"The risk exists, although it is rare" – Prof. Ewa Wender-Ożegowska on contraceptive injections and meningiomas
According to a recent study published in JAMA Neurology, long-term use of injectable hormonal contraception (depot medroxyprogesterone – DMPA) may be associated with a higher risk of meningioma, a brain tumor. The risk increases with duration of use, especially after four years of therapy and in women over 30. Prof. Ewa Wender-Ożegowska, a gynecologist, spoke to Polityka Zdrowotna about the significance of these results and their practical implications.
The study, conducted by researchers from Case Western Reserve University School of Medicine and the Cleveland Clinic, included data on more than 10.4 million women from the TriNetX database, which collects information from 68 U.S. healthcare providers. Of these, 88,668 patients used DMPA injections , a form of hormonal contraception.
The analysis showed that women using depot medroxyprogesterone had a 143% higher risk of meningioma diagnosis (7.39 vs. 3.05 cases per 100,000 patient-years). This risk increased with duration of use:
after 4–6 years – by 200% ,
after more than 6 years – by 290% .
Women who started treatment after the age of 31 were most at risk – the risk was up to three times higher in this group. No similar effect was observed for other contraceptive methods, such as combined pills, intrauterine devices, or implants. Moreover, some of them – including levonorgestrel IUDs – were associated with a lower risk of meningioma .
Meningiomas constitute approximately 40% of all primary brain tumors in women . It has long been known that their growth can be stimulated by sex hormones , especially progesterone. Many tumors express its receptors, which explains why some studies indicate a link between progestogens (progesterone derivatives) and the development of these lesions.
Prof. Ewa Wender-Ożegowska explains in an interview with Polityka Zdrowia:
Indeed, there have been publications confirming the effect of certain progestogens on the risk of meningiomas. A strong association has been demonstrated for cyproterone acetate (CPA) , a progestogen structurally related to medroxyprogesterone. Data for DMPA are more limited, but a growing body of research indicates a possible effect with long-term use.
The expert reminds that the relationship between meningiomas and hormonal contraception is not the same for all preparations:
The strongest and most well-documented association concerns high-dose cyproterone acetate (CPA) , which is why the European Medicines Agency has introduced restrictions on its use. For other progestogens, such as medroxyprogesterone, the data are less clear, but warning signs increase, especially with long-term use of DMPA .
An American study ( JAMA Neurology, 2025 ) found a relative risk (RR) of 2.43 , while a French population-based study ( BMJ, 2024 ) found an OR of 5.55 for women using DMPA for more than one year. At the same time, Prof. Wender-Ożegowska emphasizes that while the relative risk may seem high, the absolute risk remains low – events are rare.
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According to Prof. Wender-Ożegowska, there are currently no grounds for immediate discontinuation of DMPA by all patients:
There is no universal recommendation to discontinue this form of contraception. However, for planned long-term use—especially in women over 30—it is worth considering alternatives such as levonorgestrel IUDs or implants . These methods have not been associated with an increased risk of meningiomas.
The expert also reminds that DMPA preparations have limited use today – mainly in the postpartum period, when other methods cannot be used (e.g. intrauterine device after cesarean section).
It also draws attention to alarm symptoms that should prompt the patient to visit a doctor:
In women taking DMPA who report new, chronic headaches, visual disturbances, or nausea, it is worth performing a magnetic resonance imaging (MRI) and considering a neurological consultation.
Although studies indicate an association between long-term use of contraceptive injections and the risk of meningioma , experts emphasize that this is a statistical association , not evidence of cause and effect. While the absolute risk remains low, knowledge of potential side effects allows for more informed contraceptive choices.
As summarized by Prof. Ewa Wender-Ożegowska :
Most of the evidence comes from observational studies , which may be biased because they were not randomized and there are differences in populations; the evidence is stronger for CPA than for MPA. Although the relative risk may appear impressive (OR 2–5), the absolute risk is still low .
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