Tibolone

How it works

After absorption it is metabolised to compounds with tissue-selective oestrogenic, progestogenic, and androgenic effects, relieving vasomotor symptoms while providing endometrial protection without separate progestogen.

Prescribing in practice

• Like other menopausal hormone therapies it increases the risk of venous thromboembolism, stroke, and certain hormone-sensitive cancers, and it should generally be started only after a woman has been postmenopausal for an adequate interval to limit bleeding.
• It is contraindicated in known, past, or suspected breast cancer and other oestrogen-dependent malignancies, and in undiagnosed vaginal bleeding.
• It is contraindicated in active or previous arterial thromboembolic disease and in active venous thromboembolism.

Monitoring

Undertake periodic review of treatment benefit versus risk, attend breast screening, and investigate any unexpected vaginal bleeding.

Counselling the patient

• Take the tablet once daily at about the same time each day.
• Report any unexpected vaginal bleeding, breast changes, or symptoms of clot such as leg swelling or breathlessness.
• Continue with routine breast and cervical screening.

Evidence & guidelines

Licensed as menopausal hormone therapy with cardiovascular and cancer risks characterised in randomised and observational studies and summarised by the MHRA.