Meningiomas account for 40% of primary tumors in the central nervous system. They are mostly slow-growing and histologically benign; however, as they can compress adjacent brain tissue, some patients may require surgical decompression.
Risk factors for meningiomas include older age, being female, and exposure to three high-dose progestogens: nomegestrol, chlormadinone, and cyproterone acetate. In the current study, researchers investigated whether the use of other progestogens is linked to a higher risk of intracranial meningioma requiring surgery.
To do so, they analyzed data from the French national health data system (SNDS) including 18, 061 women with an average age of 57 years old who had intracranial surgery for meningioma. Each case was matched with five controls.
Progestogens examined were progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and levonorgestrel intrauterine systems. Use of each was defined as at least one prescription in the year before hospital admission or within 3-5 years for levonorgestrel intrauterine systems.
Ultimately, the researchers found that prolonged use- defined as a year or more- of medrogestone, medroxyprogesterone acetate injection, and promegestone was linked to a 4.1, 5.6 and 2.7-fold increased risk of intracranial meningioma requiring surgery. No link was found however among women using these these progestogens for less than a year.
The researchers wrote that around 74 million women use medroxyprogesterone acetate for birth control globally, meaning that the number of attributable meningiomas may be potentially high. They noted that the drug is most widely used in Indonesia (13 million women), Ethiopia (4.6 million women), and South Africa (3.6 million women).
They further found no ‘excess risk’ of meningioma for progesterone, dydrogesterone or levonorgestrel intrauterine systems. They noted, however, that no conclusions could be made about dienogest and hydroxyprogesterone due to the small number of women using these drugs.
“The progestogens investigated in our study that did not result in an increase to risk of meningioma should be considered under the specific conditions of use in France. These results may not be generalised to the use of these progestogens for other indications, increased doses, or increased duration of use. Similarly, the use of one or more of these progestogens might increase the meningioma risk, when the patient had previously received another type of progestogen,” wrote the researchers in their paper.
Sources: Neuroscience News, the BMJ
