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Researchers believe estrogen plays a role in the methylation process

Cyanocobalamin Injection, Solution NDC Package 69680-121-05 Package Information Cyanocobalamin injection is cyanocobalamin is indicated for vitamin B12 deficiencies due to malabsorption which may be associated with the following conditions:Addisonian (pernicious) anemiaGastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacteria overgrowth, total or partial gastrectomyFish tapeworm infestationMalignancy of pancreas or bowelFolic acid deficiencyIt may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption (see Drug Interactions), use of a gluten-free diet in nontropical sprue, or administration of antibiotics in tropical sprue

Alternatively, you may need hydroxocobalamin injections twice a year