A current examine signifies a major improve within the threat of creating intracranial meningioma related to extended use of sure progestogens, hormones generally utilized in ladies’s well being. This primary-of-its-kind examine, which utilized knowledge from France’s nationwide well being database, highlights the necessity for extra analysis because of the potential world well being implications, given the in depth use of those medicine.
That is the primary examine to evaluate the chance related to broadly used progestogens.
Prolonged use of sure progestogen hormone drugs has been linked to a better threat of intracranial meningioma, a kind of mind tumor, in keeping with analysis from France revealed not too long ago in The BMJ.
The researchers say this examine is the primary to evaluate the chance related to progestogens utilized by thousands and thousands of girls worldwide, and additional research are urgently wanted to realize a greater understanding of this threat.
Progestogens are much like the pure hormone progesterone, which is broadly used for gynecological circumstances corresponding to endometriosis and polycystic ovary syndrome, and in menopausal hormone remedy and contraceptives.
Meningiomas are principally non-cancerous tumors within the layers of tissue (meninges) that cowl the mind and spinal twine. Components corresponding to older age, feminine intercourse, and publicity to a few high-dose progestogens (nomegestrol, chlormadinone, and cyproterone acetate) are already identified to extend the chance of meningioma.
However there are a lot of different progestogens for which the chance of meningioma related to their use has not been estimated individually.
Research Methodology
To deal with this information hole, researchers got down to consider the real-life threat of intracranial meningioma requiring surgical procedure in ladies related to the usage of a number of progestogens with totally different routes of administration.
They used knowledge from the French nationwide well being knowledge system (SNDS) for 18,061 ladies (common age 58) who underwent intracranial meningioma surgical procedure from 2009-18.
Every case was matched to 5 management ladies with out intracranial meningioma (complete 90,305) by 12 months of beginning and space of residence.
The progestogens examined had been progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and levonorgestrel intrauterine programs.
For every progestogen, use was outlined as a minimum of one prescription within the 12 months earlier than hospital admission or inside 3-5 years for levonorgestrel intrauterine programs.
Use of a minimum of one of many three high-dose progestogens identified to extend the chance of meningioma within the 3 years earlier than hospital admission was additionally recorded to attenuate bias.
After taking account of different doubtlessly influential elements, extended use (a 12 months or extra) of medrogestone was related to a 4.1-fold elevated threat of intracranial meningioma requiring surgical procedure. Extended use of medroxyprogesterone acetate injection was related to a 5.6-fold elevated threat, and extended use of promegestone was linked to a 2.7-fold elevated threat.
Observations and Conclusions
There gave the impression to be no such threat for lower than one 12 months of use of those progestogens.
As anticipated, there was additionally an extra threat of meningioma for ladies uncovered to chlormadinone acetate, nomegestrol acetate, and cyproterone acetate, all of that are identified to extend the chance of meningioma.
Nonetheless, outcomes confirmed no extra threat of meningioma for progesterone, dydrogesterone, or the broadly used hormonal intrauterine programs, whatever the dose of levonorgestrel they contained.
No conclusions might be drawn about dienogest or hydroxyprogesterone because the variety of uncovered people was too small.
That is an observational examine so can’t set up trigger and impact, and the authors acknowledge that the SNDS database lacked info on all of the medical particulars and medical indications for which progestogens are prescribed. Nor had been they capable of account for genetic predisposition and publicity to high-dose radiation.
Nonetheless, they are saying, on condition that medroxyprogesterone acetate is estimated for use for contraception by 74 million ladies worldwide, the variety of attributable meningiomas could also be doubtlessly excessive.
Additional research utilizing different sources of knowledge are urgently wanted to realize a greater understanding of this threat, they conclude.
Reference: “Use of progestogens and the chance of intracranial meningioma: nationwide case-control examine” by Noémie Roland, Anke Neumann, Léa Hoisnard, Lise Duranteau, Sébastien Froelich, Mahmoud Zureik and Alain Weill, 27 March 2024, BMJ.
DOI: 10.1136/bmj-2023-078078
