HORMONAL CONTRACEPTION AND THE RISK OF MENINGIOMA: A NARRATIVE REVIEW OF EVIDENCE FROM PROGESTOGEN-RELATED THERAPIES
Abstract
Background: Meningiomas are the most common benign intracranial tumors in adults and show a marked female predominance, suggesting a hormonal influence. The frequent expression of progesterone and estrogen receptors in these tumors has raised concerns that exogenous hormones, particularly those used in hormonal contraception, may contribute to their development or growth.
Aim: To summarize current knowledge about hormonal contraceptive use and the risk of meningioma.
Methodology: A narrative review was conducted using PubMed and Google Scholar between January and September 2025. The search included studies related to meningioma, hormonal contraception, and specific progestins such as cyproterone acetate, medroxyprogesterone acetate, nomegestrol acetate, chlormadinone acetate, desogestrel, and levonorgestrel.
Results: Most studies do not demonstrate a consistent association between combined estrogen–progestin oral contraceptives and meningioma risk; in contrast, prolonged or high-dose exposure to specific progestin-only agents has been associated with an increased risk. Particularly, depot medroxyprogesterone acetate, cyproterone acetate, nomegestrol acetate, and chlormadinone acetate have been linked to a significantly increased risk, often related to cumulative dose and duration of use. Regression of hormone-associated tumors following treatment withdrawal has been reported, and the excess risk appears to decrease over time after discontinuation.
Conclusions: Combined oral contraceptives are generally considered safe, whereas long-term use of potent progestins may promote meningioma growth. Contraceptive choices should be chosen based on individual risk profiles, especially for women requiring extended hormonal therapy. Further studies are needed to clarify underlying mechanisms and identify women at increased susceptibility.
References
Dresser L, Yuen CA, Wilmington A et al. Estrogen hormone replacement therapy in incidental intracranial meningioma: a growth-rate analysis. Sci Rep 2020; 10: 17960.
Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An Overview of Meningiomas. Future Oncol 2018; 14: 2161–2177.
Shahin MN, Bowden SG, Yaghi NK et al. Regression of Multiple Meningiomas after Discontinuation of Chronic Hormone Therapy: A Case Report. J Neurol Surg Rep 2021; 82: e38–e42.
Blankenstein MA, Van Der Meulen-Dijk C, Thijssen JHH. Effect of steroids and antisteroids on human meningioma cells in primary culture. J Steroid Biochem 1989; 34: 419–421.
Leães CGS, Meurer RT, Coutinho LB, Ferreira NP, Pereira-Lima JFS, Da Costa Oliveira M. Immunohistochemical expression of aromatase and estrogen, androgen and progesterone receptors in normal and neoplastic human meningeal cells. Neuropathology 2010; 30: 44–49.
Chakravarthy V, Kaplan B, Gospodarev V, Myers H, De Los Reyes K, Achiriloaie A. Houdini Tumor: Case Report and Literature Review of Pregnancy-Associated Meningioma. World Neurosurg 2018; 114: e1261–e1265.
Chacko JG, Miller JL, Angtuaco EJ. Spontaneous Postpartum Resolution of Vision Loss Caused by a Progesterone Receptor-Positive Tuberculum Sellae Meningioma. J Neuroophthalmol 2010; 30: 132–134.
Maiuri F, Mariniello G, De Divitiis O et al. Progesterone Receptor Expression in Meningiomas: Pathological and Prognostic Implications. Front Oncol 2021; 11: 611218.
Agopiantz M, Carnot M, Denis C, Martin E, Gauchotte G. Hormone Receptor Expression in Meningiomas: A Systematic Review. Cancers 2023; 15: 980.
Speirs V, Boyle-Walsh E, Fraser WD. Constitutive co-expression of estrogen and progesterone receptor mRNA in human meningiomas by RT-PCR and response ofin vitro cell cultures to steroid hormones. Int J Cancer 1997; 72: 714–719.
Korhonen K, Salminen T, Raitanen J, Auvinen A, Isola J, Haapasalo H. Female predominance in meningiomas can not be explained by differences in progesterone, estrogen, or androgen receptor expression. J Neurooncol 2006; 80: 1–7.
Jay JR, MacLaughlin DT, Riley KR, Martuza RL. Modulation of meningioma cell growth by sex steroid hormones in vitro. J Neurosurg 1985; 62: 757–762.
Saitoh Y, Oku Y, Izumoto S, Go J. Rapid Growth of a Meningioma during Pregnancy: Relationship with Estrogen and Progesterone Receptors: —Case Report—. Neurol Med Chir (Tokyo) 1989; 29: 440–443.
Lusis EA, Scheithauer BW, Yachnis AT et al. Meningiomas in Pregnancy: A Clinicopathologic Study of 17 Cases. Neurosurgery 2012; 71: 951–961.
Roland N, Kolla E, Baricault B et al. Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study. BMJ 2025; 389: e083981.
Michaud DS, Gallo V, Schlehofer B et al. Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 2010; 19: 2562–2569.
Johansson T, Vinther Larsen S, Bui M, Ek WE, Karlsson T, Johansson Å. Population-based cohort study of oral contraceptive use and risk of depression. Epidemiol Psychiatr Sci 2023; 32: e39.
Ichwan S, Santoso F, Aman RA, Tandian D, Fachniadin A, Nugroho SW. Estrogen and progesterone in meningioma: Bridging the gap of knowledge. Neurol Asia 2023; 28: 1–11.
Roland N, Neumann A, Hoisnard L et al. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ 2024; 384: e078078.
Piper JG, Follett KA, Fantin A. Sphenoid wing meningioma progression after placement of a subcutaneous progesterone agonist contraceptive implant. Neurosurgery 1994; 34: 723–725; discussion 725.
Bigrigg A, Evans M, Gbolade B et al. Depo Provera. Position paper on clinical use, effectiveness and side effects. Br J Fam Plann 1999; 25: 69–76.
Roland N, Froelich S, Weill A. Medroxyprogesterone acetate and meningioma: a global issue. Front Glob Womens Health 2025; 6: 1470539.
Weill A, Nguyen P, Labidi M et al. Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study. BMJ 2021; 372: n37.
Reuter G, Potorac I, De Herdt C et al. Recommendations on the management of meningioma and sex hormone therapy: The results of a collaborative effort between neurosurgical, endocrine and gynecological societies. Brain Spine 2025; 5: 104154.
Nguyen P, Roland N, Neumann A et al. Prolonged use of nomegestrol acetate and risk of intracranial meningioma: a population-based cohort study. Lancet Reg Health Eur 2024; 42: 100928.
Cea-Soriano L, Blenk T, Wallander M-A, Rodríguez LAG. Hormonal therapies and meningioma: Is there a link? Cancer Epidemiol 2012; 36: 198–205.
Views:
27
Downloads:
12
Copyright (c) 2025 Katarzyna Malinowska, Elhatra Settaf-Cherif, Joanna Barwacz, Magdalena Adamik, Layla Settaf-Cherif, Marta Czarnowska, Radosław Sciepuro, Dagmara Gładysz
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
