Tibolone

Who tibolone is for

Tibolone suits a woman who is a year or more past her last period and still flushing through the day or waking drenched at night. It is a synthetic steroid that eases hot flushes, night sweats and broken sleep, and it slows the bone loss behind fractures. A second use is bone protection for women at high risk of fracture who cannot take the usual bone medicines. The tibolone sold here is Tibofem 2.5mg tablets, in packs of 28, 42, 84 and 168.

How tibolone works

The body breaks tibolone down into three active substances. Two of them behave like oestrogen, which is what calms flushes and slows bone loss; the third behaves like a progestogen and has some androgen (male-hormone-like) activity. That mix is why tibolone is called tissue-selective — it acts one way in some parts of the body and another way elsewhere, rather than simply topping up oestrogen.

The first months on tibolone

Hot flushes do not switch off in a week. Most women notice them thinning out over several weeks, and the effect on bone is measured in months and years rather than days. There is no break between packs: one 2.5mg tablet goes down every day, and a fixed hour (breakfast, or brushing your teeth at night) makes that easier to keep up.

Spotting in the first three months is common and usually fades. Bleeding that starts later on, or keeps going, is different and should be checked, because tibolone slightly raises the chance of cancer of the womb lining. A forgotten tablet can be taken the same day; if the next one is close, skip the missed one. Tibolone is not a contraceptive.

Side effects worth knowing

Common effects include pain low in the abdomen, vaginal discharge, tender breasts, vaginal bleeding or spotting, weight gain and extra hair growth. Rarely, tibolone can cause a blood clot in a leg or lung, a stroke — risk climbs with age — or cancer of the womb lining or breast. A swollen, painful leg, sudden breathlessness or chest pain can be a clot and needs urgent attention.

When tibolone is not the right choice

It is not used by women who have had breast cancer or another oestrogen-dependent tumour, unexplained vaginal bleeding, a previous blood clot, stroke, heart attack or angina, or active liver disease. Some medicines change how tibolone behaves: it can strengthen the blood-thinning effect of warfarin, and epilepsy medicines such as carbamazepine and phenytoin, the antibiotic rifampicin and St John's wort make it break down faster and work less well.