Tibolone, a synthetic steroid whose metabolites have estrogenic, progestogenic and androgenic properties, is an alternative to conventional HRT. It is available as an oral daily dose tablet. Tibolone has positive effects on vasomotor and urogenital symptoms, sexual function, bone density and fracture risk. Tibolone use is associated with less mastalgia and abnormal uterine bleeding compared with conventional HRT.

There may be less oestrogenic effect on mammographic density, venous thromboembolism and lipid metabolism but further clarification is required. No increased risk of breast cancer or endometrial hyperplasia/ carcinoma was observed in RCTs of up to 4 years duration; however, data regarding the long term safety of tibolone is limited. An increased risk of stroke similar to HRT was reported in a fracture prevention RCT of elderly women treated with tibolone.

Tibolone therapy in women with previous breast cancer is associated with an increase in recurrence compared with placebo particularly in women treated with aromatase inhibitors; tibolone is therefore not recommended for women with breast cancer.

10.4 Non-oestrogenic therapy

Content updated December 2010