Published: 6 March 2025

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Medroxyprogesterone acetate and meningioma

Published: 6 March 2025
Prescriber Update 46(1): 9–10
March 2025

What are meningiomas?

Meningiomas are tumours of the meninges, the membrane surrounding the brain and spinal cord. Meningiomas are often benign and asymptomatic but may cause neurological symptoms through compression of adjacent tissues.¹

Meningiomas are more common in women and the incidence increases with age.¹

Hormonal factors, including progesterone, may influence the development of meningioma. This hypothesis is supported by a higher frequency of meningioma in females than males and the presence of hormone receptors on meningiomas.^1,2

Meningioma with medroxyprogesterone depot

Medroxyprogesterone acetate is a synthetic progestogen. Medroxyprogesterone depot injection (Depo-Provera) is indicated for suppression of ovulation and treatment of endometriosis. It also has oncological indications.³ Medroxyprogesterone tablets (Provera) are indicated for treatment of dysfunctional uterine bleeding, endometriosis, menopausal hormone therapy and diagnosis of amenorrhea.⁴

A case-control study using French health system data found that prolonged exposure to injectable medroxyprogesterone acetate was associated with an increased risk of intracranial meningioma requiring surgery. The absolute risk remained low. Note that this result was based on a small number of exposed cases and should therefore be interpreted with caution.⁵ However, meningiomas have been associated with other progesterones, such as cyproterone (see below).

The Depo-Provera and Provera tablet data sheets have been updated to warn that meningioma has been reported with long-term use of medroxyprogesterone and to discontinue the medicine if meningioma occurs. Use caution when prescribing this medicine to people with a history of meningioma.³

Are oral contraceptives associated with meningioma?

An association between use of combined or progestogen-only oral contraceptives and meningioma has not been established.²

Long-term treatment with high cumulative doses of cyproterone has been associated with a significantly increased risk of meningioma.² The relevance to low doses of cyproterone contained in some oral contraceptives is uncertain. However, the ethinylestradiol + cyproterone (Ginet) data sheet contraindicates use in people with current or past meningioma and warns that treatment should be stopped if meningioma is diagnosed.⁶

More information

• See also a previous Prescriber Update article: Cyproterone acetate and the risk of meningioma (September 2020)
• Search for a data sheet

References

1. Buerki RA, Horbinski CM, Kruser T, et al. 2018. An overview of meningiomas. Future Oncology 14(21): 2161-77. DOI: 10.2217/fon-2018-0006 (accessed 24 January 2025).
2. Hage M, Plesa O, Lemaire I, et al. 2022. Estrogen and progesterone therapy and meningiomas. Endocrinology 163(2): DOI: 10.1210/endocr/bqab259 (accessed 24 January 2025).
3. Pfizer New Zealand Limited. 2024. Depo-Provera New Zealand Data Sheet 6 February 2024. URL: www.medsafe.govt.nz/profs/Datasheet/d/Depoproverainj.pd (accessed 23 January 2025).
4. Pfizer New Zealand Limited. 2024. Provera New Zealand Data Sheet 4 December 2024. URL: www.medsafe.govt.nz/profs/Datasheet/p/Proveratab.pdf (accessed 27 January 2025).
5. Roland N, Neumann A, Hoisnard L, et al. 2024. Use of progestogens and the risk of intracranial meningioma: National case-control study. BMJ 384: e078078. DOI: 10.1136/bmj-2023-078078 (accessed 23 January 2025).
6. REX Medical Limited. 2020. Ginet New Zealand Data Sheet 25 May 2020. URL: www.medsafe.govt.nz/profs/Datasheet/g/ginettab.pdf (accessed 24 January 2025).