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meningioma and progestogens

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Meningiomas are, in most cases, low grade intracranial tumors (1):

  • a systematic review found that
    • vast majority of meningiomas express progesterone receptors in almost three quarters of cases
    • proportion of cases which progesterone receptors are present is greater in some situations:
      • 1/female gender;
      • 2/the period of genital activity in women;
      • 3/during pregnancy or postpartum;
      • 3/under hormonal treatment
    • presence of progesterone receptors is associated with significantly more favorable prognostic factors
      • grade 1 meningiomas express progesterone receptors in more than three quarters of cases
      • grade 3 meningiomas express progesterone receptors in less than 20%
      • recurrent meningiomas express significantly less progesterone receptors

French study of 18,061 cases matched to 90,305 controls found prolonged use (≥one year) of medrogestone, medroxyprogesterone acetate, and promegestone increased risk of intracranial meningioma. No excess risk found for progesterone, dydrogesterone, or levonorgestrel IUS:

  • for injectable medroxyprogesterone acetate, excess risk of meningioma was 9 exposed cases /18,061cases (0.05%) versus 11 exposed controls/90,305 controls (0.01%), odds ratio 5.55 (95% CI 2.27 to 13.56)
  • prolonged use of medrogestone (5 mg, oral), medroxyprogesterone acetate (150 mg, injectable), and promegestone (0.125/0.5 mg, oral) was found to be associated with an excess risk of intracranial meningioma

A dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with the progestin cyproterone acetate (CPA) has been established (3):

  • CPA-associated meningiomas seem to be mainly located in the anterior and middle skull base, are more likely to be multiple, may harbor P1K3CA mutations in up to one-third of cases, and are more common with a longer duration of treatment

Reference:

  • Agopiantz M, Carnot M, Denis C, Martin E, Gauchotte G. Hormone Receptor Expression in Meningiomas: A Systematic Review. Cancers (Basel). 2023 Feb 3;15(3):980.
  • Roland N, Neumann A, Hoisnard L, Duranteau L, Froelich S, Zureik M et al. Use of progestogens and the risk of intracranial meningioma: national case-control study BMJ 2024; 384 :e078078 doi:10.1136/bmj-2023-078078
  • Hage M et al. Estrogen and Progesterone Therapy and Meningiomas, Endocrinology, Volume 163, Issue 2, February 2022, bqab259, https://doi.org/10.1210/endocr/bqab259 (https://doi.org/10.1210/endocr/bqab259)

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