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Common signs that it may be time to discuss HRT include: hot flashes or night sweats that disrupt sleep or leave you exhausted during the day vaginal dryness, pain during sex, or urinary symptomssometimes called the genitourinary syndrome of menopause (GSM)that affect comfort and intimacy sleep problems, fatigue, or brain fog that seem connected to other menopause symptoms mood changes, including irritability or anger, that seem tied to hormonal shifts irregular or skipped periods before age 45, which may suggest early menopause and should be evaluated These are reasons to discuss HRT, though it isn't always the best fit for everyone

women who are pregnant or may become pregnant must not handle crushed or broken tablets

Still, side effects from B12 supplements are possible, especially at higher doses, and include: Headache Nausea Vomiting Fatigue Weakness Diarrhea Tingling in the hands and feet Nasal spray Vitamin B12 is also available in a nasal spray

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