Recent research has shed light on a worrying link between long-term use of certain progestin-based hormonal medications, commonly used for contraception and the treatment of gynecological conditions such as endometriosis, and a increased risk of developing meningiomas.
These tumors, which are generally benign and form in the membranes surrounding the brain, occur more frequently in women who have used these medications for more than a year. Progestins, synthetic forms of the natural hormone progesterone, are an integral part of various treatments, including hormonal contraceptives, therapies for conditions such as polycystic ovary syndrome, and hormone replacement therapies during menopause.
Although some high-dose progestogens were previously known to increase the risk of meningioma, a new study by the National Agency for the Safety of Medicines and Health Products in France and published in the BMJ has expanded this concern to include eight most commonly prescribed forms of progestogens.
The study leveraged data from the French national health system and focused on 18,061 women, with an average age of 58 years, who underwent surgical removal of intracranial meningiomas between 2009 and 2018. By comparing these patients with healthy controls, the researchers identified a significant association between long-term use of three specific progestins and an increased need for surgical intervention due to meningiomas, the British medical journal the 27th of March.
In particular, two oral medications, medrogestone and promegestone, along with the contraceptive injection medroxyprogesterone acetate (marketed as Depo-Provera), were linked to markedly increased risks of developing these tumors.
Although most meningiomas grow slowly and are noncancerous, their location and size may require surgical removal due to pressure on the brain, posing risks to nearby brain structures. The observational nature of the study means that it cannot conclusively prove causality between hormone use and tumor development, and no increased risk was associated with several other progestogens, including progesterone and dydrogesterone, or with hormonal systems. widely used intrauterine devices.
In response to these findings, Pfizer, the manufacturer of Depo-Provera, has recognized the potential risk associated with long-term use of progestins. The company is working with regulatory agencies to update product labels and patient information to reflect this concern.
The study authors have called for more research into the safety of these hormones, especially injectable medroxyprogesterone acetate, given their global reach. Given that 74 million women worldwide use this contraceptive method, the potential number of meningiomas related to its use could be significant.
Despite these findings, experts such as Prof. Paul Pharoah, an oncological epidemiologist with extensive experience in hormone-related cancers, urge women not to abandon their contraceptive methods without consulting their healthcare providers.
It highlights that it is commonly used birth control pills and hormone replacement therapies in the UK do not carry an increased risk of meningiomas. Furthermore, the absolute risk of developing such a tumor remains extremely low, suggesting that the benefits of using long-acting contraceptives like Depo-Provera could outweigh the risks for many women.