Tibolone

Tibolone is a tablet containing a synthetic hormone. The Australasian Menopause Society explains that the body breaks it down into active substances that work in a similar way to three hormones at once: estrogen, progesterone and testosterone. The NHS website's page on types of HRT puts it simply: similar to combined HRT, with a testosterone effect as well.

The Pakistan Menopause Society calls it a STEAR, a selective tissue estrogenic activity regulator. Its recommendations describe tibolone acting like estrogen in the brain, vagina and bones, while having little or the opposite effect on the womb lining (5.6). On the breast, the Australasian Menopause Society says the evidence is mixed: a review of four trials found no significant increase, while large population studies found more breast cancer among current users of HRT, tibolone included. It says the long-term effect is not yet known. The NHS website says tibolone increases the risk of breast cancer and womb cancer, particularly with long-term use, and that your doctor will go through the risks and benefits with you.

Ordinary estrogen needs a progestogen beside it in a woman who still has her womb, to protect the lining (5.4). Because of how tibolone acts on the lining, the PMS recommendations say it generally does not need one added (5.6).

The timing matters. The NHS website says tibolone is usually only recommended once it has been at least 12 months since your last period, which is the stage called postmenopause. The Australasian Menopause Society adds that if it is taken sooner, in the perimenopause, irregular bleeding may be experienced. The PMS recommendations place it in the same stage on their chart for choosing a regimen, for women over 54 or a year past their last period, and only after the risks have been explained carefully (Figure 2).

According to the NHS website, tibolone can help with:

• hot flushes
• low mood
• vaginal symptoms
• keeping bones from thinning after the menopause, for which it can also be prescribed

The PMS recommendations add that it causes less bleeding from the womb and may improve mood and libido (5.6).

The NHS website lists breast, stomach or pelvic pain, vaginal itching, irritation or bleeding, unusual hair growth and weight gain as common side effects.

The PMS recommendations list tibolone among the HRT regimens, as a synthetic steroid alternative (5.3). For hot flushes, their first-line medicine is conventional HRT in women who are eligible and have no reason not to take it (7.1.1).

The Australasian Menopause Society says trials show tibolone is more effective than a dummy tablet (placebo) but less effective than combined HRT for controlling hot flushes.

Whether tibolone suits you depends on your age, how long it has been since your last period, and your own and your family's health history. The risks and benefits of HRT are part of that conversation, and it is one to have with the doctor who would prescribe it, not with a pharmacy counter.

If you are taking tibolone that was not prescribed for you, or was prescribed some time ago and never reviewed, book an appointment. Women's Health Concern, which counts tibolone among the types of HRT, says anyone on HRT should be reassessed by their doctor at least once a year.

See a doctor promptly about any unexpected bleeding. NICE NG23 says bleeding is a common side effect in the first six months of HRT, and in the three months after any change of dose or preparation, and is asked about at the three-month review. Unscheduled bleeding outside those times needs prompt medical help (1.8.4). The Australasian Menopause Society says slight bleeding or spotting is common when tibolone is started and tends to settle within a few months. More on that in bleeding after menopause.

Medicines get shared in families with the best intentions. A sister's tablets, a mother's leftover strip. Tibolone is a hormone, and the NHS website says it is usually only recommended from 12 months after your last period and is not suitable for everyone, which is why a prescription in your own name, after a doctor has asked about your history, matters more here than with most things in the medicine cabinet.