Family Medical Centre Logo
 +34 966 865 072 

Incorporating the Family Dental Centre  

Vitamin B12 deficiency

Vitamin B12 is essential for life. It is needed to make new cells in the body such as the many new red blood cells which are made every day. Vitamin B12 is found in meat, fish, eggs and milk but not in fruit or vegetables. A normal balanced diet contains enough vitamin B12. A lack of vitamin B12 leads to anaemia and other problems.

What is anaemia

Anaemia means that you have fewer red blood cells than normal or you have less haemoglobin than normal in each blood cell.

In either case, a reduced amount of oxygen is carried around in the blood stream. There are various causes such as lack of iron or other vitamins.

Symptoms of B12 deficiency

Due to anaemia

These symptoms are caused by the amount of oxygen in the blood.

  • They include tiredness, lethargy, feeling faint or becoming breathless.
  • Less common symptoms include headaches, palpitations, altered sense of taste, loss of appetite and ringing in the ears (tinnitus).
  • You may look pale.

Other symptoms

Cells in other parts of the body may be affected as well as your blood when you lack vitamin B12. Other symptoms that may occur include a sore mouth and tongue.

If left untreated, problems with nerves and psychological problems can develop. Psychological problems may include depression, confusion, difficulty with memory or even dementia. Nerve problems may include numbness, pins and needles, vision changes and unsteadiness.

Causes of B12 Deficiency

Pernicious anaemia

Normally when you eat foods with vitamin B12, the vitamin combines with a protein called intrinsic factor in the stomach. The combined B12 and intrinsic factor is then absorbed further down the gut at the end of the small intestines. (Intrinsic factor is made by cells in the lining of the stomach and is needed for Vitamin B12 to be absorbed.)

If you have pernicious anaemia, antibodies are formed against your intrinsic factor, or against the cells in your stomach which make the intrinsic factor. It is thought that something triggers the immune system to make the antibodies but the trigger is not known.

Pernicious anaemia usually develops over the age of 50. Women are more commonly affected than men and it tends to run in families. The antibodies which cause pernicious anaemia can be detected by a blood test to confirm the diagnosis.

Stomach or gut problems

Various problems of the stomach or gut can be a cause of of vitamin B12 deficiency.

  • Surgery which removes the stomach or the end of the small intestine.
  • Diseases of the lower bowel such as Crohn’s disease
  • Conditions of the stomach which affect the production of intrinsic factor


Some medicines used for other conditions may affect the absorption of vitamin B12. The most common example is metformin a medicine used for diabetes. Some anticonvulsants used for epilepsy may also have an effect.

Dietary causes

A normal balanced diet should give you enough Vitamin B12. Strict vegans who eat meat or dairy products may not eat enough B12. Some foods are fortified with vitamin B12 for example some breads and breakfast cereals.

Diagnosis of B12 deficiency

The level of vitamin B12 can be measured by a blood test. Further tests can then investigate the cause. This can be done by your family doctor.


Vitamin B12 injections. Normally about six injections are given at first to build the levels up quickly. An injection is then given once a month.

So, if you are experiencing any of the symptoms the good news that simple treatment can make you feel so much better!

Irregular heartbeat poses greater risk to women

This month the BBC reported study findings suggesting than an irregular heartbeat poses a greater risk to women than men. This was following 30 studies involving more than 4 million people.

In patients with atrial fibrillation (AF), the heart's upper chambers (the atria) contract randomly. This is caused by disorganized electrical signals. Sometimes the atria contract so fast in a jerky manner, the heart muscle cannot relax properly between contractions, reducing its efficiency.

AF is the world’s most common type of abnormal heart rhythm and is a strong risk factor for stroke, heart disease and heart failure.

The worrying news for women with AF is that they are:

  • Twice as likely to suffer a stroke
  • 99% more likely to die of a heart condition
  • 55% more likely to suffer a heart attack
  • 16% more likely to develop heart failure

So why are women more at risk?

  • Diagnosis is often delayed.Women might wave off symptoms like fatigue or shortness of breath, chalking them up to stress or feeling tired rather than seeing them as warning signs for heart disease.
  • Women may respond less well to AF drugs or are being diagnosed later than men.
  • AF may be more severe in women than in men.
  • Women are more likely to suffer from other co-existing medical conditions.

AF is often diagnosed during a general health check (MOT) or even a simple mini-cardiac check. Ask your medical centre for details.

Post Menopausal Bleeding

Post-menopausal bleeding is vaginal bleeding that occurs at least 12 months after your periods have stopped.

Although post-menopausal bleeding is a common problem, it's not normal. There is a golden rule in medicine – ‘post menopausal bleeding should be seen as cancer until proved otherwise’.

Most likely causes

  • inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) - caused by lower oestrogen levels.
  • cervical or womb polyps– growths, which are usually non-cancerous, that can form in the cervix (neck of the womb) or the womb itself.
  • a thickened womb lining (endometrial hyperplasia) – which can be caused byhormone replacement therapy (HRT), high levels of oestrogen or by being overweight; if left untreated this can lead to development of womb cancer(also known as endometrial cancer).
  • About 1 in every 10 women with post-menopausal bleeding will have uterine cancer, and in a few cases bleeding may be a sign of another type of cancer such as vulval, vaginal or cervical cancer.

Diagnosing the cause

Your GP will take a detailed history from you. You will then be refered to a gynaecologist. The following tests may be carried out:

  • pelvic examination - a speculum will be inserted into your vagina, (similar to having a cervical smeartest) so your vulva, vagina and cervix can be carefully examined. Most women find this a bit uncomfortable but not painful. Swabs may be taken from your vagina and/or cervix to rule out any infection. The doctor may wish to carry out a cervical smear test as well if this is overdue.
  • vaginal ultrasound scan - performed by gently inserting a fine ultrasound probe into your vagina, which you may find slightly uncomfortable. It usually takes about 10 minutes.The probe emits high-frequency sound waves to create an image of the inside of your vagina and womb, which is then displayed on a monitor. The results of this examination will then be discussed with you, and you'll find out whether you need a biopsy or hysteroscopy. This is mainly determined by the thickness of the womb lining.
  • tests on a sample of the lining of the uterus (endometrialbiopsy) – If the lining of the uterus is thickened, a small sample of tissue (biopsy) may be removed using a fine, flexible plastic tube. This can cause cramps and bleeding, which usually settles very quickly. The test can be stopped if you are finding it too uncomfortable, so let the doctor carrying out the test know if you want them to stop. The speculum is then removed and an internal examination is performed. This allows the doctor to gauge the size, shape and consistency of your womb, and also assess if there is any tenderness in your pelvis.
  • ahysteroscopy – this is a camera test using a fine telescope like instrument called a hysteroscope. This allows the doctor to look inside your uterus and remove a small sample of tissue for testing.The hysteroscope is passed through your cervix under either local anaestheticor general anaesthetic.

Treating post-menopausal bleeding

Treatment will depend on the cause:

Endometrial atrophy can be treated with oestrogen cream or pessaries, although treatment may not be necessary if symptoms are minimal.

If the cause is cervical polyps, they may need to be removed. This fairly simple procedure can be done as an out patient.

There are various types of endometrial hyperplasia which may be treated with hormone medication (tablets or an intrauterine system implant) or surgery to remove the uterus, cervix and ovaries (a total hysterectomy). Occasionally, if the changes are mild, no treatment may be necessary.

If bleeding is thought to be a side effect of HRT, altering or stopping the treatment may be recommended.

If the cause is uterine cancer, a total hysterectomy will often be recommended with appropriate follow up cancer treatment.

If you are in the menopause and experience ANY vaginal bleeding, however slight, it should not be ignored. A family doctor should be seen without delay and although chances are that it is not a serious problem, any sinister cause MUST be ruled out.

The Core Team

Dawn Blythe

Clinic Director, Practice Midwife

Yvonne Evans

Clinic Director, Nurse

Dr. An Croonenborghs

General Practitioner

Jane Evans