Use Livial to get through menopause with less negative effects

Livial contains tibolone, a synthetic steroid that simulates the activity of oestrogen, progesterone and testosterone. It thus restores hormonal balance and eases menopausal symptoms.

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Strength Quantity Price Stock
2.5mg84 tablets£49.99In Stock
Prices exclude a prescription fee. This treatment requires a quick online consultation,
which a doctor will review to determine if a prescription is appropriate.

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Dr Samantha Miller

Reviewed by Dr Samantha Miller MB ChB
(2017, University of Glasgow)
GMC number: 7561464

Information last reviewed 29/05/2021


What is Livial?

Livial is a type of hormone replacement therapy (HRT) used for relieving the symptoms of menopause in women. It is also used for the prevention of osteoporosis (weakening of the bones) in postmenopausal women who are unable to take other forms of HRT. 

How does Livial work?

Livial contains the active ingredient tibolone, a synthetic steroid that simulates the activity of the female sex hormones oestrogen and progesterone and the androgen hormone testosterone. During menopause, the amount of oestrogen produced by the ovaries decreases, causing symptoms such as mood swings, hot flushes, reduced libido and vaginal dryness. The tibolone in Livial is broken down into three compounds that act similarly to the body’s natural oestrogen, progesterone and testosterone, restoring the body’s hormonal balance and relieving the symptoms of menopause.


Active ingredients

The active ingredient in Livial is 2.5mg of tibolone.

Inactive ingredients

The inactive ingredients in Livial are potato starch, lactose monohydrate, ascorbyl palmitate and magnesium stearate.


How to start Livial?

Livial should only be started after consultation with a doctor. You can start taking this medication straight away if:

  • You are changing from a period-free HRT (a continuous combined formulation)
  • You have never used HRT before
  • It was prescribed to you following a hysterectomy
  • You are being treated for endometriosis

If you are changing over from a type of HRT which allows for monthly periods (such as Elleste Duet), you should finish your current pack, and start taking Livial the next day.

You should NOT take Livial if you have had a natural period within the last 12 months.

How to take Livial?

Always take Livial as instructed by a doctor. The recommended dose is 1 x 2.5mg tablet taken once a day. You should take your tablet with water and without chewing or breaking it. You need to take your tablet at the same time each day. To help you remember, try and make this a part of your daily routine - for example, take your tablet with breakfast each day, or when you brush your teeth in the morning or evening. The strips of tablets are marked with the days of the week to help you keep track. When you finish a strip, start a new one on the next day without leaving a gap.

If you forget to take a tablet, try and take it within 12 hours of the normal time. If 12 hours have already passed, just skip the dose and take the next tablet at the normal time. Never take a double dose to make up for a missed one. 

Side Effects

Livial side effects

Like all medications, Livial can cause side effects in some patients. If you experience any of the following, stop taking Livial immediately and see a doctor straight away:

  • A significant rise in blood pressure - this may cause a headache or blurred vision
  • Jaundice (yellowing of the skin or whites of the eyes)
  • Sudden migraines 
  • Signs of a blood clot e.g. leg pain, chest pain

Common side effects, which can affect up to 1 in 10 people, include:

  • Breast pain or tenderness
  • Stomach or pelvic pain
  • Unusual hair growth
  • Vaginal bleeding or spotting (this is common in the first few months of using HRT and usually stops over time)
  • Thrush, vaginal irritation or itching, or an increase in vaginal discharge
  • Thickening of the lining of the womb or the lining of the cervix
  • Weight gain

Uncommon side effects (affecting up to 1 in 100 women) can include:

  • Signs of fluid retention (swelling of the hands, ankles or feet)
  • Stomach upset
  • Acne
  • Painful nipples
  • Vaginal infections

Rarely, women taking Livial may experience itchy skin. 

The following have also been reported by women taking Livial:

  • Depression, headaches, dizziness
  • Joint or muscle pain
  • Rash or itching of the skin
  • Loss of vision or blurred vision
  • Changes in liver tests

Livial slightly increases the risk of developing breast cancer or endometrial cancer. It is important to go for regular health checks (breast screening and cervical smear tests) while taking this medication. Speak to your doctor for more information if you are worried.


Do NOT take Livial if you:

  • Are allergic to any of the ingredients in this medication
  • Have, have ever had, or are suspected of having breast cancer
  • Have a form of oestrogen-sensitive cancer
  • Have unexplained vaginal bleeding
  • Have endometrial hyperplasia (excessive thickening of the womb lining)
  • Have or have ever had thrombosis (blood clot in a vein)
  • Have a blood clotting disorder
  • Have or have recently had a heart attack, angina, or any other disease caused by a blood clot in an artery
  • Have or have ever had a liver disease
  • Have porphyria 
  • Are pregnant or think you  might be pregnant
  • Are breastfeeding

You should tell your doctor before taking Livial if you have ever experienced any of the following:

  • Fibroids inside the womb
  • Endometriosis (growth of the womb lining outside of the womb) or endometrial hyperplasia (excessive growth of the womb lining)
  • Increased risk of developing blood clots
  • Increased risk of developing an oestrogen-sensitive cancer
  • High blood pressure
  • A liver disorder
  • Diabetes
  • Gallstones
  • Migraines or severe headaches
  • Systemic lupus erythematosus (a disease of the immune system affecting many organs of the body
  • Epilepsy
  • Asthma
  • Otosclerosis (a disease affecting the eardrum and hearing)
  • Triglycerides (high level of fat in the blood)
  • Fluid retention due to kidney problems

If you become pregnant while taking Livial, stop taking it immediately and see a doctor. 

Drug interactions

Before taking Livial, tell your doctor or pharmacist if you are taking any other medications, including those purchased over the counter without a prescription. The following medications may interfere with the effect of Livial:

  • Medicines for blood clotting, such as warfarin
  • Medicines for epilepsy, such as phenobarbital, phenytoin and carbamazepine
  • Medicines for tuberculosis, such as rifampicin
  • Herbal remedies containing St John’s wort (hypericum perforatum)

Treatment Options

Alternatives to HRT

HRT is available on prescription from Dr Felix and is generally accepted as the most effective treatment for the symptoms of menopause. Some women choose to try herbal supplements as an alternative to HRT, although the effectiveness of such treatments is unknown. Before trying herbal alternatives, consult a doctor or pharmacist about the effects of different supplements.

Livial vs. other HRT

Livial contains the active ingredient tibolone, which is a synthetic steroid that imitates the activity of hormones. It is thought to carry a slightly lower risk of breast cancer than alternative forms of HRT containing versions of the hormones themselves. Different types of HRT are suitable for different patients, and your doctor will help you decide which is best for you.

If it’s been more than 12 months since your last period, alternatives to Livial include Elleste Duet Conti or Kliovance, which are hormone-based tablet forms of HRT. If you prefer a patch form, Evorel Conti is an option.

Women who still experience regular bleeds are not suitable for Livial and can instead be usually prescribed Elleste Duet or Trisequens, which contain monthly packs of combined oestrogen-progestogen tablets and oestrogen-only tablets, allowing for a monthly simulation of a natural period.

Some types of HRT contain an oestrogen supplement only and are therefore only suitable for women who have had a hysterectomy or who have an intrauterine system (IUS), or Mirena coil, fitted. An IUS will supply the progesterone needed to counteract the build-up of the womb lining initiated by the estrogen supplement. These HRTs can be taken orally (Premarin, Elleste Solo) or applied to the skin in transdermal patches (Elleste Solo MX80, Elleste Solo MX40, Evorel).

Livial vs. tibolone

Livial is simply a brand name of tibolone, manufactured by Organon Pharma. They both contain the same active ingredient - 2.5mg tibolone

Lifestyle changes to improve menopause symptoms

Making a few simple lifestyle changes can help you to manage the symptoms of menopause and increase the effectiveness of HRT. Increasing your intake of vitamin D will help to keep your bones healthy while exercising regularly will improve your general physical strength and wellbeing. To reduce the impact of hot flushes, try cutting down on caffeine, alcohol and spicy food, and quit smoking if you have not already done so. Discomfort caused by vaginal dryness can be managed by purchasing moisturisers and lubricants from any pharmacy, where you can speak to a pharmacist for advice.


Will I have to take HRT forever?

HRTs are usually prescribed at the lowest possible dose for the patient and for the shortest time necessary because the risks and potential side effects of HRT increase with time and age. Furthermore, while HRT often delays the onset of osteoporosis it will not prevent it altogether. When to come off HRT is a personal decision that should be discussed with a doctor. You should never stop taking Livial without first consulting a doctor.

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