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The American Academy of Family Physicians and NIH identify the following clinical manifestations: Fatigue and generalized weakness Megaloblastic anemia (abnormally large, immature red blood cells) Tingling or numbness in the hands and feet (peripheral neuropathy) Difficulty walking and balance problems Cognitive disturbances including memory difficulty and confusion Mood changes, including depression and irritability Glossitis (swollen, inflamed tongue) Early symptoms such as fatigue and mild tingling are often attributed to stress, aging, or other conditions

A deficiency in Vitamin B12 can lead to fatigue and decreased energy, as your body struggles to deliver adequate oxygen to your cells

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To reduce this risk, estrogen is generally prescribed in combination with a progestogen (progesterone or a synthetic progestogen) except in women who have had a hysterectomy