Long-term use of certain contraceptives containing progestogens may be associated with an increased risk of developing meningioma, a type of brain tumor, according to a large-scale study. The research, published in JAMA Network Open and analyzing the health records of three million women aged 15 to 59 over 25 years, found a link between progestogen-based contraceptives and meningioma cases. Meningiomas are the most common type of brain tumor in Britain, accounting for over a quarter of diagnoses and around 3,000 cases annually. While typically benign, these tumors can grow and cause symptoms such as headaches, seizures, and vision problems, potentially requiring surgery or radiotherapy.
Contraceptive Types and Associated Risks
The study identified specific contraceptives with a stronger association to meningioma. The contraceptive injection medroxyprogesterone, commonly prescribed under brand names like Depo-Provera, was linked to a 355% higher risk of developing the tumor compared to non-users. This effect was more pronounced in older women; for instance, women aged 55 to 59 using the injection for one year had one extra case of meningioma for every 5,372 users, versus one extra case for nearly 449,000 users aged 15 to 19. Combined contraceptive pills, containing both estrogen and a progestogen, were associated with up to a 66% increased risk. Specific progestogens in these pills and their associated increased odds of meningioma included cyproterone (61%), desogestrel (66%), drospirenone (58%), gestodene (44%), levonorgestrel (40%), norethisterone (38%), and norgestimate (4%). Progestogen-only pills, or mini pills, showed a 73% increase in meningioma odds for those using desogestrel, which is sold under brands like Cerazette and Cerelle. Norethisterone in progestogen-only pills did not show a clear risk increase. Women using intrauterine devices (coils) with high-dose levonorgestrel experienced a 58% increase in meningioma odds, while low-dose levonorgestrel coils showed no clear risk increase.
Findings and Expert Commentary
Researchers noted that the heightened risk generally subsided within five years of discontinuing the contraceptive. They also stated that the risk might extend to certain progestogen-containing contraceptives and high-dose intrauterine devices with levonorgestrel. Experts not involved in the study acknowledged its findings but emphasized that the overall risk to women remains small. They highlighted that the observed association is likely causal, but as an observational study, it is difficult to exclude all confounding factors. The risk was found to persist only during contraceptive use and decline afterward. Health professionals suggest these findings should facilitate informed discussions between doctors and patients regarding the risks and benefits of various contraceptive options. Non-progestogen alternatives, such as barrier methods and copper-containing IUDs, could be considered for women concerned about this association.