Livial
✅ Relieves menopausal symptoms
✅ Improves bone density
✅ Enhances libido
✅ Protects against osteoporosis
✅ Regulates hormonal balance
Livial contains Tibolone.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
💡 Quick Answer
Livial is tibolone 2.5 mg, a synthetic steroid that produces mild estrogenic, progestogenic, and androgenic activity after tissue-specific metabolism. Used for menopausal symptom relief and osteoporosis prevention in women at least 1 year post-menopause. Unlike standard combined HRT, tibolone does not require a separate progestin. Has a distinct risk profile — slightly elevated stroke risk in women over 60, and slightly increased recurrence risk in women with a history of breast cancer.
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What Is Livial?
Livial is a branded generic of tibolone 2.5 mg, a selective tissue estrogenic activity regulator (STEAR). Tibolone is a synthetic steroid that is metabolised in different tissues to compounds with estrogen-like, progestin-like, or androgen-like effects — producing a favourable profile in some tissues and less activity in others. Manufactured by Organon.
Clinical profile: estrogenic in bone, brain, and vagina (symptom relief), progestogenic in endometrium (does not stimulate endometrial proliferation — no separate progestin needed), androgenic in breast and liver (may help libido; may also affect lipid profile).
Clinical Uses
- Menopausal vasomotor symptoms (hot flushes, night sweats) — ~70–80% reduction in trials.
- Genitourinary syndrome of menopause — vaginal dryness, dyspareunia.
- Postmenopausal osteoporosis prevention — reduces vertebral fracture risk.
- Women preferring single-agent HRT — no separate progestin tablet needed.
- Some women report libido benefit from tibolone’s mild androgenic activity (unique among HRT options).
Start Criteria
- At least 12 months past the last period (tibolone in perimenopausal women causes irregular bleeding).
- Natural or surgical menopause (post-hysterectomy, post-bilateral oophorectomy).
- Symptoms significant enough to warrant treatment.
- No contraindications (see below).
How to Take
- Take one tablet (2.5 mg) once daily, at roughly the same time each day, with water. With or without food.
- Effect on vasomotor symptoms typically begins within 4–8 weeks; peak response at 3 months.
- Continuous daily dosing, every day — no cyclic breaks.
- If starting within 12 months of last period, irregular bleeding is more likely; wait until at least 1 year post-menopause.
- Review annually for ongoing need. Most guidelines recommend the lowest effective dose for the shortest effective duration.
Safety — LIFT and LIBERATE Trials
Two major trials shaped tibolone safety understanding:
- LIFT trial (osteoporosis prevention in older women): showed increased stroke risk in women over 60 taking tibolone. Use is now not recommended in women over 60 for new initiation.
- LIBERATE trial (breast cancer survivors): showed increased breast cancer recurrence when tibolone was used in women with prior breast cancer. Contraindicated in breast cancer survivors.
- In women <60 without breast cancer history, tibolone has a reasonable safety profile with efficacy comparable to low-dose combined HRT.
Side Effects
Common: vaginal discharge, breast tenderness (less than combined HRT), weight gain (mild), lower abdominal pain, breast enlargement.
Less common: androgenic effects — mild acne, increased facial hair, oily skin (from tibolone’s weak androgenic activity), mood changes.
Serious (rare): stroke (particularly in women over 60), breast cancer recurrence (in prior breast cancer survivors), VTE (lower than oral combined HRT but not zero), unexpected uterine bleeding (investigate).
Who Should Not Take Livial
- Women over 60 initiating new HRT (stroke risk) — use alternatives
- History of breast cancer — contraindicated per LIBERATE
- History of estrogen-dependent cancer or unexplained vaginal bleeding
- Current or history of VTE, DVT, or PE
- History of stroke or TIA
- Active liver disease
- Known pregnancy (should not occur post-menopause)
- Within 12 months of last menstrual period (irregular bleeding)
- Known hypersensitivity
Tibolone vs Combined HRT — Decision Framework
| Consideration | Tibolone | Combined HRT (estrogen+progestin) |
|---|---|---|
| Pills per day | 1 | 1 or 2 (depending on regimen) |
| Bleeding profile | ~90% bleed-free after 3 months | Withdrawal bleed (sequential) or bleed-free (continuous-combined) |
| Libido | Mild androgenic benefit reported | Neutral or slightly suppressive |
| Use in women over 60 | Avoid initiation (stroke risk) | Unfavourable risk-benefit over 60 |
| Breast cancer survivors | Contraindicated (LIBERATE) | Contraindicated |
| VTE risk | Low (lower than oral combined HRT) | Moderate (oral route, higher) |
Storage
Store at room temperature (15–25 °C / 59–77 °F), away from moisture. Keep in original packaging.
Frequently Asked Questions
Is tibolone HRT?
Yes, in effect — it is a form of hormone therapy for menopausal symptoms. It differs from classic HRT because one tablet delivers estrogen-like, progestin-like, and mild androgen-like effects, so no separate progestin is needed.
Can I start tibolone if I'm still having periods?
No. Tibolone causes irregular bleeding in perimenopausal women. Wait until 12 months after your last period.
Will I bleed on tibolone?
About 90% of women are bleed-free by 3 months on tibolone. Breakthrough bleeding in the first 3 months is common and usually settles. Persistent bleeding beyond 6 months needs investigation.
Is tibolone safer than combined HRT?
Mixed. Tibolone has lower VTE risk than oral combined HRT but slightly elevated stroke risk in women over 60 (LIFT trial) and contraindicated in breast cancer survivors (LIBERATE). In women under 60 without breast cancer history, it’s a reasonable option.
Can I switch from combined HRT to tibolone?
Yes, but typically after 12 months of stable HRT. Discuss with a clinician — switching involves a short overlap or washout depending on current regimen.
Does tibolone help with libido?
Some women report libido benefit from tibolone’s mild androgenic activity. This is a unique feature vs standard estrogen-based HRT.
Will tibolone cause weight gain?
Small weight changes (~1–2 kg) are reported. Tibolone is generally weight-neutral in controlled trials, though individual variation exists.
How long can I take tibolone?
Modern guideline: lowest effective dose for the shortest effective duration. Annual review. Long-term safety data are reassuring for women under 60 who don’t have contraindications.
Related Hormone & Women’s Health Products
- Premarin (Conjugated Estrogens)
- Premarin Cream (Vaginal Estrogen)
- Progynova (Estradiol Valerate)
- Endogest (Progesterone 100 mg)
- Gestoford (Progesterone 100 mg)
- Gestheal (Progesterone 200 mg)
- Susten Capsule (Progesterone)
⚕️ Medical Disclaimer: Information is educational and does not replace medical advice. Hormone therapies carry specific risks (breast cancer, VTE, stroke, endometrial cancer if unopposed estrogen) — consult a clinician before starting, stopping, or changing any hormone medication. Individual risk–benefit depends on personal and family medical history.
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| Strength | 2.5 mg |
|---|---|
| Quantity | 28 Tablet/s, 56 Tablet/s, 84 Tablet/s, 168 Tablet/s |
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