In short
- Meningioma is a tumour of the membranes around the brain. Most are benign and grow slowly.
- Long-term use of some progestins, mostly at high doses, raises the risk: cyproterone acetate, nomegestrol acetate, chlormadinone acetate and high-dose medroxyprogesterone acetate among them.
- The risk grows with the dose and the length of treatment, and goes down after the treatment stops. For most people treated, it stays small.
- Never stop a treatment on your own. Ask your doctor whether it's still the right one for you, and whether you need a brain scan.
What is a meningioma?
A meningioma is a tumour that grows from the meninges, the thin membranes that wrap the brain and the spinal cord. Most meningiomas are benign: they aren't cancer, and they grow slowly. They're more common in women than in men, and many carry receptors for progesterone, one of the reasons hormones are studied as a factor.
A small meningioma may cause no symptoms at all. A larger one can press on the brain or on nerves. Signs include headaches that are new or getting worse, problems with vision, hearing loss or ringing in the ears, seizures, memory problems, or weakness in an arm or a leg. These symptoms have many other causes. But if you notice them while taking a progestin, tell your doctor.
Which medicines are concerned?
Progestins, also called progestogens, are medicines that act like progesterone. They're used for contraception, endometriosis, heavy or irregular periods, menopause treatment, acne and excess hair, and some cancers. Most carry no known risk of meningioma. A few do, mostly at high doses and over long periods:
| Medicine | What it's used for | What European regulators decided |
|---|---|---|
| Cyproterone acetate (Androcur, for example) | Excess hair, acne, hair loss; prostate cancer in men | In 2020, the EMA restricted doses of 10 mg a day or more to cases where other treatments, including lower doses, have failed. Not to be used by anyone who has or has had a meningioma. |
| Nomegestrol acetate | Period problems, endometriosis, menopause | In 2022, high doses (3.75 to 5 mg) were restricted to cases where other options aren't suitable, at the lowest dose and for the shortest time. Not to be used by anyone who has or has had a meningioma. |
| Chlormadinone acetate | Period problems, endometriosis | The same 2022 decision, for high doses (5 to 10 mg). |
| Medroxyprogesterone acetate, high dose (Depo-Provera, for example) | The contraceptive injection; some gynaecological conditions and cancers | In 2024, meningioma was added as a risk of high doses: the injection, and tablets of 100 mg or more. Not to be used by anyone who has or has had a meningioma, except to treat cancer. |
A large French study, published in The BMJ in 2024, also found a higher risk with long-term use, a year or more, of medrogestone and promegestone, two progestins prescribed mainly in France.
The same study found no extra risk with progesterone, dydrogesterone, or the hormonal IUDs that release levonorgestrel. Low-dose cyproterone combined with an oestrogen, found in some pills prescribed for acne, hasn't shown a risk either; as a precaution, it shouldn't be used by anyone who has or has had a meningioma.
How big is the risk?
The risk grows with the dose and with how long the medicine is taken, and it's seen mostly after a year or more of treatment. Meningiomas are uncommon to begin with, so even when the risk is several times higher, most people who take these medicines will never have one. The European Medicines Agency describes the risk with cyproterone as very low.
The risk also goes down once the treatment stops, and some meningiomas have been seen to shrink after the medicine was stopped.
If you take one of these medicines
- Don't stop on your own. Stopping suddenly can bring back what the treatment was controlling, or leave you without contraception. Talk to your doctor first.
- Check the active substance, not the brand: it's written on the box and in the leaflet.
- Mention any symptom that's new or getting worse: headaches, changes in vision, hearing problems, seizures.
- Bring your questions to your next appointment. Here are five to start with.
Questions to ask your doctor
- Is this still the right treatment for me, at this dose?
- Could a lower dose, a shorter course or another option work as well?
- How long have I been taking it in total, and does that change anything?
- Should I have a brain MRI, now or later?
- Which symptoms should make me call you before my next appointment?
If you have or have had a meningioma
Tell every doctor who prescribes you a hormonal treatment, including for contraception or menopause. The medicines in the table above are not to be used after a meningioma, and your doctor can help you find options that don't carry that risk.
Sources
- European Medicines Agency, Restrictions in use of cyproterone due to meningioma risk (2020).
- European Medicines Agency, New measures to minimise risk of meningioma with medicines containing nomegestrol or chlormadinone (2022).
- European Medicines Agency, PRAC recommendations on signals: medroxyprogesterone acetate and meningioma (September 2024).
- Roland N. et al., Use of progestogens and the risk of intracranial meningioma: national case-control study, The BMJ (2024).
Hooli provides information, not medical advice. It does not replace diagnosis or treatment by a health professional. Always talk to your doctor before changing a medication.