British Medical Journal (The BMJ)Oral Contraceptives with Progestogens Desogestrel or Levonorgestrel and Risk of Intracranial Meningioma

This French national case-control study examined 92,301 women to assess meningioma risk with oral contraceptives containing desogestrel or levonorgestrel. The study provides robust evidence from comprehensive health data spanning 2020-2023, representing the largest analysis of progestogen-only contraceptives and intracranial meningioma risk to date.

⚕️ Key Clinical Considerations ⚕️

• Dose-duration relationship: Desogestrel 75μg shows increased meningioma risk only after >5 continuous years (OR 1.70), with highest risk after ≥7 years (OR 2.09).
• Low absolute risk: Number needed to harm is 67,300 women using desogestrel versus 518 for high-dose cyproterone acetate, indicating minimal population-level impact.
• Age-specific patterns: Risk predominantly affects women ≥45 years, with similar relative risk but lower absolute risk in younger users due to baseline meningioma incidence.
• Levonorgestrel safety profile: No increased meningioma risk observed with levonorgestrel alone or combined with estrogen, regardless of duration or age group.
• Reversible risk factor: Meningioma risk returns to baseline within one year of desogestrel discontinuation, supporting hormonal causation mechanism.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Counsel patients that desogestrel carries minimal meningioma risk, emphasizing the 67,300 number needed to harm and comparing favorable risk profile to cardiovascular risks of combined oral contraceptives in appropriate candidates.
• Practice Integration: Implement duration-based monitoring for desogestrel users, particularly those approaching 5+ years of continuous use, while maintaining contraceptive efficacy and avoiding unnecessary treatment discontinuation in younger women.
• Risk Management: Consider alternative contraceptive methods for women >45 years initiating progestogen-only contraception, and evaluate individual risk-benefit ratios for long-term users with previous high-risk progestogen exposure.
• Action Items: Establish protocols for meningioma screening in symptomatic long-term desogestrel users, ensure documentation of contraceptive duration in medical records, and coordinate with neurology when meningiomas are detected in progestogen users.

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