Introduction

A recent case-control study based on the French National Health Data System (SNDS) assessed the association between the use of progestin-only oral contraceptives and the risk of intracranial meningioma requiring surgery. This large-scale analysis, including more than 92,000 women in France, provides important insights for clinical practice.

Methods

• Study population: 8,391 women who underwent surgery for intracranial meningioma between 2020 and 2023, matched with 83,910 controls without meningioma (matched on age and place of residence).
• Exposure: use of desogestrel 75 µg, levonorgestrel 30 µg, or levonorgestrel (50–150 µg) combined with estrogen.
• Duration of use:
  • short-term (<1 year);
  • prolonged ≥1 year (up to >7 years).
• Statistical analysis: conditional logistic regression (odds ratios, 95% CI).
  

Main results

• Desogestrel 75 µg:
  • No excess risk with short-term use (OR 1.02; 95% CI 0.77–1.34).
  • Significant increased risk with prolonged use:
    • 5–7 years: OR 1.51 (95% CI 1.17–1.94).
    • ≥7 years: OR 2.09 (95% CI 1.51–2.90).
  • Higher risk for meningiomas located at the skull base (anterior and middle fossa).
  • Risk amplified in women with prior exposure to other progestins previously associated with meningioma (OR 3.30).
  • Risk disappeared one year after discontinuation of desogestrel.
• Levonorgestrel (alone or combined with estrogen): no excess risk identified regardless of duration of use.
  

Clinical impact

• The number needed to harm (NNH) was estimated at 67,300 women for one case of surgically treated meningioma after prolonged desogestrel exposure.
• These findings confirm that desogestrel should be prescribed with caution in cases of prolonged use, particularly in women with a history of exposure to other high-risk progestins.
• By contrast, levonorgestrel, a widely used progestin, was not associated with an increased risk.
  

Conclusion

This French nationwide study highlights a modest but significant increased risk of intracranial meningioma after more than 5 years of continuous use of desogestrel 75 µg, especially for skull base meningiomas. Conversely, no association was found for levonorgestrel, either alone or combined with estrogen. These findings should be taken into account when assessing the benefit-risk ratio in the prescription of progestin-based oral contraceptives.

Team & expertise

This article is part of the scientific dissemination mission of the Neurosurgery Department, Lariboisière Hospital – AP-HP, led by Prof. Sébastien Froelich, Université Paris-Cité. The team specializes in the management of intracranial tumors, particularly skull base meningiomas.

🔗 Source: BMJ 2024 – Intracranial meningioma and oral contraceptives

Related internal link: Intracranial meningioma