Tibolone, better known by the brand name Livial, is a hormone tablet for women after menopause. What makes it distinctive: a single tablet acts oestrogen-like, progestogen-like and mildly androgen-like at once, so you do not need a separate progestogen. Experiences with tibolone vary, especially around libido and spotting. What can you expect?
What is tibolone (Livial) and how does it work?
Tibolone is a synthetic steroid of 2.5 mg taken once daily. In your body it breaks down into active metabolites that act differently in different tissues: oestrogen-like in your bones and vagina, progestogen-like in your womb, and mildly androgenic (testosterone-like). Because it protects the womb lining itself, you do not need a separate progestogen.
Tibolone is intended for women who have had no period for at least twelve months, so after menopause. If you still menstruate irregularly, in perimenopause, it is usually not the first choice.
Tibolone versus combined hormone therapy
Tibolone is one all-in-one tablet. Combined hormone therapy such as Femoston contains oestrogen (estradiol) plus a separate progestogen. Both treat menopause symptoms, but they differ in composition, bleeding pattern and effect on libido. This table sets out the main differences:
| Feature | Tibolone (Livial) | Combined HRT (e.g. Femoston) |
|---|---|---|
| Composition | 1 synthetic steroid | Estradiol + separate progestogen |
| Separate progestogen needed | No | Yes, if you have a uterus |
| Monthly bleed | Usually none (continuous) | Sequential yes, continuous no |
| Effect on libido | Mildly androgenic, may help | More neutral |
| For whom | At least 12 months postmenopausal | Peri- and postmenopause |
Which form suits you depends on your stage, your symptoms and your preferences. Your doctor weighs this together with your medical history.
Tibolone experiences: what do users say?
Experiences with tibolone are mixed. Some women are happy with it because libido and mood improve, something they missed on other therapies. Others switch because of unexpected bleeding in the first months. This is what you hear most often.
Positive experiences: fewer hot flushes and night sweats, better mood and more interest in sex through the androgenic action, no separate progestogen tablet, usually no monthly bleed, and support for your bones.
Points women mention: spotting or breakthrough bleeding especially in the first months, tender breasts, some weight gain or bloating, genital itching, and that it is not suitable if you still menstruate regularly.
Picture two women of 58, both a few years postmenopausal. One finds her interest in sex returns and stays happy on tibolone. The other keeps spotting and switches after three months to a patch with a separate progesterone. The same tablet, a different experience.
Side effects of tibolone
Most side effects of tibolone are mild and ease as your body adjusts. Commonly reported are spotting, tender breasts, abdominal pain, weight gain and genital itching. Bleeding is most likely in the first months and settles for many women afterwards.
Contact your doctor about persistent or heavy bleeding. As with other hormone therapy there are rare but serious risks: in the LIFT trial (NEJM, 2008) tibolone lowered the risk of vertebral fracture and breast cancer but was linked to an increased risk of stroke, especially in women over 60. That is why it is usually avoided in that group and after a stroke or breast cancer. Your doctor weighs this up.
Who is tibolone suitable for?
Tibolone can suit women who are at least a year postmenopausal, have hot flushes and prefer no monthly bleed. Its mild androgenic action makes it appealing when libido or mood have changed. For some women it is less suitable: if you still menstruate regularly, are over 60, or have a history of breast cancer, stroke or thrombosis, your doctor looks at other options.
Alternatives to tibolone
If tibolone does not suit you, there are other options, usually oestrogen with a separate progestogen or a transdermal form through the skin.
- A combined tablet such as Femoston
- Transdermal oestrogen such as a Lenzetto spray, patch or gel, with a separate progestogen
- Want the overview? Read about experiences with hormone therapy for menopause
Testing your hormones before and during tibolone
Before starting tibolone or another hormone therapy, a hormone test can give your doctor a starting point. Values often looked at are oestradiol, FSH and your thyroid (TSH), because thyroid complaints can resemble menopause symptoms.
With the Menopause blood test from Lunara you can discover your hormone levels, with an assessment by a BIG-registered doctor. Want to compare all types of hormone therapy and their side effects first? That helps you weigh the options.
Frequently asked questions
Does tibolone help with hot flushes?
Yes, tibolone reduces hot flushes and night sweats in many women. The effect usually starts within a few weeks, with the full effect after several weeks. If you notice little difference after three months, discuss it with your doctor.
Do I need progesterone with tibolone?
No. Tibolone protects the womb lining itself through its progestogen-like action, so a separate progestogen is not needed. That is one reason some women like the all-in-one tablet.
Do you gain weight on Livial?
Some women notice weight gain or bloating, especially early on. Weight change in menopause is also linked to age and a slower metabolism. Fluid retention can show temporarily on the scales.
Does tibolone improve libido?
For some women, yes. Through its mild androgenic, testosterone-like action, tibolone can give interest in sex and mood a lift. This is not the case for everyone, but for some it is a reason to choose tibolone.
Can you use tibolone in perimenopause?
Usually not as a first choice. Tibolone is meant for women who have had no period for at least twelve months. If you still menstruate irregularly, tibolone can cause more spotting and your doctor tends to look at other forms first.
For women after menopause, tibolone is a convenient all-in-one choice, and its androgenic action makes it a little more comfortable for some than other forms. Still, it is no miracle: the bleeding pattern and the risks at older age call for an honest weigh-up with your doctor. Take your doubts seriously and ask your questions freely.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
References
- Farmacotherapeutisch Kompas. Tibolone. Accessed 2026.
- Thuisarts.nl. Menopause complaints. Accessed 2026.
- Cummings SR, et al. The effects of tibolone in older postmenopausal women (LIFT trial). New England Journal of Medicine, 2008. PMID 18703472.
- MacLennan AH, et al. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database of Systematic Reviews, 2004. PMID 15495039.
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