Depo-provera named as the latest culprit.
French researchers have identified three new progestogens as increasing the risk of intracranial meningioma, according to their study published in the BMJ.
The retrospective, case-controlled study of almost 100,000 women, 18,000 of whom had had surgery for meningioma, found that with prolonged use, three types of progestogen increased the risk of these usually benign, slow-growing tumours.
These were medroxyprogesterone acetate (available in Australia as Depo-Provera), as well as medrogestone and promegestone, neither of which is available in Australia.
Medroxyprogesterone acetate was associated with a 5.6-fold increased risk of meningioma after more than a year of use. But the absolute risk was low, at 0.01% in the control group compared with 0.05% in the women taking medroxyprogesterone.
No excess risk was found to be associated with progesterone, dydrogesterone or levonorgestrel intrauterine systems (Mirena) – the other progestogens in the study that are used by Australian women.
Previous research showed exposure to the progestogens nomegestrol, chlormadinone, and cyproterone acetate increased the risk of meningioma, but the study authors said this study looked at whether other widely used progestogens were also a risk.
Gino Pecoraro OAM, Brisbane obstetrician and gynaecologist and associate professor of obstetrics and gynaecology at the University of Queensland, said the study finding that the intrauterine levonorgestrel system, along with most other progestogens used in Australia, did not increase the risk of meningioma was welcome news.
“This should be reassuring to Australian women that the vast majority of contraceptives available and used in this country are not associated with an increased risk of developing meningioma,” he told media.
“The release of these findings should also be a timely reminder to women to review their contraceptive needs periodically to make sure they are still using the best product available for them.”
Professor Pecoraro said more than half of meningiomas have progesterone receptors, and previous studies have shown that at least three known progestogens have been associated with an increased risk of developing the tumours.
Gynaecologist and pelvic pain expert Dr Susan Evans said different progestogen medications react differently at multiple hormonal receptors in the body.
“Some progestogens, including medroxyprogesterone acetate and cyproterone acetate disrupt the androgen receptor,” said the associate professor at the University of Adelaide.
“This study should be a prompt for research considering different progestogens and their interaction with a full range of hormonal and endocrine receptors, including androgen receptors.”
