Livial (Tibolone) is a synthetic steroid, an alternative to the conventional hormone replacement therapy (HR), claimed to possess “tissue-specific” hormonal effects, which supposedly render this molecule less risky than estrogen-based therapies. Once in the stomach, it gets partially activated and then gets absorbed in the bloodstream, to ultimately reach target tissue organs where full activation of the compound takes place.
What makes tibolone unique is that it exerts different effects on different target tissues: in the brain, bones, and vagina, it acts like estrogen, thus reducing hot flashes, bone loss, and vaginal dryness. In the uterus, however, tibolone has a progesterone-like activity, hence protecting the inner lining of the uterus. Additionally, the active form of the drug has a weak testosterone activity which positively affects mood and sexual interest. In the breasts, tibolone seems to inhibit its own activation and the activation of estrogen, thereby preventing breast engorgement and tenderness.
Tibolone is recommended to alleviate post menopausal symptoms and/or in women after hysterectomy (surgical removal of the uterus). On the positive side, the drug reduces total cholesterol and harmful triglycerides and slightly lowers LDL (bad) cholesterol. But it also lowers HDL (good) cholesterol. This has been a source of suspicion and concern for a number of experts.
Possible side effects include vaginal spotting/bleeding upon initiation of treatment (uncommon), mild weight gain and fluid retention, and occasional mood disturbance. It was not found to be associated with increased risk of thrombosis (blood clotting), heart attacks, breast cancer, or uterine cancer,
But you do need to know that no large randomized clinical trials have been done on tibolone to comprehensively assess tibolone’s safety and. It’s also worth noting that the United Kingdom’s Million Women Study found an increased risk of breast cancer in users of all types of hormone-related therapies, including tibolone (The Lancet, Aug. 9, 2003).