Livial

Livial contains tibolone, a synthetic steroid with estrogenic, progestogenic, and androgenic activity. It is an alternative to conventional HRT and is given as a single substance without an additional progestogen – even in women with a uterus.

Livial has a favorable effect on mood and libido due to its androgenic component.

In the body, tibolone is converted into metabolites that:

• activate estrogen receptors (against hot flashes)
• activate progesterone receptors (protection of the uterus)
• activate androgen receptors (positive effect on libido)

Women at least 1 year after their last period with:

• Menopausal symptoms

2.5 mg tibolone daily.

One tablet daily, without a break.

Livial must not be taken in case of:

• Pregnancy and breastfeeding
• Current or previous breast cancer or suspected breast cancer
• Current estrogen-dependent malignant tumor or suspicion of one (especially cancer of the uterine lining)
• Undiagnosed bleeding in the genital area
• Untreated thickening of the uterine lining (endometrial hyperplasia)
• Previous or current venous thromboembolism (especially deep vein thrombosis, pulmonary embolism)
• Known tendency to thrombosis (thrombophilic disorder, e.g. protein C, protein S or antithrombin deficiency)
• Current or previous arterial thromboembolic disease (especially angina pectoris, heart attack, stroke, transient ischemic attack)
• Acute liver disease, or previous liver disease as long as the liver enzyme values have not returned to normal
• Porphyria
• Hypersensitivity to tibolone or any of the other ingredients

Spotting (initially), breast tenderness, weight gain, acne.

• Livial can increase the effect of blood-thinning medicines (anticoagulants, e.g. warfarin). Caution is needed when they are used at the same time, especially when treatment with Livial is started or stopped. The warfarin dose should be adjusted if necessary.
• Tibolone can have a moderate effect on how midazolam is processed in the body. Interactions with other medicines that are broken down by the enzyme CYP3A4 are therefore possible.
• Barbiturates, carbamazepine, hydantoin derivatives and rifampicin can speed up the breakdown of tibolone and thereby affect how Livial works.
• Preparations containing St John's wort can speed up the breakdown of hormones. This can weaken the effect and change the bleeding pattern.