Tibolone - Common brands: Livial

What tibolone is for

Tibolone is a type of hormone replacement therapy (HRT) that’s used to help with symptoms caused by the menopause, including:

• a hot face, neck and chest (hot flushes)
• vaginal symptoms
• low mood

It's also sometimes prescribed to help prevent weakening of the bones (osteoporosis) after the menopause.

Although some types of HRT can be used while your periods are still changing (perimenopause), tibolone is usually only recommended if it’s been at least 12 months since your periods stopped.

How to take tibolone

Tibolone comes as tablets that you take once a day.

Take 1 tablet a day at the same time each day. Swallow the tablet whole with some water.

The pack containing the tablets will usually be labelled with days of the week and arrows to help you make sure you take your tablets on the right day.

Check the instructions to make sure you take your medicine correctly.

Ask a pharmacist or doctor for advice if you're not sure how to take it or have any problems taking it.

If you miss a dose of tibolone

If you forget to take a dose of tibolone, take it as soon as you remember, unless it’s more than 12 hours since you were supposed to take it.

If it’s more than 12 hours later, skip the missed dose and take the next one at the usual time.

If you take too much tibolone

Taking an extra dose of tibolone is unlikely to cause problems, but it’s important to get medical advice if you take too much as it can sometimes be dangerous.

Side effects of tibolone

Like all medicines, tibolone can cause side effects, although not everyone gets them.

Common side effects

Common side effects of tibolone include:

• pain in your breasts, stomach or pelvis
• vaginal itching, irritation or bleeding
• unusual hair growth
• weight gain

Tibolone does not usually affect your ability to drive, ride a bike or use machinery.

Serious side effects

Tibolone can sometimes cause more serious side effects, although most of them are rare.

Possible serious side effects of tibolone include:

• sudden, severe headaches (similar to migraine headaches)
• pain and swelling in your legs (this may be a sign of deep vein thrombosis), or sudden chest pain or difficulty breathing (these may be signs of a pulmonary embolism)
• chest pain or severe difficulty breathing – these may be signs of a heart attack
• weakness on 1 side of the face (the mouth or eye may droop), difficulty raising the arms and keeping them raised, difficulty speaking (speech may be slurred) – these may be symptoms of a stroke
• an allergic reaction (anaphylaxis) – causing symptoms such as a swollen throat or tongue, a raised, itchy rash and difficulty breathing

There’s also an increased risk of getting breast cancer or womb cancer if you take tibolone, particularly if you take it for a long time. Your doctor will discuss the risks and benefits with you.

Who can and cannot take tibolone

Tibolone is only recommended after the menopause if symptoms such as hot flushes and vaginal problems are affecting your daily life.

You'll usually need to wait at least 12 months after your last period before taking tibolone.

Sometimes it might be possible to start taking it straight away. Your doctor will be able to advise you.

Tibolone is not suitable for everyone. For example, it may not be suitable if:

• you've had an allergic reaction or serious side effect from tibolone
• you have or have had breast cancer
• you have a condition that affects the lining of the womb, such as womb cancer or endometrial hyperplasia (when the womb lining becomes too thick)
• you have a heart condition, such as angina, heart attack or stroke
• you have a liver condition like liver disease
• you have or have had a blood clot in your legs (DVT) or in your lungs (pulmonary embolism)
• you have any unexplained vaginal bleeding

Pregnancy and breastfeeding and tibolone

You should not take tibolone if you’re pregnant or breastfeeding.

Taking tibolone with other medicines, food and drink

There are some medicines, remedies and supplements that may not mix well with tibolone.

These can include:

• medicines to prevent blood clots (anticoagulants), such as warfarin
• epilepsy medicines, such as phenobarbital, phenytoin, lamotrigine and carbamazepine
• medicines used to treat tuberculosis, such as rifampicin and rifabutin
• HIV medicines, such as nevirapine, efavirenz, ritonavir and nelfinavir
• St John’s Wort, which is a herbal remedy that’s sometimes used to treat mild depression

Before taking tibolone, tell your doctor if you're taking any other medicines, herbal remedies, vitamins or supplements.

Food, drink and alcohol with tibolone

You can eat and drink as normal while taking tibolone.