Tibolone (Livial): who it is for and cautions

Tibolone is a type of HRT sold as Livial, with generic versions available. The NHS explains that your body breaks it down into substances that work in a similar way to oestrogen, progesterone and testosterone. It treats menopause symptoms and helps prevent osteoporosis. Unlike many HRT products, it is only available as tablets.

The NHS says tibolone suits people whose last period was over a year ago and who have menopause symptoms, people with high fracture risk after menopause who cannot use other osteoporosis medicines, those with surgically induced menopause, and people taking gonadorelin analogues for endometriosis. It is used after the menopause rather than during perimenopause, when periods are still occurring.

The NHS lists a history of breast cancer, ongoing breast cancer tests or a strong family risk, oestrogen-sensitive cancers such as endometrial cancer or pending tests, unexplained vaginal bleeding, untreated endometrial hyperplasia, a history of venous thrombosis, clotting disorders, arterial clot diseases such as heart attack, stroke or angina, active liver disease, porphyria, galactose intolerance and related disorders, and pregnancy or breastfeeding. All need assessment by a prescriber before starting.

The NHS says the usual dose is one 2.5 mg tablet once a day, at the same time each day, swallowed whole with water, with or without food. If a dose is more than twelve hours late, skip it and never double up; missed doses can cause vaginal bleeding or spotting. An extra tablet is unlikely to harm. Treatment for menopause symptoms commonly lasts two to five years, but longer use may be needed. Speak to your doctor before stopping; a gradual reduction may be suggested to prevent symptoms returning.

The NHS lists breast tenderness (usually improving after four to six weeks), stomach or pelvic pain, unusual hair growth, vaginal discharge, itching or thrush, vaginal bleeding or spotting (typically settling within one to two months) and weight gain, which may be related to menopause rather than the medicine.

Contact a doctor or NHS 111 for yellowing of the eyes or skin, a sudden severe migraine-type headache, or pain, redness or swelling in one leg, usually in the calf. Call 999 for chest pain with breathlessness, signs of stroke (difficulty speaking, moving an arm or leg, or a drooping face) or a serious allergic reaction. Tell your GP about breast lumps, dimpling or nipple changes, and about vaginal bleeding that continues after six months of treatment.

• 999: chest pain with breathlessness, stroke signs, throat swelling.

• Urgent advice: leg swelling or pain in one calf, yellow skin, sudden severe headache.

The NHS says effects may take up to three months to show, so judging whether tibolone suits you is best left until it has had a fair trial, unless side effects are troublesome sooner. If symptoms return after stopping, speak to your doctor. Keep your regular HRT reviews, and report new breast changes, unexpected bleeding or leg symptoms between reviews rather than waiting.

The NHS says you can drink alcohol on tibolone, although reducing it may ease flushes and improve sleep. It does not usually affect driving or cycling. Weight gain is common at the menopause regardless; a balanced diet and regular exercise help. Long-term use carries a slight increase in the risk of breast cancer and blood clots.

Tibolone is not a contraceptive. The NHS advises non-hormonal contraception for two years after the final period if under 50, or one year if over 50. It is prescription only. Suspected side effects can be reported through the Yellow Card scheme.