Livial

How to order Livial

1. Find the drug you need on our site.
2. Pick a clinic. See the price.
3. Fill in a short health form.
4. A doctor reads your form.
5. If it is safe for you, they say yes.
6. Your order ships fast to your door.
7. It comes in a plain, sealed box.

Why use us? We compare UK clinics. We show you the price and how fast they ship. We do not sell drugs. We just help you find the best one for you.

Is it safe? Yes. All our clinics are UK-based. A real doctor reads each form. They will not sell to you if it is not safe for you.

Livial on Prescriptsy

Livial is described on Prescriptsy as independent product information.

Here you can understand how online consultation works, what medical checks partner clinics carry out, and which factors matter when comparing providers.

We do not sell medicines directly, but help users compare licensed healthcare partners on price, delivery speed, service quality, and overall trustworthiness.

Livial is a prescription-only hormone replacement therapy (HRT) containing tibolone 2.5 mg, a synthetic steroid that provides relief from menopausal symptoms and protection against postmenopausal osteoporosis.

Unlike conventional combined HRT, which uses separate oestrogen and progestogen components, Livial contains a single molecule that is metabolised in the body into three active compounds with oestrogenic, progestogenic, and mild androgenic activity.

This tissue-selective profile allows tibolone to relieve hot flushes, night sweats, and vaginal dryness while maintaining endometrial protection and, in some women, supporting libido.

Livial is suitable only for women who are at least 12 months past their last natural menstrual period.

The menopause marks the permanent cessation of menstruation, diagnosed retrospectively after 12 consecutive months without a period.

The average age of menopause in the UK is 51, though it can occur naturally between the ages of 45 and 55, or earlier in the case of premature ovarian insufficiency or surgical menopause.

During the menopausal transition, declining levels of oestrogen and progesterone produce a range of symptoms that can significantly affect quality of life.

Vasomotor symptoms (hot flushes and night sweats) are the most common reason women seek HRT, but other symptoms include vaginal dryness, urinary symptoms, joint pain, mood changes, fatigue, and reduced libido.

This page provides a comprehensive clinical guide to Livial, covering how tibolone works, who should take it, dosage, side effects, safety warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about Livial

Before reading further, note these essential safety points about tibolone.

• Livial is a prescription-only medicine (POM) for postmenopausal women only (at least 12 months after the last period).
• It must not be used by women with a current or past history of breast cancer.
• There is an increased risk of stroke, particularly in women over 60.
• Annual review by your prescriber is recommended to reassess benefits and risks.
• Report any unexpected vaginal bleeding to your GP promptly.

Understanding the menopause and HRT

The menopause results from the exhaustion of ovarian follicles and the consequent decline in oestradiol production. This hormonal shift affects multiple organ systems.

Oestrogen receptors are present throughout the body, including the brain, cardiovascular system, bones, urogenital tract, and skin, explaining the wide range of menopausal symptoms.

NICE guideline NG23 recommends that healthcare professionals should offer HRT to women with menopausal symptoms after a discussion of the short-term and longer-term benefits and risks.

The benefits of HRT include effective relief of vasomotor symptoms, prevention of bone loss, improvement in urogenital atrophy, and potential benefits for mood and sleep.

HRT preparations fall into several categories: oestrogen-only (for women without a uterus), sequential combined (oestrogen daily plus progestogen for 12 to 14 days per cycle, producing a monthly withdrawal bleed), continuous combined (oestrogen and progestogen daily without a break, designed to be bleed-free), and tibolone (a single molecule with tissue-selective hormonal activity).

The choice depends on menopausal status, whether the uterus is present, symptom profile, and individual risk factors.

How tibolone works: mechanism of action

Tibolone is a pro-steroid that undergoes extensive first-pass metabolism in the gastrointestinal tract and liver.

It is converted into three principal metabolites: 3-alpha-hydroxy tibolone and 3-beta-hydroxy tibolone, which have oestrogenic activity, and the delta-4 isomer, which has progestogenic and androgenic activity.

The relative activity of these metabolites varies by tissue, a property described as tissue-selective or organ-specific action.

In the bone, vagina, and brain, the oestrogenic metabolites predominate, providing relief of vasomotor symptoms, improvement in vaginal lubrication and elasticity, and maintenance of bone mineral density.

In the endometrium, the progestogenic delta-4 metabolite and local enzyme activity (particularly sulphotransferase, which inactivates oestrogenic metabolites) protect against endometrial hyperplasia.

This allows tibolone to be used without a separate progestogen in women with an intact uterus.

In muscle and skin, the androgenic activity may contribute to improvements in energy and libido, though these effects vary between individuals.

Tibolone does not suppress endogenous sex hormone-binding globulin (SHBG) to the same extent as conventional combined HRT, which has implications for the bioavailability of androgens.

The overall hormonal effect of tibolone is milder than that of standard HRT preparations, which may contribute to its lower incidence of breast tenderness compared with conventional combined HRT.

Clinical evidence for tibolone

The efficacy of tibolone in relieving menopausal symptoms has been established in multiple randomised controlled trials.

Studies have shown that tibolone 2.5 mg daily significantly reduces the frequency and severity of hot flushes, with reductions of 70 to 90% compared with baseline within 12 weeks.

Tibolone has also been shown to improve vaginal lubrication, reduce dyspareunia, and improve sexual function scores, including measures of desire, arousal, and satisfaction.

The LIFT (Long-term Intervention on Fractures with Tibolone) trial enrolled 4,538 women aged 60 to 85 with osteoporosis and demonstrated that tibolone 1.25 mg daily (a lower dose than the 2.5 mg used for symptom relief) reduced the risk of vertebral fractures by 45% and non-vertebral fractures by 26% over a median of 34 months.

However, the trial was stopped early because of a statistically significant increase in stroke risk (relative risk 2.19).

Breast cancer incidence was lower in the tibolone group, which was an unexpected finding.

The LIFT trial results shaped current guidance, which cautions against initiating tibolone in women over 60 due to the elevated stroke risk.

The Million Women Study, a large UK observational study, found that tibolone users had a relative risk of breast cancer of approximately 1.45 compared with never-users of HRT, which is lower than the relative risk associated with combined oestrogen-progestogen HRT (approximately 2.0) but higher than non-use.

The LIBERATE trial confirmed that tibolone should not be used in women with a history of breast cancer, as it was associated with an increased risk of cancer recurrence.

Tibolone compared with other HRT options

Tibolone offers several practical advantages over conventional HRT. It is a single daily tablet with no cyclical progestogen phase, making it simpler to use than sequential preparations.

It is designed to be bleed-free, which many women prefer.

Its mild androgenic activity may benefit women with reduced libido, an area where conventional HRT has limited evidence of effect.

However, tibolone also has disadvantages.

Unlike transdermal oestrogen (patches and gels), which bypasses first-pass hepatic metabolism and is associated with a lower risk of VTE, tibolone is taken orally and carries the VTE and stroke risks associated with first-pass metabolism.

Tibolone cannot be dose-adjusted below 2.5 mg within the available product, whereas oestrogen patches and gels allow flexible dosing.

Women who require lower-dose HRT or who have significant VTE risk factors may be better served by transdermal preparations.

Continuous combined HRT products such as Kliofem (estradiol/norethisterone acetate) and Kliovance provide a similar bleed-free approach but use conventional hormones. The choice between tibolone and these products depends on individual tolerability, risk profile, and symptom pattern.

Dosage and administration

Take one Livial tablet (2.5 mg) once daily at approximately the same time each day.

The tablet should be swallowed whole with water and may be taken with or without food. Treatment is continuous, with no break between packs.

Livial must only be used by women who are at least 12 months past their last natural period.

Annual review is recommended to assess whether continued treatment remains appropriate.

Side effects of tibolone

Common and expected effects

Vaginal bleeding or spotting may occur during the first months and usually resolves within 3 to 6 months.

Lower abdominal pain, breast tenderness, weight gain, and increased facial hair growth are common. Headache and musculoskeletal discomfort are also reported.

These effects should be discussed at your annual review.

Serious risks

The increased risk of stroke, particularly in women over 60, is the most clinically significant concern.

The risk of breast cancer is elevated compared with non-use but appears lower than with conventional combined HRT.

There is a possible small increase in endometrial cancer risk, though the clinical data are inconsistent. VTE risk is present, as with all oral HRT preparations.

When to seek urgent medical advice

Contact your GP or call NHS 111 for persistent or heavy vaginal bleeding, breast changes, or mood disturbance.

Call 999 or attend A&E if you develop signs of a stroke (facial drooping, arm weakness, speech difficulty), signs of a blood clot (sudden leg swelling, chest pain, breathlessness), or a severe allergic reaction.

Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Livial must not be used in women with breast cancer (current or past), oestrogen-dependent malignancy, undiagnosed vaginal bleeding, untreated endometrial hyperplasia, active or recent VTE or arterial thromboembolism, active liver disease, known thrombophilia, or porphyria.

It should not be started in women over 60 years of age.

Monitoring and annual review

Before prescribing, a full medical and family history is required, covering breast cancer, ovarian cancer, VTE, cardiovascular disease, and liver disease.

Breast examination, up-to-date mammography, and blood pressure measurement should be performed.

Annual review should reassess the benefit-risk balance, and women should remain breast-aware and participate in the NHS Breast Screening Programme.

Drug interactions

Tibolone may enhance the effect of anticoagulants (warfarin), requiring closer INR monitoring. Enzyme-inducing medicines (rifampicin, carbamazepine, phenytoin, St John's wort) can reduce tibolone efficacy. Inform your prescriber of all medicines and supplements you are taking.

How to get Livial in the UK

Livial is a prescription-only medicine available through the NHS.

Your GP, menopause specialist, or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC) can prescribe it after a clinical assessment.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Generic tibolone 2.5 mg is also available and is equally effective.

Living well after the menopause

HRT is one component of a broader approach to postmenopausal health. Regular weight-bearing and resistance exercise supports bone density and cardiovascular health.

A diet rich in calcium (dairy, fortified foods, green leafy vegetables) and adequate vitamin D (consider supplementation of 10 micrograms daily as recommended by Public Health England) supports skeletal health.

Maintaining a healthy weight, not smoking, and limiting alcohol to no more than 14 units per week all contribute to reducing cardiovascular and cancer risk.

Pelvic floor exercises help manage urinary symptoms.

Psychological support, including cognitive behavioural therapy (CBT), has evidence for managing hot flushes and mood symptoms alongside or as an alternative to HRT.

Sources

• Livial 2.5 mg Tablets, Summary of Product Characteristics (EMC)
• Tibolone, British National Formulary (BNF)
• NICE NG23: Menopause: diagnosis and management
• Tibolone, NHS medicines information
• Menopause, NHS
• MHRA Yellow Card Scheme