Tibolone is a synthetic estrogen steroid hormone that acts as an agonist for multiple I-type steroid receptors and therefore has weak estrogen and progestogen activity as well as some androgenic properties. The parent compound is not active but is metabolized to the active form via tissue-specific metabolism of the sulfatase, which provides estrogenic action without the need for simultaneous use of progesterone. Tibolone also appears to have reduced estrogenic activity in breast tissue. Has been proven effective against menopausal symptoms and the prevention of postmenopausal osteoporosis; it is approved in several European countries, but not the United States. Tibolone can be 1.25 and 2.5 mg tablets for Livial. Side effects include vaginal bleeding, abdominal pain, weight gain, bloating, breast tenderness, genital itching and vaginitis.

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