Tibolone is an estrogen-like compound used for the treatment of the symptoms associated with menopausal transition (i.e., climacteric symptoms) and also for the treatment of osteoporosis. Three major metabolites of tibolone are responsible for its tissue selective mechanism of action. Conversion into 3α- and 3β-hydroxy-tibolone results in estrogenic effects in brain, vagina, and bone. The δ4 isomer has progestrogenic and androgenic effects and does not cause estrogenic stimulation in the endometrium. A two-year longitudinal study indicates that low doses (1.25-2.5 mg) of tibolone effectively relieve climacteric symptoms and prevent loss of bone mass in early postmenopausal women.