Certain progestogens linked to higher brain tumor risk in women, study suggests

In a current study printed in the journal BMJ, a staff of French researchers investigated the affiliation between progestogen use and the risk of benign central nervous system tumors akin to intracranial meningioma amongst ladies.

Study: Use of progestogens and the risk of intracranial meningioma: nationwide case-control study. Image Credit: vitahima / Shutterstock

Background

Meningiomas happen each 9.5 per hundred-thousand-person years in the United States and account for 40% of the central nervous system-associated main tumors. Although histologically benign and slow-growing, they will trigger issues by exerting strain on adjoining tissue in the brain, requiring surgical intervention to decompress the world. Age is among the elements that considerably will increase the risk of meningiomas, particularly after 65 years.

Female intercourse, neurofibromatosis kind 2, and ionizing radiation publicity to the intracranial area are different recognized risk elements for meningiomas, other than age. Recent analysis has additionally indicated that the long-term use of three progestogens — chlormadinone acetate, nomegestrol acetate, and cyproterone acetate — at excessive doses also can enhance the risk of intracranial meningiomas. Studies have additionally discovered meningioma volumes to enhance throughout being pregnant and subsequently lower in the postpartum part.

Furthermore, the numerous presence of progesterone receptors in meningiomas signifies a organic hyperlink between meningioma risk and feminine sexual hormones, highlighting the necessity for strong research on progestogen use and meningioma risk.

About the study

In the current study, the researchers investigated the intracranial meningioma risk related to quite a few progestogens and numerous administration routes of those progestogens. The progestogen exposures included intravaginal, percutaneous, and oral progesterone, dydrogesterone by itself or with estrogen, hydroxyprogesterone, promegestone, medrogestone, the injectable contraceptive medroxyprogesterone acetate, dienogest by itself or with estrogen, and intrauterine programs of levonorgestrel.

The study additionally aimed to characterize elements akin to age, location of meningioma, and tumor grade for the ladies included in the case group and decide how most of the meningiomas that had been surgically handled could possibly be attributed to the usage of one of many progestogens. The knowledge for this case-control study was obtained from France’s nationwide well being knowledge system.

The study included ladies of all ages who lived in France and had undergone surgical therapy for intracranial meningioma between 2009 and 2018. The management group included ladies who matched in the world of residence and delivery 12 months with the case group contributors. The World Health Organization’s anatomical, therapeutic, and chemical classification was used to outline progestogen publicity.

The numerous administration routes assessed in the study had been percutaneous, oral, intramuscular, intravaginal, and intrauterine. For progestogens administered through the intravaginal, oral, intramuscular, or percutaneous routes, one dispensation in the 12 months previous the index date was thought-about as an publicity, whereas for intrauterine progestogens and levonorgestrel intrauterine programs, an publicity was one dispensation in three or 5 years previous the index date, respectively.

The researchers analyzed three modes of publicity to progestogens. The first was publicity to the progestogen of concern. The second was publicity to a excessive dose of one of many three progestogens already related to elevated meningioma risk (nomegestrol acetate, chlormadinone acetate, and cyproterone acetate) in the three years main up to the index date. The third mode was the absence of publicity to any of the progestogens. The evaluation additionally included a variety of medical and sociodemographic elements as covariates.

Results

The outcomes confirmed that long-term use of promegestone, medrogestone, and the injectable contraceptive medroxyprogesterone acetate was related to a higher risk of intracranial meningioma. However, short-term use spanning lower than a 12 months of any of those progestogens was not discovered to enhance the meningioma risk.

Furthermore, the usage of intravaginal, percutaneous, and oral progesterone, dydrogesterone by itself or with estrogen, quick—or long-term use of spironolactone, or levonorgestrel intrauterine programs was not related to any enhance in intracranial meningioma risk.

The use of promegestone, medrogestone, and medroxyprogesterone acetate was not discovered to be linked to the incidence of malignant meningiomas, and the variety of instances of intracranial meningiomas that wanted surgical therapy that was related to promegestone, medrogestone, and medroxyprogesterone acetate was considerably fewer than these related to nomegestrol acetate, chlormadinone acetate, and cyproterone acetate.

Conclusions

To conclude, the findings reported that long-term use of three progestogens — promegestone, medrogestone, and the injectable contraceptive medroxyprogesterone acetate — was discovered to enhance the intracranial meningioma risk in ladies. However, these progestogens didn’t enhance the risk of malignant meningiomas, and the usage of these progestogens for lower than a 12 months was not discovered to enhance the intracranial meningioma risk. Additionally, different progestogens akin to spironolactone, dydrogesterone, progesterone, or hormonal intrauterine programs weren’t linked to elevated risk of meningiomas.