Tibolone is a hormone replacement therapy (HRT) that’s suitable for postmenopausal women who have not had a period for at least 12 months to treat symptoms such as vaginal dryness, irritation, low mood, and hot flushes.

The active ingredient, tibolone, is a synthetic hormone that is broken down by the body to produce substances that work similarly to the hormones oestrogen, progesterone, and testosterone.

Tibolone tablets are taken once a day and can also prevent the development of osteoporosis after menopause. Tibolone is also available under the brand name Livial.

During the menopause, the amount of oestrogen produced by a woman’s body falls, causing symptoms such as:

• hot flushes
• night sweats
• vaginal dryness and irritation
• mood changes

Some women are prescribed HRT to help relieve these symptoms and improve their quality of life. Unlike other forms of HRT that may contain synthetic oestrogen and/or progesterone, tibolone is an artificial hormone that’s broken down in the body to produce oestrogen, progesterone, and testosterone, restoring hormonal balance.

Tibolone also has positive benefits for bones which are at risk of becoming weak after menopause, increasing the risk of fractures (osteoporosis). Because tibolone acts like a combination of oestrogen, progesterone, and testosterone, it mimics the effects of the natural hormones that decline during menopause and in turn this helps to preserve bone mineral density (BMD), prevents fractures, and stimulates bone growth.

How long does Tibolone take to work?

Tibolone usually relieves menopausal symptoms within the first few weeks of treatment, but it can take up to 3 months for you to notice the full effects.

How effective is Tibolone?

Clinical research shows that tibolone is especially effective at treating oestrogen-withdrawal symptoms, like hot flushes, sweating, and vaginal dryness. It can also significantly increase sexual arousal and libido more effectively than oestrogen-based treatments alone.

In another study, where 42 postmenopausal women began the trial experiencing severe symptoms, it was found that after 3 months of tibolone treatment, only mild or moderate menopause symptoms occurred.

Each tibolone tablet should be swallowed whole with a glass of water at the same time each day. You must not chew or crush the tablets.

Tibolone strips are marked with the days of the week. You should start the strip by taking a tablet marked with the correct day of the week. For example, if it is Monday, take a tablet marked “Mo” on the top row. Then, follow the arrows until the strip is empty and start a new strip the next day, do not leave a gap between strips.

The usual dose is one 2.5mg tibolone tablet per day.

When to take Tibolone?

Tibolone tablets should be taken at the same time each day. If you struggle to remember to take your pill, you could try using:

• an alarm
• a pill reminder app
• a pill box

What if I miss a dose of Tibolone?

If you miss a dose and it is:

• less than 12 hours late, take the missed pill as soon as you remember.
• more than 12 hours late, skip the missed dose and take your next tablet at the usual time.

You must not take a double dose of tibolone to make up for a missed one.

Tibolone is a prescription-only medication, so you will need a doctor’s approval to obtain it and it cannot be bought over-the-counter.

It is possible to request tibolone treatment online from reputable online doctor or pharmacy services. Alternatively, it may be available on the NHS, depending on the severity of your symptoms and availability.

Can I buy Tibolone online?

Yes, you can request tibolone online at Superdrug Online Doctor, by:

1. Filling out a brief health and lifestyle questionnaire.
2. Ordering your preferred treatment and making payment.
3. One of our doctors will review your order and questionnaire answers.
4. If approved, your treatment will be posted to your address or made available for collection at your local Superdrug Pharmacy.
5. If your order is not approved, one of our doctors will contact you via your account with other treatment options.

If you have already been prescribed tibolone by your GP, you can request further packs from Superdrug Online Doctor.

Can I buy Tibolone over the counter?

No, tibolone is not available without a prescription.

Gina is a type of HRT that can be bought over the counter without a prescription.

Can I get Tibolone on the NHS?

Yes, tibolone may be available on prescription from the NHS, but you will need to make an appointment with your doctor so they can assess if it is suitable for you to take.

Like all treatments, tibolone may cause some side effects, however not everyone will experience them.

Common side effects (may affect up to 1 in 10 women), include:

• stomach or pelvis pain
• breast pain
• thrush
• thickening of the lining of the womb or cervix
• vaginal bleeding or spotting(common at the start, talk to your doctor if it continues after 6 months)
• abnormal cervical smear
• inflammation of the vulva or vagina
• weight gain
• vaginal issues like increased secretions, itching, or irritation
• unusual hair growth

Uncommon side effects (may affect up to 1 in 100 women), include:

• swollen, hands, feet, or ankles (fluid retention)
• acne
• fungal infections
• vaginal infections
• painful nipples or breasts
• upset stomach

Rare side effects (may affect up to 1 in 1000 women), include:

• itchy skin

Some have also reported the following side effects when taking tibolone:

• depression
• dizziness
• headache
• joint or muscle pain
• skin issues such as rash or itching
• loss of vision and blurred vision
• changes in liver tests

There have been reports of breast cancer and increased growth of cancer cells in the womb. Talk to your doctor if you notice any prolonged or troublesome side effects.

How long do Tibolone side effects last?

Some of the common tibolone side effects should improve after 4 to 6 weeks as your body gets used to the medication. However, if they last longer than this or you find them difficult to manage, speak to your doctor for advice.

What to do if you get Tibolone side effects

Mild tibolone side effects can usually be managed at home. Here are some of the things you can do to help you cope with them:

Breast pain

This usually gets better on its own within 6 weeks, but speak to your doctor if it lasts longer or is very painful, as they may advise switching to a different HRT.

Weight gain

It’s common to gain weight around the time of menopause but you can manage your weight by eating a healthy, balanced diet and regular exercise.

Vaginal bleeding or spotting

Avoid using perfumed soaps around your vagina and if you still experience symptoms after 2 months, contact your doctor as you may need a different type of HRT.

Stomach or pelvic pain

Get plenty of rest and eat and drink slowly.It can help to eat smaller, more frequent meals and apply a heat pad or covered hot water bottle on your stomach.

Unusual hair growth

Speak to a pharmacist about products you can buy to remove unwanted hair. If you find this side effect particularly bothersome, speak to your doctor about alternative forms of HRT.

If you are concerned about any side effects or experience any of the following serious side effects, you should seek medical attention immediately:

• high blood pressure
• the skin or whites of your eyes go yellow (jaundice)
• sudden migraine-type headaches
• signs of a blood clot

Do not take tibolone if you:

• are allergic to any of its ingredients
• have or have ever had breast cancer
• have or suspect you have cancer which is sensitive to oestrogen
• experience unexplained vaginal bleeding
• are or think you maybe pregnant
• are breastfeeding
• have or ever had liver disease
• have or ever had a blood clot in a vein, such as in the legs or lungs
• have excessive thickening of the womb lining
• have porphyria, a rare blood disorder
• have recently had a heart attack, stroke, or angina

You should talk to your doctor before taking Tibolone if you have or have ever had:

• fibroids inside your womb
• endometriosis or a history of excessive growth of the womb lining
• an increased risk of developing blood clots
• an increased risk of getting oestrogen-sensitive cancer
• high blood pressure
• a liver disorder
• diabetes
• gallstones
• migraine or severe headaches
• a disease of the immune system that affects many organs of the body
• epilepsy
• asthma
• a disease affecting the eardrum and hearing (otosclerosis)
• a very high level of fat in your blood
• fluid retention due to heart or kidney problems

To avoid risk-factor side effects, it is important to tell your doctor any relevant familial or personal medical history. This way, your doctor can assess whether tibolone is a safe and suitable treatment option for you.

Other medications and tibolone

Some medicines can affect the effectiveness of tibolone and can cause irregular bleeding. Tell your doctor if you are taking the herbal remedy St John’s Wort or any medications for:

• epilepsy
• tuberculosis
• HIV infection
• blood clotting

Tell your doctor before taking Tibolone if you are or going to take any prescription, over-the-counter, or herbal medications.

Do you lose weight when taking Tibolone?

Weight gain can be a side effect of taking tibolone however, not everyone will experience this. Some studies have found that tibolone can reduce waist and hip circumference and the thickness of stomach fat.

Weight fluctuations are very common during the menopause due to the change of hormones. Eating a healthy balanced diet and taking regular exercise will help to manage your weight.

Can Tibolone increase the size of my breasts?

No, taking tibolone has not been shown to affect the size of the breasts.

How long can you stay on Tibolone?

Tibolone is safe to take long-term, depending on your familial medical and personal health history. How long you will need to take tibolone for will depend on your symptoms. It is common to take it for 2 to 5 years to treat menopause symptoms, but you may need to take it for longer. Your doctor will talk to you and advise on this.

Can I drink alcohol with Tibolone?

Yes, you can drink alcohol while taking tibolone. However, we advise against this because alcohol can worsen menopause symptoms like hot flushes, night sweats and anxiety.

Will Tibolone affect my mood?

Yes, tibolone may affect your mood, with some studies demonstrating that it can positively impact your mood and reduce negative symptoms, similar to oestrogen-based HRT.