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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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 which 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 which 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 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
  • 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), wait for your next period and start taking Livial as soon as your period ends. 

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 2.5 mg tablet taken once a day. You should take your tablet with water and without chewing or breaking it 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 has 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
  • Jaundice (yellowing of the skin or whites of the eyes)
  • Sudden migraines 
  • Signs of a blood clot

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

  • Breast pain
  • 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
  • You have, have ever had, or are suspected of having breast cancer
  • You have a form of oestrogen-sensitive cancer
  • You have unexplained vaginal bleeding
  • You have endometrial hyperplasia (excessive thickening of the womb lining)
  • You have or have ever had thrombosis (blood clot in a vein)
  • You have a blood clotting disorder
  • You have or have recently had a heart attack, angina, or any other disease caused by a blood clot in an artery
  • You have or have ever had a liver disease
  • You have porphyria 
  • You are pregnant or think you  might be pregnant
  • You 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 and lead to irregular bleeding:

  • 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 via the NHS and online at 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 synthetic version 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.

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).

Women who have not had a hysterectomy or who do not have a mirena coil fitted will need to use HRT containing both and oestrogen and a progesterone supplement. Climesse, Elleste Duet Conti and Kliovance are more suited to women who have not had a natural period in the past 12 months, as the progesterone component is taken continuously and therefore does not cause a monthly bleed. Women who still experience regular bleeds are usually prescribed Elleste Duet, which contains monthly packs of combined oestrogen-progesterone tablets and oestrogen-only tablets, allowing for a monthly simulation of a natural period.

Lifestyle changes to improve menopause symptoms

Making a few simple lifestyle changes can help you to manage the symptoms of menopause and increase the effectivity 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 delays the onset of osteoporosis it does 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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