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[Aaby]

Hi I'm 66 years old and have recently been prescribed Tibolone for amongst other things prevention of osteoporosis. The patient information leaflet says that if Tibolone is prescribed for over 65s can cause dementia.I asked my GP about this and she said that it was rubbish! Does anyone know anything about this or has anyone been prescribed Tibolone age 66 for the first time? Thanks

[CLKD]

Hi!  If it mentions dementia in the leaflet, it may be worth your GP contacting a dedicated menopause clinic or referring you directly.  There are waiting lists for both NSH and Private clinics.  Or you could look at the Treatments box at the top of the Forum - white lettering on deep pink - to see if there's any info there.

I wonder what the difference might be between 64 and 65 

[Taz2]

Hi Aaby. I think I would be more worried about the risk of stroke. I don't think Tibolone is recommended over the age of 60 due to stroke risk. Is there any reason why you can't have a patch or gel HRT which doesn't carry a stroke risk.

As for the dementia warning this is standard for all HRT products (apart from topical ones such a vagifem) that are taken for the first time when over the age of 65. Usually this is because not enough clinical trials have been undertaken in older women.

Taz x

[Aaby]

Thanks It's all very confusing with different opinions between Doc and online information! I'm not sure if it's worth any risks  I'm a young 66 so would like to make good decisions going forward. Apologies for posting in wrong place I'm new to this site and I'm finding navigating it tricky atm!

[Taz2]

No need to apologise as it can take quite a while to get used to where everything is. 

Do you have other menopause symptoms or is it "just" the osteoporosis? I ask because HRT is not actually licensed purely for the reduction of osteoporosis risk and there are other medications which will help with strengthening the bones. You might have tried these of course and not got on with them hence the GP offering Tibolone. If you are having troublesome meno symptoms then this may be why the GP has decided to prescribe this medication and might have missed the fact that prescribing when the patient is over 60 can cause higher risk. Maybe you could tell us a bit more about yourself and your meno journey so far so we can help a bit more.

This link may be useful https://theros.org.uk/information-and-support/osteoporosis/treatment/hormone-replacement-therapy/

Taz x

[Aaby]

Thanks 👍 symptoms mainly joint pain, sleeping problems brain fog and anxiety. Was told during menopause hurt not safe so not an option! Think Tibolone not the answer for me?

[Taz2]

If the Tibolone was prescribed to prevent osteoporosis have you had Dexa scans which have shown you are at risk? If so then as you will see from the link I posted HRT will help with this and a patch or gel HRT would be more suitable for your age. I'm not sure on your overall health of course which can have a bearing on prescribing HRT for the first time when over 60. Do you know why you were told HRT wasn't safe? Advice has changed over the past few years thankfully.

Taz x

[Aaby]

Doctors opinion at the time on menopause unfortunately! I fell recently and # a vertebrae and also I mentioned to the doctor that my mother had suffered osteoporosis. I had a dexa scan years ago probably during menopause which showed osteopenia but was not offered any treatment at that time just told to exercise which I have always done
However I am concerned re Tibolone and stroke/dementia risks. I have been told by doctor that I can have a Dexa scan in the next few months. Thanks for your help

[Furyan]

As I understand it, the risk isn't immediate, it slowly increases, so you could try the tibolone and see if it suits you. I have been reading about tibolone for days and I hadn't come across anything connecting it to dementia, that'll be in the next batch of papers I expect.

I'm 53 and have been taking tibolone 2.5mg for seven months. I'd be happy to stay on it until I'm 90 if they'll let me. I wasn't sure at first because it's so mild feeling, you don't feel like you are taking hormones, so I wondered could it do any good?

I think it is, it gives me strength and energy so all the other niggles become easier to cope with. It seems to outperform HRT on bone density, my family have osteoporosis too and I have extra risk factors of my own on top, so it's a concern, tibolone sounds good.

Hi Poppytoast - how is the tibolone going for you in terms of symptom control? Interested because this might be a last resort for me if another option doesn’t work out…🤔

[sheila99]

You may be interested in this https://www.sciencedirect.com/science/article/abs/pii/S1471769702000175
Which found a positive effect on bone density.
Taz2-I haven't found anything to indicate it carries more risk than any other hrt. Do you have a link? Seems a bit daft to create something for post meno women that you can't use after 60.

[Taz2]

Hi sheila. I've been having a good look around the various articles on this and it seems that there are no recent trials. I have found this https://www.gov.uk/drug-safety-update/tibolone-benefit-risk-balance#:~:text=For%20women%20older%20than%20about,for%20women%20with%20a%20uterus.  but also found another article that seems to show the risk of stroke is higher but this is then shown in a BMS article to be due to flawed interpretation of results. This is an extract "The increased risk of stroke with tibolone has also been reported with estrogen therapy,20,39 but the biologic mechanism is not certain. A randomized, placebo-controlled trial showed that 2.5 mg of tibolone and conjugated equine estrogen plus medroxyprogesterone slightly increased the intima–media thickness by 0.004 mm per year.40 Tibolone increases levels of C-reactive protein, a risk factor for stroke, to a degree similar to that of conjugated equine estrogen.41 In randomized trials, tibolone decreased HDL cholesterol levels but improved lipoprotein(a) levels, did not significantly change homocysteine levels, and increased plasminogen levels.41,42 Treatment with tibolone had no effect on blood pressure or fasting blood glucose levels.40

Since the risk of stroke rises exponentially with age, tibolone should generally not be used in elderly women. Tibolone has been used by women between the ages of 50 and 60 years for menopausal symptoms and the prevention of osteoporosis when the risk of stroke was low, but it should be avoided in women who have strong risk factors for stroke, such as hypertension, smoking, diabetes, and atrial fibrillation.43 Although the overall number of adverse events was small, there was no increased risk of venous thromboembolism, as has been seen with hormone therapy and SERMs, or an increased risk of coronary events, as has been seen with conjugated estrogen combined with medroxyprogestrone"

Whole article here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684062/  The BMS article https://thebms.org.uk/2008/08/tibolone-risks-and-benefits-in-older-women/

As you say it is odd that its for post menopausal women yet could seem to be risky in over 60s. Most of the trials seem to stop at age 59. It is obviously good for bone strength and reducing the risk of fractures. Seemingly reducing the risk of breast cancer and other cancers too. The latest PIL doesn't really contraindicate use in over 60's so maybe the advice has been updated?

Taz x