A study from France published today in The BMJ reveals that prolonged usage of particular progestogen hormone medications is linked to a heightened risk of developing intracranial meningioma, a type of brain tumor.
The researchers highlight that this study marks the first attempt to evaluate the risk linked with progestogens utilized by millions of women worldwide. They stress the urgent need for further studies to enhance our comprehension of this risk.
Progestogens, akin to the natural hormone progesterone, find extensive application in treating gynecological conditions such as endometriosis and polycystic ovary syndrome, as well as in menopausal hormone therapy and contraceptives.
Meningiomas predominantly manifest as non-cancerous tumors within the meninges, the protective layers covering the brain and spinal cord. Known factors such as advancing age, female gender, and exposure to three high-dose progestogens (nomegestrol, chlormadinone, and cyproterone acetate) have already been associated with an increased meningioma risk.
However, numerous other progestogens lack individually estimated risk levels concerning meningioma occurrence.
In a bid to address this knowledge gap, researchers embarked on evaluating the real-world risk of intracranial meningioma necessitating surgery in women associated with the usage of various progestogens delivered through different administration routes. Leveraging data from the French national health data system (SNDS), the study encompassed 18,061 women (with an average age of 58) who underwent intracranial meningioma surgery between 2009 and 2018.
Each case was meticulously matched with five control women lacking intracranial meningioma (totaling 90,305), based on year of birth and geographical area of residence.
The examined progestogens included progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and levonorgestrel intrauterine systems. Utilization of each progestogen was defined as having at least one prescription in the year prior to hospital admission, or within 3-5 years for levonorgestrel intrauterine systems.
Additionally, the use of any of the three high-dose progestogens known to elevate meningioma risk within 3 years before hospitalization was documented to mitigate bias.
Upon adjusting for other potential influencing factors, the researchers noted that prolonged use (a year or more) of medrogestone was associated with a 4.1-fold increase in the risk of intracranial meningioma requiring surgery. Similarly, prolonged use of medroxyprogesterone acetate injection was linked to a 5.6-fold increased risk, while prolonged use of promegestone showed a 2.7-fold increase in risk.
However, there appeared to be no elevated risk associated with usage lasting less than one year for these progestogens.
As anticipated, women exposed to chlormadinone acetate, nomegestrol acetate, and cyproterone acetate, all known to heighten meningioma risk, exhibited excess risk. Conversely, no heightened risk of meningioma was observed for progesterone, dydrogesterone, or various hormonal intrauterine systems, irrespective of the levonorgestrel dose they contained.
Conclusions regarding dienogest or hydroxyprogesterone could not be drawn due to the limited number of exposed individuals.
Given that medroxyprogesterone acetate is estimated to be used for contraception by 74 million women globally, the potential for a high number of attributable meningiomas is noted. The authors stress the urgent need for further investigations utilizing alternative data sources to better comprehend this risk.
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