British Medical Journal (The BMJ)Use of Progestogens and the Risk of Intracranial Meningioma: National Case-control Study

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This large-scale French case-control study evaluated the association between various progestogens and risk of intracranial meningioma requiring surgery. The research provides new evidence about commonly prescribed progestogens, including those used for contraception, and builds on previous knowledge about high-dose progestogens known to increase meningioma risk.

Study Design:

• National case-control study using French National Health Data System
• 18,061 women who underwent meningioma surgery (2009-2018)
• Matched with 90,305 controls for age and residence
• Mean age: 57.6 years
• Analyzed multiple progestogens including oral, injectable, and intrauterine formulations

Key Findings:

• Increased meningioma risk with prolonged use (≥1 year) of:
  • Medrogestone (OR 3.49, 95% CI 2.38-5.10)
  • Injectable medroxyprogesterone acetate (OR 5.55, 95% CI 2.27-13.56)
  • Promegestone (OR 2.39, 95% CI 1.85-3.09)
• No increased risk associated with:
  • Oral/intravaginal progesterone
  • Dydrogesterone
  • Levonorgestrel IUDs (13.5mg or 52mg)
  • Spironolactone
• Insufficient data to assess:
  • Dienogest
  • Hydroxyprogesterone

HCN Medical Memo
Physicians should consider meningioma risk when prescribing long-term progestogen therapy, particularly with medrogestone, injectable medroxyprogesterone acetate, or promegestone. For patients requiring long-term progestogen treatment, progesterone or levonorgestrel IUD appear to have more favorable safety profiles regarding meningioma risk. Regular monitoring may be warranted for patients on higher-risk progestogens.

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