Hormonal Contraceptives Linked to Increased Risk of Rare Brain Tumors

Broadened Scope of Risk in Hormonal Contraception

A comprehensive analysis of 25 years of health data from approximately three million women has expanded the list of hormonal contraceptives associated with a heightened risk of intracranial meningioma. While the injectable contraceptive Depo-Provera, containing medroxyprogesterone acetate (DMPA), has been the focus of lawsuits alleging failure to warn of risks, the new study published in JAMA Network Open indicates that other common formulations carry similar, albeit smaller, associations.

The study found that beyond Depo-Provera—which showed the most significant link with a 4-fold relative increase in risk—five other birth control drugs involving progestogens such as desogestrel, drospirenone, gestodene, and levonorgestrel also showed elevated risk factors. According to the Danish Medicines Agency, these oral contraceptives and “mini-pills” are associated with a 1.5-fold relative risk increase.

Clinical Context: Balancing Absolute and Relative Risk

Medical professionals emphasize that while relative risk statistics can appear high, the absolute risk of developing a meningioma remains small for the general population. Paul Pharoah, a cancer epidemiologist at Cedars-Sinai Health Sciences University, noted that the lifetime incidence of meningioma is roughly 5 per 1,000 women, increasing to 6 per 1,000 for those using medroxyprogesterone.

Paul Pharoah, a cancer epidemiologist, explains that while a 4-fold relative increase in risk seems very high, the absolute risk of meningioma is small. He says that these very small increases in risk need to be balanced against the benefits of different forms of contraception and that it is important that women do not stop using their birth control pills without consulting their doctor.

The European Medicines Agency (EMA) reported that for desogestrel- or etonogestrel-containing medicines, one additional meningioma is estimated to occur for every 67,300 women. Most meningiomas are benign, though they can cause significant health complications—including seizures and cognitive impairment—if they grow near critical structures in the brain.

Patient Experiences and Legal Challenges

For many women, the diagnosis has resulted in life-altering surgeries. Lauren Lewington, a patient from north Wales, described the physical toll of a meningioma she attributes to 15 years of Depo-Provera use. After experiencing severe headaches and facial numbness, she underwent multiple operations, though surgeons could not remove the entire tumor due to its proximity to blood vessels.

Regulatory Response and Monitoring Requirements

Regulatory bodies have begun updating safety protocols to reflect these findings. Similarly, the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) has mandated that the use of desogestrel- or etonogestrel-containing medicines is now contraindicated for women who have or have had a meningioma.

• Worsening headaches or memory loss
• Changes in vision or hearing loss
• Loss of smell
• Seizures
• Unexplained weakness in arms or legs

The research indicates that the risk persists only while the contraceptive is in use, with the elevated risk generally disappearing within five years of discontinuation. Patients currently using hormonal contraception are advised to consult their healthcare provider regarding these findings rather than stopping their medication abruptly.

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