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Levels of O and H 2 O 2 produced by these inflammatory responses in the peritoneal, ovarian and oviductal environments of endometriomal implants are significantly higher than those which are generally encountered in their healthy counterparts (40, 93)

For individuals requiring supplementation due to confirmed deficiency or malabsorption, therapeutic doses vary considerably depending on the underlying cause: Dietary deficiency : 50150 micrograms daily orally, or cyanocobalamin tablets as prescribed Pernicious anaemia : Initially hydroxocobalamin 1 mg intramuscularly three times weekly for two weeks, then maintenance injections every two to three months [3] Neurological involvement : More intensive regimens may be required, with hydroxocobalamin injections on alternate days until symptom improvement [3] NICE guidance emphasises that supplementation should be evidence-based rather than speculative

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