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Livial tablets are a form of HRT for women in the menopause. This medication uses the active ingredient tibolone to replace some of the hormones missing during the menopause, which it does by mimicking the activity of the estrogen hormone and supporting the replacement of androgen testosterone and progesterone.

What is Livial?

Livial is a hormone replacement therapy (HRT) tablet which contains the active ingredient tibolone, a synthetic medication most commonly used for the purpose of HRT when it is important to mimic the activity of not just estrogen, but also progesterone and androgen testosterone in the body.

Estrogen is the primary sex hormone in the female body, parts of which rely heavily on its presence. When levels of estrogen are low, tissues and other important substances can begin to degenerate, which is why people suffer from certain symptoms during the menopause. Low levels of estrogen often cause night sweats, hot flushes, depressed moods and more. When taken by mouth, Livial can be broken down into three separate compounds which act similarly to the natural progesterone, estrogen and testosterone in the body, helping to balance hormones more effectively.

When is Livial used?

Livial is most commonly used to reduce the uncomfortable symptoms of the menopause in women with lower levels of estrogen and other crucial hormones. In some cases, Livial can also be used to reduce or prevent the risk of osteoporosis in women that are postmenopausal. The reduced levels of estrogen in your system when you go through the menopause can have an impact on the bones, causing them to become brittle and thin. Livial’s extra estrogen helps to prevent this bone loss and the risk of fracture.

However, it should be noted that Livial is typically not used specifically to treat osteoporosis, as there are much more effective medications for people at high risk of suffering from fractures that your doctor is likely to suggest before offering you this one. Livial is however considered to be an ideal option for hormone replacement in women who are at particularly high risk of developing fractures, particularly those who have had prolonged therapy with corticosteroids in the past.

If you are experiencing the menopause naturally, it is not recommended to start using this substance until at least 12 months after you have had your last menstrual bleed. This medication can cause irregular bleeding and other side effects when it is taken too soon.

How do you use Livial?

Your doctor will provide detailed instructions on how to use Livial when prescribing the medication to you. It is important to follow these instructions carefully. If you have any concerns or questions, read the patient leaflet that is provided with this medication or contact your doctor or pharmacist for additional information.

Usually, Livial HRT is taken by mouth once a day, at the same time each day. Taking your Livial tibolone tablet at the same time each day will help to reduce your risk of missing a dose. You can take this medication with or without food, depending on your preferences, although it should be swallowed with water.

If you forget to take Livial HRT at your typical time, and it has not been more than 12 hours since the time when you were supposed to take the dose, you can take it as soon as you remember. If your dose of Livial HRT is more than 12 hours late, take your next dose as usual and forget the missing one. It is important not to double up on Livial if you miss a pill.

Missing a dose of this medication may increase your risk of side effects such as unexpected bleeding. You will need to continue taking this drug every day until your doctor advises otherwise – even if your symptoms stop.

What dosages are available?

Livial HRT comes in a single dose that is generally the option prescribed for all patients. Unless your doctor recommends that you should be using a different dose, the most common treatment is to take a single Livial tibolone tablet once a day. You will need to check with your doctor regularly to ensure that you should be continuing to take this medication, as is it not intended for long-term therapy.

What are the side effects of Livial?

There is a good chance that you will experience not symptoms at all when using Livial tibolone. However, it is worth being aware of the possible side effects that can occur. Remember that sometimes, the milder side effects associated with this medication will go away on their own as your body adjusts to the replacement hormones.

If you notice any side effects that are not listed here, contact your doctor or pharmacist for additional advice. If you are concerned about your safety, you can visit an emergency healthcare provider or hospital.

Common side effects include:

  • Vaginal spotting or bleeding;
  • Vaginal discharge;
  • Itching or thrush;
  • Tenderness in the breasts;
  • Strange or unusual hair growth;
  • Weight gain;
  • Pelvic or abdominal pain;
  • Thickening in the lining of the uterus.

There are some slightly more uncommon side effects associated with Livial HRT which may cause concern. For instance, some people will experience an increase in acne, nipple pain and fluid retention.

Some more unlikely side effects include:

  • Itching or rash;
  • Dizziness;
  • Dermatitis;
  • Migraine or headache;
  • Changes or disturbances in vision;
  • Pain in joints or muscles;
  • Depression or mood swings;
  • Alteration in liver function;
  • Irregular brown patches on the skin;
  • Blood clots in your blood vessels;
  • Gall stones.

If you experience any side effects that are not listed above, and you are concerned, speak to a doctor immediately. Though a serious allergic reaction to this medication is rare, seek emergency attention if you have trouble breathing, extreme dizziness, or notice swelling in the tongue, lips and throat.

When should you not use Livial?

There are many forms of HRT available for people who want to reduce the symptoms of the menopause. After a careful assessment of your condition and history, your doctor may decide that Livial tibolone is not right for you. For instance, this medication should never be taken by women who are or think they may be pregnant. It is important not to use this medication when you are breastfeeding as it can pass into the blood and therefore into breast milk.

Do not use Livial HRT if you:

  • Have or have ever had breast cancer;
  • Have any cancers that are sensitive to estrogen, such as cancer of the womb;
  • Experience unexplained bleeding from the vagina;
  • Have excessive thickness in your womb lining that has not been treatment;
  • Have ever had a blood clot in a vein in your lungs or legs;
  • Have a disorder that changes the clotting of your blood;
  • Have ever had a disease caused by blood clots in the arteries;
  • Have ever had liver disease, or your liver function is not normal;
  • Have a rare problem called porphyria which affects your blood;
  • Are hypersensitive to any of the ingredients in this medication.

Women may remain fertile for up to two years following their last menstrual period if they are under the age of 50. Your treatment with Livial tibolone will not provide any contraception if you are in this group and you will need to use a non- hormonal contraceptive instead. Speak to your doctor about your options.

Does Livial interact with any other medications?

When starting any new medication, it is important to tell your pharmacist or doctor what kind of drugs you are already taking. This includes any medicines that you purchase without a prescription, herbal substances and vitamins. Make sure that you check with your doctor before you begin taking any new medications when using Livial HRT to ensure that the combination is safe.

There is a chance that taking Livial tibolone could affect the way that the anticoagulant medication warfarin works in your system. If you are taking any blood clotting substance with Livial, you will need to be closely evaluated by your doctor.

Additionally, the following medications can reduce the levels of Livial HRT in your blood, causing more irregular symptoms:

  • St John’s Wort;
  • Phenytoin;
  • Primidone;
  • Rifampicin;
  • Carbamazepine;
  • Barbiturates.

In rare circumstances, women who suffer from diabetes when taking Livial HRT may need to adjust their antidiabetic tablets or insulin. Your doctor will often ask you to monitor your blood sugar carefully and let them know if your glucose is affected by the medicine.

Where can you buy Livial?

Livial HRT is available from most registered pharmacies. You will be able to order this medication online with us and have it delivered to a registered EU pharmacy, following a consultation with one of our certified doctors.

Can you get Livial without a prescription?

Livial tibolone is not available without a prescription. Your doctor will need to do a full review of your medical history and condition to determine that this treatment is suitable for you. There are many different kinds of HRT available today, and your doctor will usually be able to prescribe or recommend an alternative if Livial tibolone is not suitable.


Maturitas, 1995, Ginsburg J, Prelevic G, Butler, D, Okolo, S, Clinical experience with Tibolone, [accessed on 22 August 2019], available at:

Netdoctor, 2015, online, Livial, Tibolone [accessed on 22 August 2019], available at:

News Medical, 2019, online [accessed on 22 August 2019], available at: (MSD).aspx

Patient Leaflet(s)

Reviewed by:

Dr Imran Malik, General practitioner Registrationnumber: GMC: 4741365 Last checked: 19-12-2023 | Still valid

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