The National Health Service (NHS) has issued a caution for individuals considering the use of a widely prescribed medication, advising that certain groups should consult their general practitioner prior to starting the treatment. This medication, available only through prescription, is not universally appropriate.

Tibolone, a form of hormone replacement therapy, is commonly used to alleviate the symptoms of menopause and to aid in the prevention of osteoporosis. It is regularly prescribed to assist women navigating the challenges of menopause. Nevertheless, health authorities have identified 12 specific groups that should exercise caution when considering tibolone.

According to an article by Yorkshire Live, individuals who fall into these categories are strongly urged to seek medical advice before commencing tibolone treatment.

1. Have ever had an allergic reaction to tibolone or any other medicine
2. Have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
3. Have a type of cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you’re having tests for this
4. Have any unexplained vaginal bleeding
5. Have too much thickening of the womb lining (endometrial hyperplasia) that is not being treated
6. Have ever had a blood clot in a vein (thrombosis), such as in your legs (deep vein thrombosis) or your lungs (pulmonary embolism)
7. Have a condition that affects how your blood clots, such as protein C, protein S, or antithrombin deficiency
8. Have or recently had a condition caused by blood clots in the arteries, such as a heart attack, stroke or angina
9. Have ever had liver disease and your liver function tests are not back to normal
10. Have a rare inherited condition called porphyria
11. Have a rare inherited problem of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
12. Are pregnant or breastfeeding

The NHS clarifies, “Tibolone functions by restoring hormone levels and can also be prescribed to prevent bone thinning post-menopause, known as osteoporosis.” They further explain, “Tibolone operates similarly to combined hormone replacement therapy (HRT) which includes oestrogen and progestogen. However, some studies indicate it might not elevate oestrogen levels as effectively as traditional combined HRT.”

Importantly, tibolone is intended for those who are post-menopausal, having experienced their last menstrual period over a year ago. However, exceptions are made for individuals who have undergone surgery to remove their ovaries or are using gonadorelin analogues, in which case tibolone can be started immediately.

“It’s only suitable if you had your last period more than a year ago (post-menopause). However, if you’ve had surgery to remove your ovaries or you’re taking gonadorelin analogues you can start taking it straight away.”

Meanwhile, people taking certain medicines including warfarin, phenytoin, carbamazepine and rifampicin should also seek medical advice before using tibolone. Herbal remedies are also included in the list.

The NHS continues: “It’s not possible to say that other herbal remedies and supplements are safe to take with tibolone. They are not tested in the same way as pharmacy or prescription medicines. They’re generally not tested for the effect they can have on other medicines.

“All of these products might affect other medicines you’re taking, so it’s important to check with your doctor or pharmacist before starting to take them.”