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Patients who are also suffering from gastrointestinal disorders, such as small intestinal bacterial overgrowth (SIBO), Celiac or Crohns may not be absorbing Vitamin B12 optimally due to an underlying inflammatory load and unfavourable microbiome

Exploring the role of gut microbiota in obesity and PCOS: Current updates and future prospects

Dosing may be adjusted based on body weight and goals

Bigger blood sugar swings More reactive hypoglycemia Sugar + carb cravings Feeling hungry again shortly after meals Ghrelin (your hunger hormone) becomes more unpredictable Some women suddenly experience: Constant hunger Stronger appetite in the luteal phase Emotional eating tendencies Difficulty feeling satisfied Cortisol becomes more reactive Perimenopause is a time of reduced stress resilience, and cortisol + blood sugar are dance partners