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To address heterogeneity, the population, intervention, comparison, outcome, and study design (PICOS) framework was utilized in setting up a search strategy (Table 1)

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Treatment with cyanocobalamin would be efficient only in cases of vitamin B 12 deficiency

Instead, it often reflects overlapping biological and neurological factors, including: Hormonal changes associated with aging, perimenopause, menopause, or postpartum periods Shifts in hormone levels , even when standard lab values appear normal. Genetic predispositions affecting neurotransmitter or receptor activity Metabolic conditions such as diabetes or insulin resistance Declines in overall metabolic health Chronic stress, fatigue, or nervous system dysregulation Traditional approaches often emphasize estrogen, testosterone, or other hormonal therapies

Final thoughts: Oral vs