Recent research has suggested that the contraceptive pill desogestrel is linked to a small increase in the risk of developing an intracranial meningioma brain tumour, although the risk is relatively low, and only appears with long-term desogestrel use, say the experts.
These tumours are usually non-cancerous, but can lead to neurological problems, and sometimes require surgery.
Meningioma has previously been linked to synthetic progestogen drugs, like desogestrel, which are designed to mimic the natural hormone progesterone so important in the menstrual cycle and pregnancy.
The researchers, led by a team from the French National Agency for Medicines and Health Products Safety, wanted to build on those earlier studies to check the risk for desogestrel.
Their study estimated that among women using desogestrel continuously for more than five years, one in 17 331 would develop a tumour that requires surgery. Under five years, the risk is one in 67 300.
That’s relatively small, and the way the study is structured means it doesn’t show direct cause and effect. However, the study team is recommending caution with extended use of this contraceptive pill, and regular testing for any brain issues.
“Monitoring for meningioma should focus on women who have used desogestrel 75 micrograms for more than five continuous years, in whom we found a small risk of meningioma,” they wrote in their paper, published in The BMJ.
The findings are based on records of 92 301 women, with an average age of 59.7 years. Each of the 8 391 women in that group who had undergone surgery for a meningioma was compared with 10 women without tumours, matched by age and location.
As well as noting the small risk increase, the researchers also observed that the association disappeared after a year without taking desogestrel. That’s good news, and may help with future treatments.
“Although direct evidence is still lacking, stopping treatment when desogestrel-related meningioma is diagnosed may preclude the need for surgery as regression of meningioma can be expected in line with cessation of any other progestogen-induced meningioma,” neurosurgeon Gilles Reuter from the Centre Hospitalier Universitaire de Liège in Belgium, who wasn’t involved in the study, wrote in an accompanying editorial.
In the same analysis the researchers also looked at levonorgestrel, another synthetic progestogen, but in this case the data showed no increased risk – even when it was used for more than five years.
That means taking levonorgestrel may be a better option for older women than some of the other contraceptive pills previously linked to meningioma risk, though as always, it’s important that any decisions about drugs and treatment are made in consultation with health professionals.
Study details
Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study
Noémie Roland, Epiphane Kolla, Alain Weill et al.
Published in The BMJ on 28 April 2025
Abstract
Objective
To assess the risk of intracranial meningioma associated with oral contraceptives containing desogestrel, levonorgestrel, or levonorgestrel combined with oestrogen.
Design
Case-control study.
Setting
French national health data system (Système National des Données de Santé).
Participants
A total of 8 391 women living in France who required surgery for intracranial meningioma in 2020-23. Each patient was matched to 10 women without intracranial meningioma (controls) on year of birth and area of residence.
Main outcome measure
Risk of intracranial meningioma associated with oral contraceptives containing desogestrel 75µg, levonorgestrel 30µg, or levonorgestrel 50-150 µg combined with oestrogen, and duration of use: short term use was defined by one or more dispensations within the year before the index date only, and prolonged use was defined by continuous use of one year or more (up to seven or more years of continuous use). Conditional logistic regression was used to calculate odds ratios.
Results
A total of 92 301 women, mean age 59.7 years (standard deviation 12.9 years), were included. Among 8391women who had undergone surgery for intracranial meningioma, 287 (3.4%) used desogestrel 75µg (v 2769/83 910 (3.3%) controls), 17 (0.2%) used levonorgestrel 30 µg (v 140 (0.2%)), and 157 (1.9%) used levonorgestrel combined with oestrogen (v 1933 (2.3%)). In analyses of desogestrel according to duration of use, the odds ratio for risk of intracranial meningioma for short term use was 1.02 (95% confidence interval 0.77 to 1.34) and for prolonged use was 1.32 (1.14 to 1.53). Risk was driven by more than five continuous years of use: odds ratio 1.51 (1.17 to 1.94) for five to seven years and 2.09 (1.51 to 2.90) for ≥7 years. Excess risk was greater in women with meningiomas located in the middle or anterior part of the skull base (1.90 (1.47 to 2.46) and 1.50 (1.17 to 1.93), respectively) and in those who had previously used a progestogen of known associated increased risk (3.30 (2.64 to 4.11)). Results showed no excess risk of intracranial meningioma for levonorgestrel (alone or combined with oestrogen) regardless of duration of use. The estimated number needed to harm with desogestrel was 67 300 women for one intracranial meningioma requiring surgery. Risk was no longer observed one year after discontinuation of desogestrel.
Conclusions
The results showed a small increased risk of intracranial meningioma in women who had used desogestrel 75 µg for more than five continuous years, but no risk in users of levonorgestrel (alone or combined with oestrogen).
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