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Suggest Treatment For Withdrawal Symptoms Of Livial

Posted on Thu, 9 Jun 2016

Question: Hi Doctor,
My wife ( age -42 yrs) had total hysterectomy on Dec-2013 . She was then 39+. Doctor advised 'Livial 2.5 mg' after the surgery. Presently she has omitted the drug but she is experiencing too much hot occasionally and also sometimes flushing. Is it right to stop the drug now ? She also had lapcoli on Aug-2013. Since then she is having bowel clearance problem

Answered by Dr. Deepti Verma (1 hour later)

Brief Answer:
Can continue with the drug

Detailed Answer:
Hi dear,
I have gone through your question and understand your concerns.
Since livial is an hormone replacement therapy, stopping it will lead to symptoms like hot flushes and feeling excessive heat.
If she is having severe discomfort, then she should continue with the drugs.
Hope you found the answer helpful.
Regards
Dr Deepti Verma
OBGYN

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepti Verma (12 hours later)

Is there any adverse effect on body of Livial for continued use ? Some sources say that prolonged use may cause cancer

Answered by Dr. Deepti Verma (3 hours later)

Brief Answer:
Estrogen and progesterone

Detailed Answer:
Hi dear, prolonged use of tibolone may cause uterine cancer.
So, one can switch over to hormonal replacement therapy therapy containing estrogen and progesterone hormone.
Regards
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepti Verma (18 hours later)

Dear Doctor,

I have already mentioned that my wife had total hysterectomy in Dec-2013. Then how the chance of uterine cancer will arise.
Also to let you know she has already taken Livial 2.5 for more than 2 years ( started in Jan-2014). What are the other side effects of Livial for taking 2 years or more ? We are really concerned.
Also kindly let us know if wife has to switch to estrogen and progesterone hormone therapy then what is the medicine and dose. How long should she continue that and is there any side effect of estrogen and progesterone therapy ?

Answered by Dr. Deepti Verma (17 hours later)

Brief Answer:
Detailed answer below

Detailed Answer:
Hi dear,
There are no chances of uterine cancer if the hysterectomy is done.
Livial causes decreased bone density, leading to bone pain. She should take calcium and vitamin D3 for that.
The medicine given in HRT are estradiol valerate and medroxyprogesterone acetate.
The dose needs to be decided after properly examining the patient. The duration of HRT depends upon the cure of symptoms.
Long term use of HRT can lead to increased chances of hypertension, thrombosis, diabetes and chances of stroke.
Hope you found the answer helpful.
Regards
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Deepti Verma (8 hours later)

Dear Doctor,

After reading your detail information, we have seen that both in Livial and Estrogen Progesterone HRT, there are multiple harmful side effects.
My wife wants to know if she can tolerate flushing and hot feeling etc, can she go without any drug ? She has already taken Livial 2.5 for 2 years and now 42 yrs. Is there any other problem ( apart from flushing, hot feeling sometimes) if she discontinues the drug and does not go for any HRT in future ?

Answered by Dr. Deepti Verma (8 hours later)

Brief Answer:
Absolutely no problem

Detailed Answer:
Hi dear, there is absolutely no problem if she do not wants to take HRT and can tolerate hot flushes.
However, she should take calcium and vitamin D supplements as bone strength decreases after hysterectomy.
Hope you found the answer helpful.
Regards
Dr Deepti Verma

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Above answer was peer-reviewed by : Dr. Deepak