Objective: To study whether tibolone affects lipid profile and diffused intima media thickness (IMT) of the common carotid arteries (CCA) in postmenopausal women (PMW). Methods: Twenty-two PMW and 20 premenopausal women participated in the study. The PMW were randomly divided into 11 women who did not receive any treatment and 11 women who received tibolone (2.5 mg once a day). Results: After 6 months the treated women had lipoprotein(a) (Lpa), total-cholesterol (total-C), and LDL-cholesterol (LDL-C) levels lower than before, while in the non-treated women Lpa was increased. The IMT of CCA was unmodified in the treated women, whereas it increased in non-treated women. Conclusions: This preliminary study suggests that a 6-month tibolone treatment could counteract the increase of the IMT of CCA observed in untreated PMW.