Contraceptive Injections Linked to Higher Brain Tumor Risk in Women
Study finds small but significant meningioma risk with Depo-Provera use
A large U.S. study has found that women using the contraceptive depot medroxyprogesterone acetate (dMPA), commonly known as Depo-Provera, face more than double the risk of developing meningioma, a common brain tumor. While the overall risk remains low, the findings highlight the importance of awareness and individualized counseling for women considering or currently using this form of birth control.
Study Details
The study, published in JAMA Neurology, analyzed data from over 10 million U.S. women using the TriNetX national health database. Researchers reviewed contraceptive histories, comparing women who used dMPA with those who used other methods or none. Previous studies in France suggested a strong association between dMPA and meningioma, and this new U.S.-based study confirms that risk in a much larger population.
Methodology
Population: 10,425,438 women (mean age 33 years).
Groups: dMPA users, oral medroxyprogesterone acetate users, users of other contraceptives, and controls.
Controls: 8.1 million women who did not use any of the evaluated contraceptives.
Adjustments: Propensity score matching controlled for race, age, BMI, and neurofibromatosis.
Outcome Measure: Meningioma diagnosis using ICD-10 codes.
Key Findings
Women using depot medroxyprogesterone acetate (dMPA) injections were found to have a 2.43-fold higher risk of developing meningioma compared with women who did not use this contraceptive, with the risk being most pronounced in those who began using it after age 31 or continued for four years or more.
Researchers estimated that 59% of meningioma cases in dMPA users could be attributed to the drug, although the overall number needed to harm was 1,152, indicating a relatively low absolute risk.
Oral medroxyprogesterone acetate was linked to only a modest increase in risk (1.18-fold), while other contraceptives such as IUDs, combined oral pills, and implants showed no significant association. These findings suggest that both prolonged exposure and older age amplify the risk, though the general clinical risk remains low.
Implications for Practice
For most women, the overall risk of brain tumor from dMPA remains low. However, clinicians are encouraged to:
Review patient history, especially those with prior brain radiation, breast cancer, or neurofibromatosis, where risk may be higher.
Consider discussing alternative contraceptive options with women over 30 or those requiring long-term use.
Counsel patients that while risk exists, it does not warrant an immediate halt in prescribing dMPA for appropriate candidates.
As editorialists noted, the study has “low overall clinical significance” but provides critical evidence for shared decision-making in contraceptive counseling.