Factors such as older age, female sex, and direct exposure to 3 high-dose progestogens (chlormadinone, cyproterone, and nomegestrol acetate) are currently understood to increase the threat of meningioma.But there are many other progestogens for which the danger of meningioma associated with their usage has not been estimated individually.Study MethodologyTo address this knowledge space, researchers set out to assess the real-life danger of intracranial meningioma needing surgical treatment in females associated with the use of a number of progestogens with various paths of administration.They used information from the French national health information system (SNDS) for 18,061 females (average age 58) who went through intracranial meningioma surgery from 2009-18. Extended use of medroxyprogesterone acetate injection was associated with a 5.6-fold increased danger, and prolonged use of promegestone was linked to a 2.7-fold increased risk.Observations and ConclusionsThere appeared to be no such risk for less than one year of usage of these progestogens.As expected, there was likewise an excess danger of meningioma for females exposed to chlormadinone acetate, nomegestrol acetate, and cyproterone acetate, all of which are known to increase the risk of meningioma.However, results revealed no excess risk of meningioma for progesterone, dydrogesterone, or the extensively used hormone intrauterine systems, regardless of the dosage of levonorgestrel they contained.No conclusions could be drawn about dienogest or hydroxyprogesterone as the number of exposed individuals was too small.This is an observational study so cant develop cause and result, and the authors acknowledge that the SNDS database lacked info on all the clinical details and medical signs for which progestogens are recommended. Nor were they able to account for hereditary predisposition and exposure to high-dose radiation.However, they say, provided that medroxyprogesterone acetate is approximated to be used for birth control by 74 million women worldwide, the number of attributable meningiomas may be potentially high.Further studies using other sources of information are urgently needed to get a much better understanding of this threat, they conclude.Reference: “Use of progestogens and the danger of intracranial meningioma: nationwide case-control study” by Noémie Roland, Anke Neumann, Léa Hoisnard, Lise Duranteau, Sébastien Froelich, Mahmoud Zureik and Alain Weill, 27 March 2024, BMJ.DOI: 10.1136/ bmj-2023-078078.
