Some Hormonal Contraceptives May Raise Meningioma Risk
A large Danish study found higher meningioma risk with several progestogen contraceptives, particularly injectable medroxyprogesterone, although the absolute risk remained low.
Several commonly used progestogen-based contraceptives were associated with a higher risk of meningioma, a usually benign brain tumor.
The strongest association was seen with injectable medroxyprogesterone. More modest increases were observed with several oral contraceptives and high-dose levonorgestrel IUDs.
Importantly, meningioma remains rare. For most contraceptives, the absolute increase in risk was small.
Study Details
Meningiomas are the most common primary brain tumors in adults and occur substantially more often in women. Most are noncancerous, but depending on their location and size, they can cause seizures, neurological symptoms, or require surgery.
Researchers have long suspected a hormonal connection because many meningiomas contain progesterone receptors, and high-dose progestogens have previously been linked to tumor development.
The new study, published in JAMA Network Open, investigated whether the association also extends to progestogens commonly used for contraception.
Methodology
Researchers used Danish national health registries covering approximately 3 million females aged 15 to 59 between 2000 and 2024.
They identified 1,473 women diagnosed with meningioma and compared each with 10 matched controls.
Researchers then examined prior use of individual hormonal contraceptives, including oral contraceptives, progestogen-only pills, injections, and hormonal IUDs.
The analysis also examined how recently contraception had been used and how long women had been exposed.
Key Findings
Injectable medroxyprogesterone had the strongest association, with about 4.6 times higher odds of meningioma.
Progestogen-only desogestrel was associated with about 73% higher odds.
Combined oral contraceptives containing desogestrel, drospirenone, gestodene, levonorgestrel, or cyproterone were associated with modest increases in risk.
High-dose levonorgestrel IUDs were associated with approximately 58% higher odds, particularly after more than one year of use.
Low-dose levonorgestrel IUDs did not show a statistically clear increase in risk.
Risk was generally highest among current or recent users and largely disappeared about five years after stopping contraception.
The Absolute Risk Matters
The relative-risk numbers can sound alarming, but meningioma is uncommon.
For example, among women aged 40 to 44, the researchers estimated that approximately 5,968 women would need to use injectable medroxyprogesterone for one year for one additional meningioma diagnosis to occur.
For most oral contraceptives and hormonal IUDs, the corresponding number was in the tens of thousands or substantially higher.
That distinction matters. A large percentage increase in a rare event can still represent a small absolute risk.
Implications for Practice
These findings do not mean women using hormonal contraception should abruptly stop treatment.
Instead, they provide additional information for shared decision-making, particularly for women using injectable medroxyprogesterone or higher-dose progestogen formulations over longer periods.
For clinicians, the study suggests that contraceptive choice may eventually need to account not simply for whether a product contains a progestogen, but also the specific molecule, dose, route, and duration of exposure.
The study was observational, so it cannot prove that these contraceptives caused the tumors. Residual confounding also remains possible, particularly for the more modest associations.
Still, the consistency across multiple analyses, the stronger signal with medroxyprogesterone, and the decline in risk after stopping treatment strengthen the case that progestogen exposure deserves continued investigation.
For patients, the practical message is simpler: the risk appears real for some contraceptives, but the absolute risk for most women remains low. Treatment decisions should balance this risk against the substantial benefits of effective contraception.