VOLUME 3 - NUMBER 2 - 2021

Long-term menopausal treatment using an ultra-high dosage of tibolone in an elderly Chinese patient – Case report

  • Lingyan Zhang, Xiangyan Ruan, Muqing Gu, Alfred O. Mueck
  • Case reports, 82-85
  • Full text PDF
  • This report describes the special case of a Chinese woman with severe vasomotor symptoms (VSMs), depressed mood, low energy and genitourinary syndrome of menopause, including problems of sexual dysfunction, who was treated with tibolone. The aim of the report is to highlight the value of individualizing menopausal hormone therapy (MHT) type and dosage. Since 16 years of previous treatment with various other forms of MHT had not provided satisfactory efficacy in this patient, at the age of 71 years she was prescribed tibolone, starting at the usual lowest dosage of 1.25 mg/day. We gradually had to increase the dosage of tibolone up to 7.5 mg/day, which is three-fold the recommended maximum dosage. We added three-monthly sequential dydrogesterone to reduce the risk of breakthrough bleeding and the risk of endometrial cancer. To date, we have observed no side effects and no remarkable abnormal laboratory assessments, with the exception of increased thyroid-stimulating hormone, which we monitor six-monthly. Even though the patient has been informed about potential risks, such as increased risks of stroke, breast cancer and endometrial cancer, as described in the discussion, she has now been willing to accept this ultra-high dosage for seven years, and wishes to continue with this treatment.

  • KEY WORDS: MHT, ultra-high dosage tibolone, elderly women.