Livial

Livial contains tibolone, a synthetic steroid with oestrogenic, progestogenic, and weak androgenic properties, used for the relief of menopausal symptoms and the prevention of osteoporosis in postmenopausal women.

It is a unique HRT option because it combines the activities of all three sex hormones in a single compound, avoiding the need for a separate progestogen.

Tibolone is metabolised into three active compounds: a delta-4 isomer with progestogenic and androgenic activity, and two hydroxy metabolites with oestrogenic activity.

These metabolites act differently in various tissues; for example, the oestrogenic effect predominates in bone and vaginal tissue (relieving vaginal dryness and maintaining bone density), while the progestogenic activity protects the endometrium.

The androgenic component may improve libido, which some women find beneficial.

Livial is designed for continuous use without a cyclical bleed, making it suitable for postmenopausal women who are at least 12 months past their last natural period and who wish to avoid monthly withdrawal bleeds.

Clinical studies have confirmed its effectiveness in reducing vasomotor symptoms and maintaining bone mineral density.

Take one tablet daily at the same time each day, without a break between packs. Swallow with water, with or without food.

Do not start Livial until at least 12 months after the last natural menstrual period. If switching from a cyclical HRT regimen, complete the current cycle before starting Livial.

If you miss a dose and it has been less than 12 hours, take it as soon as you remember. If more than 12 hours have elapsed, skip the missed dose and continue as usual.

One tablet (2.5 mg tibolone) daily, taken continuously. There is only one dose strength. Treatment should be at the lowest effective dose for the shortest duration necessary.

Reassess the need for treatment at least annually. No dose adjustment is required for hepatic or renal impairment, though tibolone is not recommended in severe hepatic disease.

Common: vaginal spotting or bleeding (particularly in the first few months, usually settles), abdominal pain, breast tenderness, abnormal cervical smears, leucorrhoea, pelvic pain, weight gain, endometrial thickening on ultrasound.

Uncommon: acne, hirsutism (reflecting the androgenic activity), headache, migraine, oedema, dizziness, pruritus. Rare: liver function abnormalities, visual disturbance, rash.

The risk of breast cancer, stroke, and endometrial cancer should be discussed as part of the overall HRT risk-benefit assessment.

Livial carries similar risks to other HRT preparations, including a small increased risk of breast cancer with long-term use, an increased risk of stroke (particularly in women over 60), and a possible increased risk of endometrial cancer.

Investigate any unscheduled vaginal bleeding. Use the lowest effective dose for the shortest time. Livial is not a contraceptive. Annual review is recommended.

Tibolone may interfere with thyroid function tests by reducing thyroxine-binding globulin.

Contraindicated in undiagnosed vaginal bleeding, known or suspected breast cancer, other oestrogen-dependent malignancies, active or previous venous thromboembolism, active arterial thromboembolic disease (recent MI or stroke), untreated endometrial hyperplasia, severe hepatic disease, porphyria, pregnancy, and known hypersensitivity to tibolone or any excipient.