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

A doctor will review your order and write you a prescription, if appropriate. This prescription is then forwarded to a pharmacy. The pharmacy will have your medicine delivered to you within one to three working days. Read more about this process here.

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Livial tablets are a form of hormone replacement therapy for women in the menopause. This medication uses the active ingredient tibolone to replace some of the hormones missing during the menopause. This substance mimics the activity of the estrogen hormone and supports the replacement of androgen testosterone and progesterone too.

What is Livial? 

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

Estrogen is the primary sex hormone in the female body. Parts of the body in a female rely heavily on the presence of this hormone. When your levels of estrogen are low, tissues and other important substances can begin to degenerate - which is why people suffer from symptoms during the menopause. Low levels of estrogen often cause symptoms like night sweats, hot flushes, depressed mood, 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 female body, helping to balance your 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 bone, causing them to become brittle and thin. Livial's extra estrogen helps to prevent this bone loss and the risk of fracture.  

However, it's worth noting 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 considered to be an ideal option for hormone replacement in women who are at particularly high risk of developing fractures however, particularly those who have had prolonged therapy with corticosteroids in the past.  

If you are experiencing the menopause naturally, it's 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's important to follow these instructions carefully. If you have any concerns or questions, look at the patient leaflet that is provided with this medication or contact your doctor or pharmacist for additional information.  

Usually, Livial is taken by mouth once per day, at the same time each day. Taking your 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, though it should be swallowed with a drink of water.  

If you forget to take Livial at your typical time, and it has not been more than 12 hours since the time when you were supposed to take your dose, you can take this substance as soon as you remember. If your dose of Livial is more than 12 hours late, take your next dose as usual and forget the missing dose. 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 like 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 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 strategy is to take a single tablet once per 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's a good chance that you won't experience any symptoms at all when you're using Livial. 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 which may cause some concern too. 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 shouldn't you use Livial? 

There are many forms of hormone replacement therapy 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 is not right for you. For instance, this medication should never be taken by any woman that is pregnant or thinks that they may be pregnant. It is important not to use this medication when you are breast feeding as it can pass into the blood and therefore into breast milk too.  

Do not use Livial if you: 

  • Have or have ever had breast cancer 
  • You 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 
  • You have ever had a blood clot in a vein in your lungs or legs 
  • You have a disorder that changes the clotting of your blood 
  • You have ever had a disease caused by blood clots in the arteries 
  • You have ever had liver disease, or your liver function isn't 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 she is under the age of 50. Your treatment with Livial will not provide any contraception if you are in this group. 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's important to tell your pharmacist or doctor what kind of drugs you might already be 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, too. This will ensure that the combination is safe.  

There's a chance that taking Livial could effect 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 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 may need to adjust their antidiabetic tablets or insulin when using this medicine. 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 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 is not available without a prescription. Your doctor will need to do a full review of your medial 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 is not suitable.  



Maturitas, 1995, Ginsburg J, Prelevic G, Butler, D, Okolo, S, Clinical experience with Tibolone,  [Accessed on the 22nd of August 2019], Available at:  

Netdoctor, 2015, online, Livial, Tibolone  [Accessed on the 22nd of August 2019], Available at:  

News Medical, 2019, online [Accessed on the 22nd of August 2019], Available at: 

Assessed by:

Dr Imran Malik, General practitioner
Registration number: GMC: 4741365

Dr Imran Malik studied undergraduate medicine at King's College University in Central London and clinical studies at the prestigious King's College Hospital. He graduated with a MBBS degree in 2000 and went on to gain postgraduate memberships with the Royal Society of Medicine and also General Practice in 2006.