Use of medroxyprogesterone acetate and risk of meningiomas: a comparative safety study

Abstract

Background: Medroxyprogesteroneacetate (MPA), a widely used hormonal contraceptive, has been associated with increased risk of meningiomas. However, the risk of meningiomas associated with MPA compared to oral contraceptives containing ethinylestradiol-levonorgestrel (EE-LNG) remains unclear. This study aimed to evaluate the relative risk of meningiomas in women using MPA versus EE-LNG. Research Design and Methods: A nested case-control study was conducted using the PharMetrics Plus database (2006–2020). The cohort included new users of MPA and EE-LNG. Incident meningioma cases were matched to controls based on age and calendar time. Conditional logistic regression was used to account for confounders, including prior radiotherapy, hormonal contraceptive use, and obesity. Main Outcome Measures: The primary outcome was the incidence rate ratio (IRR) of meningiomas in MPA users compared to EE-LNG users. Results:  Among women using MPA for more than one year, the adjusted IRR for meningiomas was 3.55 (95% CI: 1.85–6.85), indicating a significantly higher risk compared to EE-LNG users.  Conclusions: MPAuse is linked to a substantially increased risk of meningiomas, underscoring the importance of assessing its long-term use. Further research is warranted to confirm these findings and guide clinical practice.