Tibolone is a type of Hormone Replacement Therapy (HRT). It is a tablet that you take daily to help with symptoms of the menopause, such as hot flushes and low mood. You may also be prescribed tibolone if you are at risk of fractures from osteoporosis after going through the menopause.

During the menopause, your body loses the female hormones oestrogen and progesterone. This reduced amount of hormones causes symptoms such as hot flushes, night sweats, low mood and vaginal dryness. HRT works by replacing the lost hormones which stops the symptoms from appearing.

Tibolone works differently to some forms of HRT. your body breaks down tibolone to create oestrogen and progesterone itself. It is known as a combined HRT as it gives your body both oestrogen and progesterone.

The active ingredient it contains is tibolone. You will find tibolone prescribed and sold both under its generic name (tibolone) and under the brand name Livial in the UK.

The dose of tibolone is one 2.5mg tablet daily.

How quickly does tibolone take to work?

It can take up to two weeks to feel the benefits of taking combined HRT. For some women, it can take up to 3 months before you feel it’s working fully.

How effective is tibolone?

Studies have found that the combination of oestrogen and progesterone that tibolone creates is an effective way to treat symptoms of menopause caused by both oestrogen withdrawal (hot flushes, sweating, and vaginal dryness) and also reduced levels of progesterone (lower libido).

You can only take tibolone if it has been 12 months since your last period and you still have your womb. Take one 2.5mg tablet of tibolone each day:

• start with the correct day of the week at the top of the strip
• take the tablet at the same time each day
• swallow the tablet whole with water
• do not take a break between strips

If you need to have surgery while you are taking tibolone, make sure you tell your surgeon. There is an increased risk of clotting so you may need to stop taking it for a few weeks before the operation.

Can I start taking tibolone immediately?

Yes, if you have never used HRT before and your period was more than 12 months ago, you can take it immediately.

If you are already taking another form of HRT, your doctor will advise you on transferring. If you are taking a type of HRT which means you have a period, you should start taking tibolone when your period ends.

I have forgotten to take my tablet. What should I do?

If you forget to take your tablet at the right time and it is less than 12 hours from when you usually take it, take it as soon as you remember. If you are over 12 hours late, do not take the missed pill immediately but wait until your normal time and take your tibolone tablet as usual.

Do not take a double dose.

What should I do if I take more tibolone than I have been prescribed?

Talk to your doctor if you take more tibolone than you should have. It is unlikely to cause you harm, but an overdose of oestrogen and progesterone can make you feel or be sick or have some vaginal bleeding.

How long should I take tibolone?

It is usually recommended to take HRT while it is needed to stop your menopause symptoms but not for longer than five years. This timeframe is to help manage the increased risk of developing specific diseases that are associated with HRT.

Can I buy tibolone online?

If you have already been prescribed it by a doctor you can buy tibolone online. You can get a repeat prescription from a reputable website such as Superdrug Online Doctor.

The process is simple:

1. Fill in our brief medical questionnaire.
2. Our doctors will quickly review your answers to make sure it is safe to continue to prescribe you tibolone.
3. Your order is then sent to an address of your choice in a discreet package.
4. You can also choose to collect it from your local Superdrug pharmacy.
5. If you have any questions, you can message our doctors through your Patient Account.

Check that the site you are using to buy medication is operating legally and safely by using the government’s online checker.

Can I get tibolone on the NHS?

You will usually need to have a consultation with your doctor before getting tibolone on the NHS. Using Superdrug Online Doctor, you can have this consultation quickly and discreetly without the need for a face-to-face appointment.

With any medication, some people will get side effects and others will not. If you do get side effects, they will usually be mild and go away after a few weeks. If they do not go away or impact your life, talk to your doctor about alternative HRT options.

Taking HRT can increase your risks of certain illnesses. Attending regular check-ups and letting your doctor know about any changes you notice is essential.

The following side effects can be serious. You should stop taking tibolone and see a doctor immediately if they happen to you:

• signs of allergic reaction such as wheezing and shortness of breath, hives and itchy nose or eyes, and swollen lips, tongue, eyes or face
• symptoms of jaundice such as your skin or whites of your eyes going yellow
• symptoms of a blood clot such as sudden chest pain, swollen legs and difficulty breathing
• new migraine-type headaches
• an increase in blood pressure

Common (up to 1 in 10) side effects reported by women include:

• vaginal bleeding or spotting
• stomach or pelvis pain
• unusual hair growth
• thrush, itching, secretions
• breast pain
• inflammation of the vulva and vagina (vulvovaginitis)
• weight gain
• changes or thickening to the womb or cervix
• abnormal results from a smear test

Uncommon side effects affect up to 1 in 100 women and include:

• vaginal infections
• fungal infections
• retaining fluid in hands, ankles and feet
• feeling or being sick or having diarrhoea
• acne
• painful nipples

Women also report depression, joint pain, muscle pain, rashes, blurred or lost vision, dizziness and headaches as side effects of taking tibolone. The occurrence of these is not known.

The patient information leaflet has more information on the side effects and risks of taking tibolone.

Is there an increased risk of getting a blood clot or having a stroke from taking tibolone?

There is a very slight increase in the risk of a blood clot in the vein if you are taking tibolone. Your risk is 1.3 to 3 times higher than if you are not taking tibolone.

The risk of having a stroke is 1.5 times higher if you are taking tibolone.

Is there an increased risk of getting cancer from taking tibolone?

There is a small increase in the risk of getting breast cancer from taking tibolone, but this risk is lower than if you take combined oestrogen-progestogen HRT or oestrogen-only HRT. The increased risk depends on how long you take HRT and declines once you stop taking it.

There is an even smaller increase in the risk of getting ovarian cancer (which is a much rarer form of cancer). In women aged 50 to 54 who are not taking HRT, the incidence of ovarian cancer is 2 in 2000; for those women taking combined HRT, the incidence is 3 in 2000. The increased risk from taking tibolone is similar to other types of HRT.

The risk of getting cancer from taking HRT will depend on different factors in your personal and family medical history. Your doctor can advise you on the benefits and risks of taking HRT.

Will taking tibolone make me put on weight?

Some women report that taking HRT makes them put on weight. There is no scientific evidence to back this up, although weight gain is commonly associated with the menopause. Eating a balanced diet and taking regular exercise will help you maintain a healthy weight.

Will taking tibolone make me depressed?

Some women report that taking tibolone makes them depressed, whereas others report that taking it helps with the low mood they have experienced during the menopause. If you think taking tibolone is affecting your mental health, talk to your doctor about other options for managing your menopause symptoms.

Will taking tibolone cause hair loss?

Women report that tibolone causes both hair loss and hair growth. Although it is not listed as an official side effect, tibolone has androgenic characteristics, which means it can stimulate male traits such as hair loss. If you believe taking tibolone is causing hair loss, talk to your doctor or a trichologist (a specialist in hair and scalp).

Does tibolone cause bleeding?

It is possible to experience bleeding when you start taking tibolone, although this usually stops when your body has adapted to the new hormone levels. If the bleeding continues after 6 months or starts after taking tibolone for six months, talk to your doctor.

You should not take tibolone if you:

• have had a period within the last 12 months
• are pregnant or might be pregnant
• have or have had in the past breast cancer or cancer of the womb lining
• have untreated thickening of the womb or unexplained vaginal bleeding
• have blood clots or a blood clotting disorder or disease caused by blood clots
• have or have had liver disease
• have a rare blood condition called porphyria
• are allergic to any of the ingredients

If you are taking any medication (including herbal supplements) you should tell your doctor. The following medicines may interact with tibolone and affect how it works:

• phenobarbital, phenytoin and carbamazepine for epilepsy
• rifampicin and rifabutin for tuberculosis
• nevirapine, efavirenz, ritonavir and nelfinavir for HIV infection
• warfarin
• herbal remedies containing St John’s Wort

Can I drink alcohol while taking tibolone?

You can drink alcohol while taking tibolone as it does not affect concentration or alertness. As alcohol is linked to an increase in the risk of developing certain cancers and taking HRT is also linked to an increase in developing certain cancers, it is recommended to follow government guidance and moderate your alcohol intake. Drinking alcohol can also increase side effects such as nausea, headaches or depression.

If you find tibolone is not working for you, there are alternatives to help treat your menopause symptoms.

Lifestyle changes

Changes to your lifestyle can help with menopause symptoms:

• keeping your room cool at night
• eating a balanced diet and taking regular exercise
• stopping smoking
• reducing your stress levels
• reducing your caffeine and alcohol intake

Other HRT options

HRT comes in different forms, such as gels, tablets and creams. What is right for you will depend on the severity of the symptoms, whether you are still getting your periods, and whether you still have your womb. When you take HRT that is absorbed into your body, it is called systemic HRT. There are 3 main types:

1. oestrogen-only: usually only recommended if you have had your womb removed
2. combined oestrogen and progesterone
3. tibolone

Oestrogen-only medications include tables such as Vagifem and creams such as Estriol, Ovestin. Combined HRT is available both in tablets such as Kilofem, Elleste Duet Conti, Kliovance, Premique, Femoston Conti and Indivina and also in patches such as Evorel Conti and Evorel Sequi. Different brands can have different types of the hormones you need, and in different quantities, so you may find one works better for you than another.

Alternative remedies

Some women use remedies such as St John’s wort, angelica, evening primrose oil, ginseng and black cohosh to treat symptoms of the menopause. Scientific evidence is mixed in terms of how effective these are and what are the right doses.

St John’s wort can interact with other medicines with serious implications.