Livial is a branded version of the postmenopausal hormone replacement therapy (HRT) Tibolone. Tibolone HRT medicines treat symptoms associated with menopause, like issues sleeping, changes in mood, and brain fog.

It can also be used to treat osteoporosis or prevent it from developing in postmenopausal women.

Livial was approved in the UK in March 1991 and has since become a popular choice of treatment for women who cannot tolerate combined hormone replacement therapy containing estradiol and progestogen.

At euroClinix, we prescribe Livial specifically for treating symptoms of menopause in postmenopausal women or those who have had their ovaries removed. If you still have intact ovaries, then a combination HRT, like Estradiol may be more suitable, as the risk of developing endometrial cancer is lower.

During menopause, oestrogen levels lower as the body stops producing eggs leading to unpleasant symptoms like hot flashes, mood swings, vaginal dryness and difficulty sleeping.

Unlike traditional HRT options that combine oestrogen and progestogen, Livial (tibolone) is a synthetic steroid that is processed into compounds that act like oestrogen, progestogen, and testosterone. This targets specific tissues in the bones, brain, and vagina, helping to restore hormonal balance and ease symptoms of menopause.

Since it does not require the addition of progestogen, Livial is more suitable for women who have had their ovaries removed (hysterectomy). The risk of endometrial cancer is higher in women with intact ovaries.

The drop in oestrogen also increases the risk of osteoporosis, a condition that weakens bones. By acting directly on bone tissue, Livial helps strengthen bones and reduces the risk of osteoporosis in postmenopausal women.

Taking this medicine to treat your menopause symptoms can offer several health benefits.

Tibolone, the active ingredient in Livial, has been found in clinical trials to be an effective treatment for menopausal symptoms.

One clinical trial involving 162 postmenopausal women aged 40-65 years old found a significant improvement in symptoms associated with menopause when taking Tibolone 2.5 mg tablets.

Here are the key findings after 24 weeks:

The same study also showed that the quality of sex life was improved during treatment with Tibolone, offering not only relief from symptoms, but enhanced sexual well-being.

Another study found Tibolone to be more effective than placebo in treating menopausal symptoms. This study suggests that if 67% of women taking a placebo experience symptoms affecting the blood vessels, between 35% and 45% of women taking tibolone will do so.

Before you are prescribed this treatment, you will need to fill out a consultation form so our medical team can determine if it is safe and suitable for you.

Who can take it?

This medication is suitable for postmenopausal women who have not had a period for over a year, or who have had their ovaries removed. It is better suited for women without ovaries as the risk of endometrial cancer is significantly higher than with other treatments.

Who cannot take it?

This medication is not suitable if you have or have had:

• Breast cancer
• Cancer which is sensitive to oestrogen
• Unexplained vaginal bleeding
• Excessive thickening of the womb lining (endometrial hyperplasia)
• A blood clot in a vein (thrombosis)
• A blood clotting disorder (such as protein C, protein S, or antithrombin deficiency)
• A disease caused by blood clots in the arteries, such as heart attack, stroke or angina
• Liver disease
• A rare blood disease called porphyria
• An allergy to tibolone or any other ingredient found in this medicine

If you experience any of these conditions for the first time after starting treatment, stop taking it immediately and consult your doctor.

Cautions

While not contraindications, the following conditions mean the safety of this treatment will need to be determined in your consultation. Tell our medical team if you have any of the following:

• Fibroids inside your womb
• Growth of the womb lining (endometriosis)
• Increased risk of developing blood clots
• Increased risk of developing an oestrogen-sensitive cancer like breast cancer
• High blood pressure
• A liver disorder like hepatitis
• Diabetes
• Gallstones
• Migraine or severe headaches
• An immune system disease like type 1 diabetes
• Epilepsy
• Asthma
• A disease affecting the eardrum and hearing (otosclerosis)
• A very high level of fat in your blood (triglycerides)
• Fluid retention due to heart or kidney problems
• An intact uterus

Please disclose your health status during your online consultation with euroClinix. Our medical team will evaluate whether this treatment is suitable for you and may adjust your medications if needed.

Dosage

There is only one dosage of Livial offered by euroClinix: 2.5 mg.

The recommended dosage is one 2.5 mg tablet daily for as long as you need to control your menopause symptoms.

Each strip contains 28 tablets, with one to be taken every day.

The strips of tablets are marked with the days of the week. Begin your treatment by taking a tablet marked with the current day, and follow the arrows until the strip is empty.

Always follow your doctor’s advice when taking this medication.

When do I take it?

You can take your tablet at whatever time of day works best for you.

You should take your doses at the same time each day. Doing so ensures effectiveness and regulates the amount of the active substance in your body.

What if I miss a dose?

Follow these instructions if you forget to take your tablet:

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

Do not take a double dose to make up for a missed one.

Most women will feel the effects after a few weeks of treatment, but it can take up to three months for HRT to most effectively treat your symptoms.If there is no noticeable improvement after this time, consult your doctor for further guidance.

This treatment will not delay or “cure” menopause, only treat the symptoms. If you stop taking it, your symptoms may return.

Livial can be taken long-term for as long as you need to control your menopause symptoms, but you will need to check up with your doctor after 3 months to see if it is working correctly and to identify potential risks.

Tibolone use has been associated with an increased risk of hormone-sensitive cancer, so it will only be prescribed long-term if the benefits outweigh the risks. Ask your doctor for more information about the risks associated with taking this HRT medication.

Taking this medication can produce side effects.

*Vaginal bleeding is usually nothing to worry about during the first few months of taking HRT. Consult your doctor if the bleeding persists or is extreme.

Side effects of an unknown frequency

• Depression
• Dizziness
• Headache
• Joint or muscle pain
• Skin problems
• Vision problems
• Changes in liver tests

How to manage side effects

Side effects can be unpleasant. Here are some tips to help manage and reduce some of the most common ones:

To manage weight gain, I recommend patients exercise regularly and maintain a healthy diet. If you experience extreme mood changes, consult your doctor and they may make adjustments to your treatment.

Dr. Caroline Fontana Lead Prescribing Doctor

For personalised advice, inform your doctor about any persistent or severe side effects.

Serious side effects

The following Tibolone side effects may be a sign of something serious. Stop treatment and see a doctor if you get any of the following:

• Your blood pressure rises
• Your skin or the whites of your eyes go yellow (jaundice)
• You suddenly have migraine-type headaches
• You have signs of a blood clot

Some medicines may interact with the effectiveness of Livial (Tibolone) or increase the risk of side effects. Tell your doctor about all the medicines you are taking, including the following:

• Blood thinners (e.g., Warfarin) - Livial may increase the effect of blood thinners, which can affect clotting.
• Epilepsy medications (e.g,. Phenytoin) - these drugs may reduce the effectiveness of Livial.
• Medications broken down by the liver (e.g., Midazolam) - taking Livial may change how other medicines are processed in your body.
• Medications that speed up the liver’s processing (e.g., carbamazepine, rifampicin) - these medications can make Livial break down faster.
• Herbal supplements containing St. John’s Wort - these can speed up how your body processes hormones like oestrogen and progestogen.

All treatments you plan to take, even over-the-counter or herbal ones, should be discussed with your doctor. Consult them for more information and personalised advice.

Follow these guidelines when storing your medicine:

• Store below 25°C in the original packaging
• Do not use this medicine after the expiry date
• Keep this medicine out of the sight and reach of children
• Do not throw away medicines via wastewater or household waste.*

*Take any unused medication to your local pharmacy for proper disposal. These measures help to protect the environment.

No, Livial can only be obtained with a prescription from a licensed healthcare provider.

Prescriptions are necessary because they:

• Ensure appropriate use for your specific condition.
• Prevent potential misuse and associated health risks.
• Allow for monitoring of side effects and interactions with other medications.

Ordering Livial online from euroClinix is convenient.

Follow these simple steps:

1. Complete a quick online consultation to check your eligibility.
2. UK-registered doctors review your responses to ensure the medication is right for you.
3. Upon approval, an e-prescription will be issued.
4. Enjoy free delivery from our licensed pharmacy with tracking details.

Your privacy is our top priority. euroClinix uses secure, encrypted transactions and complies with UK medical standards to keep your information confidential.

Start your online consultation today to enjoy professional care from the comfort of your home.

euroClinix is trusted by thousands of users in the UK for its safe and convenient service. Here’s why:

• Experienced doctors manage your consultations and prescriptions.
• Online consultations, swift approvals, and discreet doorstep delivery make ordering quick and convenient.
• A supportive team is on hand to answer treatment-related questions or concerns.
• Patients can manage their prescriptions hassle-free through our secure platform.

Join thousands who trust euroClinix for their healthcare needs and take control of your health today.

The price of Livial at euroClinix includes everything you need:

• Free online consultation with our experienced doctors
• Free prescription, if approved
• Free delivery straight to your door

Our pricing is transparent, with no hidden fees. Order today and benefit from our complete, all-inclusive service.

If this treatment is not right for you, there are other treatments available for your condition.

Once you have decided on a treatment, simply fill out a consultation form at the top of this page, and our doctors can start you on your journey to getting better. Once approved, your chosen medicine can be sent out, and you can start your treatment without delay.