Injectable contraceptive meningioma risk

3 minute read


Experts urge patient-centred contraceptive counselling as evidence grows and lawsuits mount in the US.


In one of the largest studies to date, the injectable contraceptive depot medroxyprogesterone acetate (DMPA) has been associated with a more than twofold increase in meningioma risk.

More than 10 million US patients between 2004-2024 were included in the analysis, which compared women who had used a single progestin or contraceptive treatment with a control group who had not been exposed to any.

In matched analyses, the incidence of meningioma was around 7 per 100,000 patient-years in the DMPA group, compared with 3 per 100,000 in the control group.

The increased risk was mainly observed in long term use of DMPA or treatment initiation after the age of 31. Use for between four and six years was associated with around a threefold increase in risk, but women who used it for longer than six years were nearly four times more likely to develop meningioma than controls.

Women who started using DMPA between 31 and 40 years of age had almost a fourfold higher risk of meningioma than controls. Those starting from the age of 41 had around a threefold increase in risk.

“It is important for doctors to consider this information in the context of individual patient risk and contraceptive needs and preferences, to support patient-centred and informed contraceptive choice,” medical director of Family Planning Australia, Dr Clare Boerma, told Oncology Republic.

“Given this evidence, it would be reasonable to avoid use of DMPA in people with a history or diagnosis of meningioma, and to tell patients about the small absolute risk of meningioma associated with use, particularly for longer durations and in those aged over 31,” she said.

The finding that women who used the contraceptive injection were 2.43 times more likely to be diagnosed with meningioma was consistent with previously published research of a positive dose-dependent association, Dr Boerma explained.

“While this relative risk may sound alarming, we need to consider that meningioma is relatively rare, and so the absolute risk is more important in determining clinical relevance for your patients,” she said.

“The difference in risk between the incidence of meningioma in the DMPA group vs the control group was found to be 0.00087, with a number needed to harm from using DMPA of 1152.”

“This means that 1152 people would need to use DMPA to cause one extra diagnosis of meningioma. Out of those who do develop meningioma, this study suggests that 59% would be attributable to the DMPA use.”

As far as continuing to prescribe DMPA, she explained that it remains an important contraceptive choice for some, such as for avoiding medication interactions or for those requiring a discrete method of contraception.

“If a patient is concerned about their risk of meningioma, it may be appropriate to explore other contraceptive options,” she said.

Oral medroxyprogesterone acetate (OMPA) showed a statistically significant increase in risk as well, with a relative risk 1.2 times higher than controls.

No other contraceptives showed an increased meningioma risk.

Overall mean age was 33 years at inclusion, and 26 years for the depot medroxyprogesterone acetate group.

No participants had a history of meningioma, and the included treatments were DMPA, OMPA, combined oral contraceptives, IUDs (copper, 52 mg levonorgestrel and low dose levonorgestrel), progestin only pills or subdermal implants.

Dr Boerma could not comment on the class action lawsuits underway in the US against Pfizer.

As of October 2 this year, more than 1200 lawsuits have been filed in the federal multidistrict litigation system by individuals alleging they developed meningiomas after using DMPA.

JAMA Neurology, 2 September 2025

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