Brain tumors and Progestogens

A recent study published in the British Medical Journal found that prolonged use of hormones used in some contraceptives may be associated to the increased risk intracranial meningioma. Meningiomas are tumors that grow from the membranes that surround the brain and the spinal cord. They are slow-growing and mostly benign, but it can cause symptoms requiring surgery. The median age of diagnosis of meningiomas is 65 years.

The authors of the paper conducted a national case-control study involving 108,366 women in France. The purpose of the study was to examine the risk for a common brain tumor with use of progestogens. Women who had intracranial surgery were include in the cases and matched with five controls by age.

The researchers found that the use for one year or more of 150 mg medroxyprogesterone acetate was associated with a 5.6-fold increased risk of intracranial meningioma requiring surgery. The use of cyproterone acetate, medrogestone, and promegestone was also associated with an excess risk of meningioma.

Medroxyprogesterone acetate known as Depo Provera, is used for contraception approximately by 74 million women worldwide. The authors of the study reported that 3 out of 9 meningiomas diagnosed in women who used medroxyprogesterone were younger than 45 and one was observed before the age of 35. The number of attributable meningiomas in young women who use Depro provera may potentially be high.

The researchers reported that “no excess risk of meningioma was associated with the use of progesterone, dydrogesterone, or spironolactone, or the hormonal intrauterine systems”.

“Further studies are also needed to assess the meningioma risk with the use of medroxyprogesterone acetate, which, in this study, was considered at a dose of 150 mg and corresponded to a second line injectable contraceptive that is rarely used in France. Studies from countries with a broader use of this product, which, furthermore, is often administered to vulnerable populations, are urgently needed to gain a better understanding of its dose-response association.”

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