Recent research has highlighted a possible link between long-term use of depot medroxyprogesterone acetate (DMPA), commonly known as Depo-Provera, and an increased risk of intracranial meningioma.
A meningioma is a tumour arising from the meninges, the protective layers surrounding the brain and spinal cord. Most are benign and slow-growing, but they can still cause significant symptoms by compressing nearby nerves or brain structures.
A major 2024 French study of more than 18,000 patients undergoing meningioma surgery found that women exposed to injectable medroxyprogesterone acetate for at least one year had a roughly 5.5-fold increased relative risk compared with unexposed individuals. Despite this, the absolute risk remained low. These findings have led some regulators to update prescribing guidance, particularly for patients with current or previous meningiomas.
The association is biologically plausible because many meningiomas contain progesterone receptors, suggesting hormones may influence tumour growth. Similar links have been reported with other high-dose progestogen medications, including cyproterone acetate, nomegestrol acetate and chlormadinone acetate.
Hormone-associated meningiomas often occur at the skull base, where nerves controlling vision, hearing, balance, smell, swallowing and facial sensation pass through confined spaces.
Symptoms may include:
- Persistent headaches
- Loss of smell
- Facial numbness or tingling
- Double or blurred vision
- Visual field loss
- Hearing loss or tinnitus
- Dizziness or imbalance
- Facial weakness
- Difficulty swallowing
- Voice changes
- Seizures
- Memory, cognitive or personality changes
- Limb weakness or sensory changes
Most people with these symptoms will not have a meningioma. However, persistent, progressive or unexplained neurological symptoms should be assessed, especially those affecting vision, hearing, smell or facial sensation.
At London Skull Base Specialists, we diagnose and treat complex skull base meningiomas, including those affecting the olfactory groove, sphenoid wing, cavernous sinus, petroclival region and foramen magnum. These tumours often require highly specialised care because of their proximity to critical nerves and blood vessels.
Our multidisciplinary team provides advanced imaging, endoscopic and open skull base surgery, stereotactic radiotherapy and long-term surveillance, tailoring treatment to each patient.
Although recent studies have attracted attention, the overall risk associated with Depo-Provera remains low. Patients should not stop prescribed medication without medical advice. Those with prolonged exposure who develop persistent neurological symptoms should seek assessment.
If you have concerns about long-term Depo-Provera use, a meningioma diagnosis, or symptoms of concern, London Skull Base Specialists can provide a comprehensive evaluation. Early specialist review can offer reassurance, clarify diagnosis and, where needed, provide access to the full range of modern treatment options.
References
- Roland N, Neumann A, Hoisnard L, et al. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ. 2024;384.
- Weill A, Nguyen P, Labidi M, et al. Use of high-dose cyproterone acetate and risk of intracranial meningioma. BMJ. 2021;372.
- Roland N, Neumann A, Hoisnard L, et al. Progestogens and intracranial meningioma risk: French national health database analyses. BMJ. 2024.
- Medicines and Healthcare products Regulatory Agency (MHRA. Medroxyprogesterone acetate: risk of meningioma and measures to minimise this risk. Drug Safety Update. 2024.
- Froelich S, Abecassis IJ, et al. Progestin-associated meningiomas: clinical behaviour, management considerations and outcomes. Neurosurgical Review. 2024.
