Long-term progesterone use increase intracranial meningioma risk in women: BMJ

A comprehensive national case-control study conducted in France revealed a significant link between the use of specific progestogen-based medications and a higher risk of developing intracranial meningioma. The key findings were published in the British Medical Journal.

This research utilized data from the French National Health Data System and scrutinized the health records of over 108,000 women by focusing on 18,061 cases who underwent brain surgery for meningioma from January 2009 to December 2018.

The study meticulously matched each patient case with five control subjects after adjusting for year of birth and area of residence to ensure the reliability of the findings. The outcome of this study evaluated the use of various progestogens that included progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest and levonorgestrel intrauterine systems by determining exposure based on at least one dispensation of the drug within the year preceding the index date.

In the users of medrogestone, medroxyprogesterone acetate (injectable) and promegestone the findings unveiled a marked increased risk of meningioma associated with prolonged use (≥one year) of these medications. Medrogestone users expressed a 3.49 times higher risk, while the injectable medroxyprogesterone acetate users showed a 5.55 times increased risk and the promegestone users had a 2.39 times increased risk of developing the brain tumor when compared to non-users.

Also, the study provided some potential outcomes for users of progesterone, dydrogesterone and levonorgestrel intrauterine systems that indicated no additional risk of meningioma associated with these specific progestogens. The results concerning dienogest and hydroxyprogesterone were inconclusive due to insufficient data.

As part of the study, certain medications were utilized as positive controls due to their known association with meningioma risk. Cyproterone acetate, nomegestrol acetate, and chlormadinone acetate were among these, with findings supporting the elevated risk previously identified, further validating the study's methodology and outcomes.

The revelations from this extensive research are particularly concerning given the widespread use of medroxyprogesterone acetate as a contraceptive method. The study calls for heightened awareness among healthcare providers and patients regarding the potential risks associated with prolonged use of certain progestogens. The findings of this study underline the importance of individual risk assessment in the prescription of progestogen-based medications which calls for a more careful approach in their use, especially in women at risk for intracranial meningiomas.

Reference:

Roland, N., Neumann, A., Hoisnard, L., Duranteau, L., Froelich, S., Zureik, M., & Weill, A. (2024). Use of progestogens and the risk of intracranial meningioma: national case-control study. In BMJ (p. e078078). BMJ. https://doi.org/10.1136/bmj-2023-078078