For HEAVY PERIODS, vitamin B12 is essential to replace what is lost in menstrual flow, and it helps to reduce heavy periods by stabilizing hormones levels. Vitamin B12 is needed for red blood cell formation and maturation, normal functioning of the brain and nervous system, and it restores critical DNA synthesis and activity in every cell. In addition, vitamin B12 is necessary for myelin sheath and nerve conduction, for neurotransmitters and brain metabolism, and for maintaining mood. It is also involved in energy production, via roles in fatty acid and amino acid metabolism. The body needs iron, vitamin B12 and folic acid (another one of the B group of vitamins) to produce more red blood cells; if one or more of these nutrients is lacking, anemia can develop. Heavy menstrual bleeding or menorrhagia taxes the body’s demand for this important vitamin.
Vitamin B12, or cobalamin, is a water-soluble vitamin that is involved in the metabolism of every cell of the human body. Neither fungi, plants, nor animals can make vitamin B12. Many people have a dietary B12 deficiency, as it is only prevalent in red meats, organ meats like liver, and eggs. Vegan and vegetarian women receive little or no vitamin B12 in their diets. The absorption of vitamin B12 is fraught with hurdles: In the stomach, vitamin B12 needs to bind with a protein called Intrinsic Factor to absorb, plus sufficient acid to release it from protein foods. Then it must travel all the way through the small intestine to the far end, the terminal ileum, where it can pass into the blood stream. Any stomach disorders, or conditions like pernicious anemia where Intrinsic Factor is lacking, can prevent B12 absorption, as can intestinal inflammation such as Crohn’s disease if a damaged terminal ileum cannot take up vitamin B12.
As early as the 1940s, researchers connected the evidence of B vitamin deficiency with gynecological disorders.2 With the development of birth control pills in the 1950s, the FDA approved use of the ‘pill’ with its synthetic hormone-mimicking chemicals to suppress heavy menstrual bleeding. It took 20 years for the oral contraceptive pill’s side-effects to be brought to public awareness. Researchers in the 1940s were apparently following a valuable lead by showing that estrogen is not fully inactivated by the liver if there is a vitamin B deficiency. This would result in relatively higher estrogen levels in proportion to progesterone. Since the liver is critical in manufacture and detoxification of hormones, this could explain a link between women suffering heavy periods and vitamin B12 deficiency and hormone imbalance.3 Thus vitamin B12 may have a protective role to prevent excessive menstrual flow by enhancing a healthy progesterone to estrogen ratio.
Since poor absorption can be a problem with vitamin B12 – which is the largest and most structurally complicated of the B vitamins – patients need a formula that that can circumvent the stomach so that the B12 can efficiently reach the blood stream. Studies as early as 1998 validate the use of correct oral treatment as being equally effective as injections, with a conclusion that stated: In cobalamin deficiency, 2,000mcg of cyanocobalamin administered orally on a daily basis was as effective and may be superior for raising blood B12 levels as 1,000mcg administered intramuscularly on a monthly basis.4
Aside from those with genetic methylation defects in the metabolism of vitamin B12 and folic acid, our patients have excellent results with a sublingual vitamin B12 that dissolves slowly under the tongue. For that reason, we recommend a lozenge formulation with only natural flavorings that is best taken in the morning or afternoon as it may cause a quick energy boost. We like to use a vitamin B12 that is combined and balanced with an ample amount of folic acid, which should always be included with vitamin B12 to make sure that a folic acid deficiency is not masked.
Recommendation: Vitamin B-12 (as cyanocobalamin) 2,500mcg or more, can be combined with Folic Acid 400 to 800 mcg, dissolved slowly under the tongue, the morning or early afternoon, once daily, or as directed by your healthcare provider.
- Briani, Chiara, et al. “Cobalamin deficiency: clinical picture and radiological findings.” Nutrients 5.11 (2013): 4521-4539.
- Greene, R. R., and B. M. Peckham. “Vitamin B Complex, Menorrhagia, and Cancer: A Critical Review.” American Journal of Obstetrics and Gynecology 54.4 (1947): 611-617.
- Biskind, M. S., G. R. Biskind, and L. H. Biskind. “Nutritional deficiency in the etiology of menorrhagia, metrorrhagia, cystic mastitis, and premenstrual tension. 2. Farther observations on treatment with the vitamin B complex.” Surgery, Gynecology and Obstetrics 78 (1944): 49-57.
- Kuzminski AM, Del Giacco EJ, et al. Effective treatment of cobalamin deficiency with oral cobalamin. Blood 1998;92:1191-1198.
- National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management. January 2017. (NICE Guidelines; Volume 44).
- Livdans-Forret AB, Harvey PJ, Larkin-Thier SM. Menorrhagia: A synopsis of management focusing on herbal and nutritional supplements, and chiropractic. The Journal of the Canadian Chiropractic Association. 2007;51(4):235-246.