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Dr Odile Bagot (Gynecologist-obstetrician)
A French study whose results have just been published in the British Medical Journal confirms the increased risk of meningiomas, or tumors of the meninges, during prolonged exposure to certain progestins. Find out which ones.
Prolonged use of certain progestins may expose women to an increased risk of meningiomas. This is the result reported this week by a large French study. However, progestogen medications can be used as contraceptives, but also to treat gynecological pathologies such as endometriosis or as hormone replacement therapy for menopause. So what is the risk?
New progestins enter the risk category
Previous studies had already shown the increased risk of meningioma linked to prolonged use and high doses of three progestins:
“It was necessary to know whether there was a similar risk with other progestins, depending on various routes of administration,” explains the National Medicines Safety Agency (ANSM) in a press release.
The Epi-Phare group therefore embarked on this research thanks to a large cohort: 19,061 women aged 45 to 74 and operated on for a meningioma between 2009 and 2018 were therefore included in the study, and have were compared to 90,305 control women. According to their observations, the scientists noted several data:
- A 2 times greater risk of meningioma when using Surgestone;
- A risk 3.5 times greater for Colprone;
- Finally, Depo Provera (injectable medroxyprogesterone acetate) is associated with a 5.6 times higher risk of being operated on for a meningioma than the general population.
However, after less than one year of use, the study shows no additional risk for these three progestins, if no other risky progestins have been used beforehand.
These other progestins that are not linked to meningiomas
What this study also says is that other progestins pose no or few known risks, according to the data collected.
- Thus exposure to progesterone by oral/intravaginal or percutaneous routes (Utrogestan and generics) and to dydrogesterone (Duphaston) used in the hormonal treatment of menopause, was not significantly associated with an increased risk of surgery. intracranial meningioma;
- The results for levonorgestrel IUDs (hormonal IUDs: Mirena, Donasert, Kyleena and Jaydess), a widely used contraceptive, are very reassuring and in favor of the absence of risk of meningioma;
- No lessons could be learned regarding dienogest (Visanne and generics) or hydroxyprogesterone, prescribed for endometriosis.
A study, however, reassuring for women in menopause or using the IUD
Taking note of these data, Dr Odile Bagot, gynecologist and member of our committee of experts, approves these details and even regrets that they are not more thorough.
“The first results are not surprising and confirm what we already knew about the three progestins: Surgestone, Colprone and Deo Provera. They were not part of the progestins not to be given but we nevertheless avoided prescribing, unless when there was no alternative.
On the other hand, according to the professional, this study also provides reassuring data in other cases.
“What is reassuring is that the micronized progesterone biosimilar utrogestant which is widely prescribed to women approaching menopause does not pose a risk of meningioma. The other good news is that progesterone IUDs don’t have this effect either. We can therefore think that it is a dose-dependent effect.
A study to be extended to other progestins?
Finally, the gynecologist is surprised by a choice in the list of targeted progestins:
“What is missing, however, in my opinion, is to extend this study to Desogestrel (optimizette, cerazette, etc.) which is the mini progestin pill most used in women. If she doesn’t particularly worry us, it would have been interesting to include her in this cohort.”