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Lifestyle Foundations: Consistent strength training (essential for preserving muscle mass and bone density in perimenopause), 7-8 hours of quality sleep, protein adequacy, and sustainable stress management practices are established and maintained

Despite this, Eng persisted

In particular, respiratory viral infections were shown to be associated with inhibition of Nrf2 and activation of the nuclear factor-kappa B (NF-B) pathway, leading to increased oxidative damage and promoting inflammation [29, 30]

NICE Clinical Knowledge Summaries and British Society for Haematology guidelines support B12 supplementation in these clinical contexts, with treatment regimens tailored to the underlying cause