on the type of supplement.
  • Take B12 Injections – B12 injections of 100 mcg per dose are administered in the muscle or under the skin from 30 mcg to 500 mcg per dose.

Can Someone Take Too Much Vitamin B12?

Because B12 is water-soluble, it is considered safe to take in high-dose supplements. In fact, many non-deficient people do this because they believe it provides a boost in energy. While it may provide some additional energy, particularly in those who were B12 deficient in the first place, high-dose B12 is not always recommended.

Due to its low toxicity, there is no Tolerable Upper Intake Level (UL) set for B12. A vitamin’s UL is the maximum daily recommended dose someone should take. Exceeding the UL amount could produce adverse side effects in most people. Because unused B12 is excreted through urine, a UL is unnecessary for water-soluble vitamins like B12.

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How Long Does It Take to Build Adequate Levels of B12?

The amount of time it takes to build up vitamin B12 levels in the body can vary depending on the severity of the deficiency and the method of treatment. Generally, it will take several weeks to several months for B12 levels to return to normal after starting supplementation. Some improvement in symptoms may be seen within a few days to a week after starting treatment, but it can take longer for more severe symptoms to resolve. Certain nerve damage may never be fully repaired, especially if you’ve gone more than six months without treatment.

Arizona Gynecology Consultants: Test for Vitamin B12 Deficiency

Vitamin B12 Deficiency Test

Women who have experienced any of the symptoms discussed here may be deficient in vitamin B12. It is important to have proper testing done to confirm a B12 deficiency so you can establish an appropriate treatment plan to increase levels of B12 in the body. Because many of the symptoms associated with B12 deficiency are also common symptoms of other conditions, confirming or ruling out those potential causes is also important.

Arizona Gynecology Consultants can test for B12 deficiency as well as other conditions. Women who are concerned about having a B12 deficiency or believe their symptoms may be caused by a different condition should contact Arizona Gynecology Consultants’ knowledgeable and compassionate staff. Make an appointment to get the appropriate testing done as soon as possible and take control of your health.

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About Esosa Nwambuonwo

Nurse Practitioner Esosa is an Arizona board certified nurse practitioner. She was born in Nigeria and has lived in Phoenix since she was 6 years old. She obtained a bachelor’s in nursing from the University of Arizona. She then spent the next 16 years working at Mayo Clinic and specialized in the post-operative patient population as well as gastrointestinal disease, gynecological care and palliative patient care. She has years of experience in pain management, patient education and disease management. Esosa decided to extend her nursing role and further her education because she believed she had more to offer to the nursing practice and patients. She obtained a master’s degree in family nurse practitioner from Grand Canyon University. Learn More About Esosa Nwambuonwo