Contraceptive Progestogens and Incident Meningioma

Nicklas Hasselblad Lundstrøm; Mette Hjorslev Knudgaard; Michael Skaarup Pedersen; Marie Louise Schougaard Christiansen; Charlotte Wessel Skovlund

doi:10.1001/jamanetworkopen.2026.22603

. 2026 Jul 2;9(7):e2622603. doi: 10.1001/jamanetworkopen.2026.22603

Contraceptive Progestogens and Incident Meningioma

Nicklas Hasselblad Lundstrøm ¹, Mette Hjorslev Knudgaard ¹, Michael Skaarup Pedersen ², Marie Louise Schougaard Christiansen ¹, Charlotte Wessel Skovlund ^3,^✉

¹Division of Pharmacovigilance and Quality Management, Danish Medicines Agency, Copenhagen, Denmark

²Regulatory and Clinical Assessment, Danish Medicines Agency, Copenhagen, Denmark

³Data Analytics, Danish Medicines Agency, Copenhagen, Denmark

Accepted for Publication: May 14, 2026.

Published: July 2, 2026. doi:10.1001/jamanetworkopen.2026.22603

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License, which does not permit alteration or commercial use, including those for text and data mining, AI training, and similar technologies. © 2026 Hasselblad Lundstrøm N et al. JAMA Network Open.

^✉

Corresponding Author: Charlotte Wessel Skovlund, PhD, Data Analytics, Danish Medicines Agency, Axel Heides gade 1, Copenhagen 2300 S, Denmark (charlotte.skovlund@gmail.com).

Author Contributions: Dr Wessel Skovlund had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Hasselblad Lundstrøm and Hjorslev Knudgaard contributed equally as co–first authors.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Hasselblad Lundstrøm, Hjorslev Knudgaard, Schougaard Christiansen, Wessel Skovlund.

Drafting of the manuscript: Hasselblad Lundstrøm, Hjorslev Knudgaard, Wessel Skovlund.

Critical review of the manuscript for important intellectual content: Hasselblad Lundstrøm, Skaarup Pedersen, Schougaard Christiansen.

Statistical analysis: Hjorslev Knudgaard, Skaarup Pedersen, Wessel Skovlund.

Administrative, technical, or material support: Hasselblad Lundstrøm, Schougaard Christiansen.

Supervision: Hasselblad Lundstrøm, Schougaard Christiansen, Wessel Skovlund.

Conflict of Interest Disclosures: None reported.

Data Sharing Statement: See Supplement 2.

Additional Contributions: We thank Søren Friis, MD, Danish Cancer Institute, Danish Cancer Society, for valuable guidance and help with the definition of meningioma codes and statistical programmer Susanne Bruun for reviewing the SAS programs. No compensation was received for this work, and written permission was obtained to include them in the acknowledgments.

Additional Information: The study was conducted by the Danish Medicines Agency, which is a government authority under the Ministry of Health in Denmark. No external funding was used.

^✉

Corresponding author.

PMCID: PMC13329708 PMID: 42390859

Key Points

Question

What is the association between the use of different contraceptive progestogens and the risk of meningioma?

Findings

In this 25-year nationwide case-control study, the use of several contraceptive progestogens was associated with an increased risk of meningioma. Odds ratios of meningioma were generally higher for current or recent use within the past year.

Meaning

These findings suggest that the risk of meningioma may extend beyond high-dose progestogens and medroxyprogesterone injections to include some contraceptive progestogens, including high-dose intrauterine devices with levonorgestrel.

Abstract

Importance

Meningioma is a known adverse reaction of high-dose progestogens, but evidence regarding the risk associated with progestogens used as contraception is limited.

Objective

To examine whether different progestogens used as hormonal contraception are associated with increased risk of meningiomas.

Design, Setting, and Participants

This nested case-control study conducted over a 25-year study period from January 1, 2000, to December 31, 2024, is a Danish nationwide population-based register study, which included 3 million females aged 15 to 59 years with residence in Denmark. Meningioma cases were dentified, and for each case, 10 controls were matched on age, birthplace, and marital status and randomly selected from the cohort if considered eligible on the day of the case’s meningioma diagnosis. Data were analyzed from July 10, 2025, to May 12, 2026.

Exposure

Use of progestogens was identified in the registers by date of dispensing or procedural records and grouped by route of administration and active substance. Exposure time was determined by redeemed daily doses or product duration. If a female switched to a different product or became pregnant, her exposure time was changed to the new exposure. The females included were allocated to their most recent use, defined as the exposure closest to the matching date.

Main Outcomes and Measures

The main outcome was incident meningioma and was identified in the Danish National Cancer Register using validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses and International Classification of Diseases for Oncology, Third Edition codes.

Results

A total of 1473 cases and 14 717 controls with a median age of 48 years (IQR, 42-53 years) were included in the nested cohort. For combined oral contraceptives, the estimated odds ratios (ORs) for the association between use of progestogens and meningioma were 1.61 (95% CI, 1.00-2.59) with cyproterone, 1.66 (95% CI, 1.31-2.10) with desogestrel, 1.58 (95% CI, 1.05-2.37) with drospirenone, 1.44 (95% CI, 1.17-1.77) with gestodene, 1.40 (95% CI, 1.12-1.76) with levonorgestrel, 1.38 (95% CI, 0.77-2.47) with norethisterone, and 1.04 (95% CI, 0.70-1.54) with norgestimate. For oral progestogen-only contraceptives, the ORs were 1.73 (95% CI, 1.17-2.56) with desogestrel and 0.95 (95% CI, 0.57-1.57) with norethisterone. For injectable medroxyprogesterone, the OR was 4.55 (95% CI, 2.19-9.45). For intrauterine devices (IUDs) with high-dose levonorgestrel, the OR was 1.58 (95% CI, 1.28-1.94), and for IUDs with low-dose levonorgestrel, the OR was 1.14 (95% CI, 0.59-2.22). Exposure within the past year was associated with the highest risk.

Conclusions and Relevance

In this case-control study conducted using data from the entire Danish population, recent use of the contraceptive progestogens cyproterone, desogestrel, drospirenone, gestodene, levonorgestrel, injectable medroxyprogesterone, and high-dose IUD was associated with increased risk of meningioma. These findings are considered relevant information for the treated women and the prescribing physicians.

This case-control study uses Danish registry data to examine whether different progestogens used as hormonal contraception are associated with risk of meningiomas.

Introduction

Meningioma is the most common intracranial tumor in adults, representing 38% to 42% of all primary central nervous system tumors.^1,2,3 Although benign in approximately 90% of cases, it can cause seizures, cognitive impairment, and focal neurological deficits and often requires surgical and/or radiotherapeutic treatment with risks of complications and recurrence.³ Population-based data from the United States show an incidence rate of 10.15 per 100 000 persons overall, with rates of 13.90 and 6.02 for women and men, respectively.¹ In Denmark, the incidence is 12.6 per 100 000 persons overall, with 17.9 and 7.4 per 100 000 for women and men, respectively.⁴ The consistently higher incidence among women across populations supports a hormonal role in meningioma development.

Biological plausibility is supported by the presence of progesterone receptors in up to 87% of all meningiomas.⁵ Clinical observations describe tumor growth during pregnancy and with exogenous progestogen therapy, followed by regression of the tumor after delivery or after withdrawal of treatment.^{6,7,8,9,10,11,12}

In recent years, the risk of meningioma with different progestogens has been assessed on separate occasions by the European Medicines Agency. For cyproterone,^13,14 nomegestrol,¹⁵ chlormadinone,¹⁵ and medroxyprogesterone,¹⁶ the product information of the respective progestogens was updated to inform about the risk of meningioma. Currently, an evaluation of the risk of meningioma with etonogestrel and desogestrel is ongoing.¹⁷

Although an increased risk of meningioma has been established for several high-dose progestogens, conflicting evidence for hormonal contraceptives remains, with most studies evaluating broad categories such as oral contraceptives or intrauterine devices. Some report an association,^18,19,20 whereas others do not,^21,22 and a few suggest a risk for specific substances, such as desogestrel and medroxyprogesterone, but not for others.^{23,24,25,26,27}

Due to the potentially serious consequences of meningiomas and because they have been identified as an adverse drug reaction of several progestogens, it is important to investigate whether progestogens used for contraception also carry this risk. To the authors’ knowledge, this study is the first to assess meningioma risk systematically by hormonal composition across all contraceptive types in a cohort of females, while taking the timing of use, pregnancy, and prior use of hormone replacement therapy (HRT) into consideration.

Methods

Study Design

This nested case-control study was conducted using nationwide, population-based Danish registers, including administrative and health registers covering all Danish residents. Linking at a personal level is possible due to a personal registration number allocated to all citizens at birth or on immigration. Health care in Denmark is tax funded, providing equal access for all residents, and information on vital status and migration status is considered complete.

Hormonal contraception includes multiple different products with a wide variety of active substances and different routes of administration. When grouping them on individual progestogens and when also considering that meningioma is rare among women of reproductive age using hormonal contraceptives, this will inevitably result in multiple small exposure groups. Given this context, a nested case-control design rather than a full cohort approach was chosen. This design is well suited when studying many and rare exposures, as it allows for efficient estimation without the need to model the entire cohort while preserving the underlying risk-set structure.

In addition, the matching in the nested case-control design allows for the control of key confounders by design (age, time period, birthplace, and marital status). This is particularly important in the presence of small exposure groups, where conventional regression-based adjustment in a full cohort setting would not be possible. Furthermore, in the nested case-control study design, key parameters such as time since exposure and duration could easily be taken into account.²⁸

Setting and Participants

The background population included females aged 15 to 59 years living in Denmark during the study period (2000-2024) with no registered diagnosis of neurofibromatosis. From this population, eligible cases were identified as females with a validated diagnosis of meningioma in the National Cancer Register.²⁹ The date of diagnosis was set as the index date. Cases were excluded if they had redeemed a prescription of HRT, antiandrogen medication, or infertility hormones before the index date; if they had a cancer diagnosis prior to the index date; or if they immigrated within 5 years before the index date. See eTable 1 in Supplement 1 for an overview of data sources and definitions of variables.

For each case, 10 controls were randomly selected from the background population. The controls had to be alive and with no previous meningioma diagnosis at the index date. Controls and cases were matched at index date on age, place of birth (municipality in Denmark or continent for women not born in Denmark), and marital status. The same exclusion criteria as those used for the cases were applied for the controls. See Figure 1 for a graphical representation of the study design.

Exposure

Information on hormonal contraception use was derived mainly from the Danish National Prescription Register, supplemented with information from the National Patient Register and the National Hospital Medication Register. The progestogens were grouped by route of administration, and oral products were grouped by either 1 of the 2 following categories: combined oral contraceptives (with estrogen) or oral progestogen-only contraceptives. Hormone intrauterine devices (IUDs) were further divided into high dose (52 mg) or low dose (13.5 and 19.5 mg). A list of the progestogens authorized for contraception and used in Denmark during the study period is shown in eTable 2 in Supplement 1. Start of exposure was defined as the dispensing date or the procedure or administration date for progestogens administered at the hospital. The end date of the treatment was defined by the end of the days of supply or the end of the duration of the device (5 years for the 52-mg IUD and the 19.5-mg IUD and 3 years for the 13.5-mg IUD and the implant). If a new hormonal contraceptive was initiated before the exposure time of the previous one had expired, the exposure time on the first product was defined as stopped on the start date of the new product, and the exposure time was from then on allocated to the newest product. If a woman was registered with a pregnancy (birth or abortion), the exposure time was defined as stopped on the estimated day of the pregnancy start. For pregnancies resulting in a birth, the time during pregnancy was included as a separate exposure group, to account for a possible increased risk during and right after a pregnancy. Time since exposure was then calculated as the time from the exposure end date to the index date and divided into the 4 categories: current use (<1 year), recent use (1-5 years), former use (>5 years), and no use. Duration of exposure was calculated as the cumulative exposure time in each group and divided into the following categories: 0 to 1 year, 1 to 5 years, 5 or more years, and no use.

For the analyses, the women were allocated to the exposure category that they had been exposed to most recently (relative to index date) according to the “time since exposure” categories. If a woman’s “time since exposure” category was the same for more than 1 exposure, the one with the longest duration was selected. “No use” was used as reference.

Main Outcomes and Measures

Incident meningioma was defined by having a record of 1 of the specified diagnoses of meningioma (including spinal meningioma) together with 1 of the selected morphology codes in the National Cancer Register with data available for the period 1978 to 2024 (codes are specified in eTable 1 in Supplement 1). Odds ratios (ORs) were estimated for the defined hormonal contraception exposure groups. Results are presented only for groups with 5 or more events to comply with the rules of the General Data Protection Regulation. Numbers needed to harm were calculated in 5-year age groups under the assumption that the ORs for the progestogen-meningioma association did not differ across age groups.

Statistical Analysis

A stratified Cox proportional hazards model (PROC PHREG in SAS) was used to estimate the association between the defined exposure groups of interest and meningioma. Each matching risk set was defined at the index date and treated as a stratum. An artificial time variable (set to a constant value of 1 for all observations) was introduced to calculate ORs equivalent to what would be estimated by conditional logistic regression, thereby effectively controlling for the variables also used for matching. Additionally, the exposure groups were stratified by time since exposure and duration of exposure. To evaluate the robustness of the results, multiple sensitivity analyses were conducted. First, the main analysis was adjusted for parity. Second, a sensitivity analysis (no mixed use) including women who had only used 1 type of hormonal contraception during the past 5 years was conducted to minimize influence from prior exposure to other progestogens. Third, an analysis that included only premenopausal females (ie, 15-49 years) was done to test whether the estimates were different if menopausal females were excluded and to exclude a potential effect from HRT not captured by the exclusion criteria. Finally, a sensitivity analysis in which only intracranial meningiomas were included was conducted.

Data management was conducted on the Danish Health Data Authority’s secure server, complying with national data security and privacy guidelines. In Denmark, informed consent and ethical approval are not required for studies based on nationwide health registries. Statistical software SAS, version 9.4 (SAS Institute) and R studio, version 4.3 (R Project for Statistical Computing) were used. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for case-control studies was adhered to. Data were analyzed from July 10, 2025, to May 12, 2026.

Results

From the background population of 3 million females aged 15 to 59 years, 2606 cases with meningioma were identified, and after exclusions, 1473 cases and 14 717 controls were eligible for inclusion. A flowchart of the selection process is shown in Figure 2. The median age of the women in the case group was 48 years (IQR, 42-53 years). Demographic characteristics are presented in eTable 3 in Supplement 1. Descriptive statistics for the different hormonal contraceptive groups are shown in Table 1. For cases, the mean (SD) age was youngest for users of low-dose IUD (41.1 [6.7] years) and oldest for nonusers (51.5 [6.8] years). The mean (SD) time since exposure for cases was 0.0 (0.0) years for low-dose IUD due to the product being relatively new on the market; on the other hand, the mean (SD) time since exposure for combined oral contraceptive with norethisterone was 11.0 (8.6) years. The mean (SD) duration for cases was longest for high-dose IUDs (5.5 [3.2] years) and shortest for low-dose IUDs (2.8 [1.1] years).

Table 1. Use of Hormonal Contraception for Cases and Controls.

Type of progestogen	Cases				Controls
Type of progestogen	Women, No. (%)	Age, mean (SD), y	Time since exposure, mean (SD), y	Duration of use, mean (SD), y	Women, No. (%)	Age, mean (SD), y	Time since exposure, mean (SD), y	Duration of use, mean (SD), y
No use	384 (26)	51.5 (6.8)	NA	NA	4465 (30)	50.6 (7.3)	NA	NA
Combined oral contraceptives
Cyproterone	21 (1.4)	42.2 (11.6)	5.9 (6.4)	4.5 (4.4)	177 (1.2)	44.6 (8.1)	7.3 (7.3)	5.4 (4.3)
Desogestrel	119 (8.1)	45.7 (7.6)	7.7 (7.0)	4.8 (4.6)	953 (6.5)	45.4 (8.3)	7.6 (7.0)	5.1 (4.6)
Drospirenone	30 (2.0)	42.1 (8.5)	2.6 (3.6)	2.9 (3.0)	255 (1.7)	42.5 (8.4)	4.9 (5.2)	3.0 (3.1)
Gestodene	177 (12)	46.2 (7.5)	6.3 (6.5)	5.7 (5.1)	1636 (11)	44.9 (8.3)	7.4 (6.7)	5.4 (4.6)
Levonorgestrel	136 (9.2)	42.1 (10.3)	4.5 (6.1)	4.7 (4.0)	1295 (8.8)	43.8 (9.8)	5.3 (6.5)	5.1 (4.6)
Norethisterone	13 (0.9)	46.6 (8.9)	11 (8.6)	2.9 (2.7)	119 (0.8)	49.0 (7.2)	11 (7.5)	3.7 (2.9)
Norgestimate	31 (2.1)	47.6 (7.7)	9.3 (7.6)	3.6 (4.4)	396 (2.7)	45.4 (8.0)	7.9 (6.7)	4.5 (4.1)
Oral progestogen-only contraceptives
Desogestrel	35 (2.4)	42.8 (8.4)	1.2 (2.3)	3.1 (2.9)	284 (1.9)	43.5 (7.6)	1.7 (3.2)	3.3 (3.2)
Norethisterone	17 (1.2)	47.9 (6.7)	5.7 (6.5)	3.8 (3.8)	232 (1.6)	46.9 (8.1)	6.3 (6.9)	3.5 (3.7)
Long-acting reversible contraceptives
Medroxyprogesterone (injection)	10 (0.7)	45.2 (7.3)	2.6 (7.5)	4.1 (3.7)	29 (0.2)	43.8 (10.1)	6.8 (7.4)	4.7 (4.8)
Levonorgestrel (high-dose IUD)	235 (16)	46.8 (6.4)	1.2 (2.3)	5.5 (3.2)	2062 (14)	46.6 (6.1)	1.4 (2.7)	5.6 (3.5)
Levonorgestrel (low-dose IUD)	11 (0.7)	41.1 (6.7)	0.0 (0.0)	2.8 (1.1)	136 (0.9)	38.2 (8.2)	0.3 (0.9)	2.9 (1.6)

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Abbreviations: IUD, intrauterine device; NA, not applicable.

In Figure 3, ORs for the association between most recent use of the respective progestogens and meningioma are shown for the main analysis of the cohort aged 15 to 59 years and stratified by current use and additionally by duration among current users. In the main analysis, among the 1473 cases and 14 717 controls, for combined oral contraceptives the estimated odds ratios (ORs) for the association between use of progestogens and meningioma were 1.61 (95% CI, 1.00-2.59) with cyproterone, 1.66 (95% CI, 1.31-2.10) with desogestrel, 1.58 (95% CI, 1.05-2.37) with drospirenone, 1.44 (95% CI, 1.17-1.77) with gestodene, 1.40 (95% CI, 1.12-1.76) with levonorgestrel, 1.38 (95% CI, 0.77-2.47) with norethisterone, and 1.04 (95% CI, 0.70-1.54) with norgestimate. For oral progestogen-only contraceptives, the ORs were 1.73 (95% CI, 1.17-2.56) with desogestrel and 0.95 (95% CI, 0.57-1.57) with norethisterone. For injectable medroxyprogesterone, the OR was 4.55 (95% CI, 2.19-9.45). For IUDs with high-dose levonorgestrel, the OR was 1.58 (95% CI, 1.28-1.94); the increased risk was first evident after use for more than 1 year. For IUDs with low-dose levonorgestrel, the OR was 1.14 (95% CI, 0.59-2.22). Exposure within the past year was associated with the highest risk. From the stratified analyses, time since exposure was found to be a significant parameter, with risk estimates being highest among current users, and the association disappeared 5 years after discontinuation except for desogestrel as combined oral contraceptive (eFigure 1 in Supplement 1).

Stratification by duration of use among those with most recent use of hormone contraception showed inconsistent results across the different hormonal contraceptive groups, probably due to effects from other more significant parameters, such as time since exposure. Therefore, duration was examined only for current use to ensure that the results were not affected by time since exposure. This stratified analysis suggests a tendency toward an increased risk with increasing duration and no increased risk for duration less than 1 year (Figure 3). However, for some progestogens, there was insufficient power to examine duration of use.

The sensitivity analysis in which the results of the main analysis were adjusted for parity did not change the results significantly. Sensitivity analyses for women with use of only 1 type of hormonal contraceptive in the 5-year period prior to meningioma diagnosis, for premenopausal females (ie, 15-49 years), and for a reduced cohort only including intracranial meningiomas yielded similar results as the main analysis (eFigure 2 in Supplement 1). However, women with a pregnancy during the year before the index date had a slightly increased risk of meningioma (OR, 1.32 [95% CI, 1.08-1.61]). The numbers needed to harm according to progestogen type and age group are shown in Table 2.

Table 2. Numbers Needed to Harm for 1 Additional Meningioma Diagnosis Per Year of Use According to Type of Progestogen and Age Group.

Type and progestogen	Number needed to harm, by age group, y
Type and progestogen	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59
Combined oral contraceptives
Cyproterone	2 597 771	573 227	256 163	140 251	59 613	34 528	25 091	26 278	31 081
Desogestrel	2 414 847	532 863	238 125	130 375	55 416	32 097	23 324	24 428	28 892
Drospirenone	2 739 966	604 604	270 185	147 928	62 876	36 418	26 464	27 717	32 782
Gestodene	3 627 812	800 517	357 734	195 861	83 250	48 219	35 040	36 697	43 404
Levonorgestrel	3 941 308	869 693	388 647	212 787	90 444	52 386	38 067	39 868	47 155
Norethisterone	4 225 361	932 373	416 657	228 122	96 963	56 161	40 811	42 742	50 553
Norgestimate	37 955 493	8 375 294	3 742 732	2 049 164	870 986	504 473	366 587	383 932	454 101
Oral progestogen-only contraceptives
Desogestrel	2 170 443	478 933	214 025	117 180	49 807	28 849	20 964	21 956	25 968
Long-acting reversible contraceptives
Medroxyprogesterone (injection)	448 937	99 064	44 270	24 238	10 303	5968	4337	4542	5372
Levonorgestrel (high-dose IUD)	2 749 683	606 748	271 143	148 452	63 099	36 547	26 558	27 815	32 898
Levonorgestrel (low-dose IUD)	11 034 031	2 434 780	1 088 049	595 713	253 205	146 656	106 571	111 613	132 012

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Abbreviation: IUD, intrauterine device.

Discussion

Principal Findings

In this nationwide case-control study of females aged 15 to 59 years, several progestogen-containing contraceptives were associated with an increased risk of meningioma. The risk estimates were highest for medroxyprogesterone injections. An increased risk was also found for combined oral contraceptives with cyproterone, desogestrel, drospirenone, gestodene, and levonorgestrel; for desogestrel as progestogen-only contraceptive; and for high-dose IUD. Generally, 5 years after discontinuation, the increased risk was no longer present.

Comparison With Prior Studies

In line with previous studies,^22,24,25,26 the present study found a highly increased risk of meningioma with medroxyprogesterone injections. As in this study, Roland et al^23,24 found an increased risk of meningioma with current use of cyproterone and desogestrel (as oral progestogen-only contraceptive). Roland et al 2025²⁴ found no increased risk with levonorgestrel as IUD (neither for 13.5 mg nor 52 mg). Except for the studies by Roland et al,^23,24 none of the previous studies differentiate between current use and prior use, which may have skewed the results toward the null hypothesis, as the studies by Roland et al^23,24 and the present study suggest that the timing of exposure is important (ie, current use).

Generally, in previous studies, the use of HRT was not taken into account even though some studies report an increased risk of meningioma with HRT.^30,31 In Roland et al,²⁴ the authors could only partially adjust for HRT, as data for nonreimbursed treatments were unavailable. This could potentially have underestimated the risk, as the underlying cohort’s risk may be increased due to use of HRT. In the present study, all women with a prescription of HRT (or other relevant hormones) prior to index date were excluded (n = 944; approximately 36% of the cases).

Although not a primary exposure of interest, an increased risk of meningioma was observed among women with a pregnancy during the year preceding the index date. Given the pronounced increase of progesterone during pregnancy, the frequent expression of progesterone receptors in meningiomas,^5,32 and the consistently higher incidence observed among women,^1,4 a pregnancy-related effect is biologically plausible and has been described in the literature over several decades, although not confirmed in larger epidemiological studies.^8,9,10,33,34 This association between recent pregnancy and meningioma risk contrasts with findings from a Swedish register-based study that did not observe an increased risk,³⁵ highlighting the need for studies specifically designed to evaluate pregnancy-related meningioma risk.

Implications

The numbers needed to harm differed greatly depending on the specific progestogen used and the age group with the highest risk observed for the oldest women. Medroxyprogesterone showed the highest risk with relatively low numbers needed to harm, whereas all combined oral contraceptives, oral progestogen-only contraceptives, and IUDs had relatively high numbers needed to harm, especially among the youngest women. However, the present study suggests an increased risk of meningioma for several progestogens not previously associated with meningioma. This study also shows that the excess risk of meningioma disappears 5 years after discontinuation. These findings are considered relevant information for the treated women and the prescribing physicians.

Strengths and Limitations

Denmark is known for its high-quality nationwide registers with complete information on population demographics, detailed information about long-term medication use, and complete follow-up information with no risk of recall bias. The outcome was defined as a first-time meningioma diagnosis recorded in the National Cancer Register, which is recognized for its high validity and completeness of cancer diagnoses.²⁹

A nested case-control design was selected, enabling inclusion of multiple categories of hormonal contraception and allowing for the incorporation of factors such as time since exposure and duration of use. This design also has the advantage of effectively controlling for the matching variables (age, birthplace and marital status), for which adjustment in a cohort study could be challenging due to the rarity of meningiomas. At least 5 years of prior hormone prescriptions were ensured by study design, and women with known potential risk factors such as hormone therapy and cancer diagnoses were excluded. Finally, 4 sensitivity analyses were performed: (1) among women who had used only 1 type of hormonal contraception, (2) in a premenopausal cohort of females 15 to 49 years old, (3) in which the results of the main analysis were adjusted for parity, and (4) in a cohort including only intracranial meningiomas. All displayed consistent results supporting the results of the main analysis.

This study has several limitations. One is that some women may have had their long-acting reversible contraception removed before the end of the recommended use period. If they did not switch to another hormonal contraceptive or became pregnant, their subsequent time would still be allocated to this exposure category, even though they were not exposed anymore. This could lead to an underestimation of the risk.

Risk estimates could be calculated only for progestogens used in Denmark during the study period and for which more than 5 meningioma cases were observed. Therefore, some progestogens were not examined in this study.

For norethisterone and norgestimate as a part of combined oral contraceptives, the mean time since exposure was long, and the proportion of current users was low. Therefore, the study could not provide reliable information on these substances. The low-dose IUD has recently been introduced to the market, and therefore the short duration may explain the absence of an association for levonorgestrel as a low-dose IUD in the analysis.

Conclusions

This case-control study found that recent use of combined oral contraceptives with cyproterone, desogestrel, drospirenone, gestodene, and levonorgestrel was associated with a slightly increased risk of meningioma. Desogestrel as oral progestogen-only contraceptive also showed a slightly increased risk. High-dose IUD with levonorgestrel was found to increase the risk when used for more than 1 year. The high increased risk for medroxyprogesterone injections found in prior studies was confirmed.

Supplement 1.

eTable 1. Overview of data sources and definitions of variables

eReferences.

eTable 2. List of progestogens and corresponding medicinal products used for contraception that were authorized in Denmark in the period 1995-2024

eTable 3. Demographic characteristics of the nested cohort of women selected as cases or controls

eFigure 1. Main analyses stratified by “time since exposure” to progestogen of interest

eFigure 2. Sensitivity analyses: 1) adjusted for parity, 2) no mixed use (only one type of progestogen used within 5 years from index date), 3) premenopausal women aged 15 to 49 years and 4) intracranial meningiomas only

jamanetwopen-e2622603-s001.pdf^{(1MB, pdf)}

Supplement 2.

Data Sharing Statement

jamanetwopen-e2622603-s002.pdf^{(13.9KB, pdf)}

References

1.Price M, Ballard C, Benedetti J, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017-2021. Neuro Oncol. 2024;26(suppl 6):vi1-vi85. doi: 10.1093/neuonc/noae145 [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Cea-Soriano L, Wallander MA, García Rodríguez LA. Epidemiology of meningioma in the United Kingdom. Neuroepidemiology. 2012;39(1):27-34. doi: 10.1159/000338081 [DOI] [PubMed] [Google Scholar]
3.Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821-1834. doi: 10.1093/neuonc/noab150 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Meningiom i Danmark, 2010-2023. Danish Neuro-Oncology Registry (DNOR) . Accessed September 29, 2025. https://dnog.dk/assets/files/dnor-%C3%A5rsrapporter/Meningeomer_OFFICIEL_270625.pdf
5.Baxter DS, Orrego A, Rosenfeld JV, Mathiesen T. An audit of immunohistochemical marker patterns in meningioma. J Clin Neurosci. 2014;21(3):421-426. doi: 10.1016/j.jocn.2013.06.008 [DOI] [PubMed] [Google Scholar]
6.Laviv Y, Bayoumi A, Mahadevan A, Young B, Boone M, Kasper EM. Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy. Acta Neurochir (Wien). 2018;160(8):1521-1529. doi: 10.1007/s00701-017-3146-8 [DOI] [PubMed] [Google Scholar]
7.Bernat AL, Oyama K, Hamdi S, et al. Growth stabilization and regression of meningiomas after discontinuation of cyproterone acetate: a case series of 12 patients. Acta Neurochir (Wien). 2015;157(10):1741-1746. doi: 10.1007/s00701-015-2532-3 [DOI] [PubMed] [Google Scholar]
8.Kerschbaumer J, Freyschlag CF, Stockhammer G, et al. Hormone-dependent shrinkage of a sphenoid wing meningioma after pregnancy: case report. J Neurosurg. 2016;124(1):137-140. doi: 10.3171/2014.12.JNS142112 [DOI] [PubMed] [Google Scholar]
9.Chakravarthy V, Kaplan B, Gospodarev V, Myers H, De Los Reyes K, Achiriloaie A. Houdini tumor: case report and literature review of pregnancy-associated meningioma. World Neurosurg. 2018;114:e1261-e1265. doi: 10.1016/j.wneu.2018.03.187 [DOI] [PubMed] [Google Scholar]
10.Phang SY, Whitfield P. Postpartum regression of a presumed cavernous meningioma. Case Rep Oncol Med. 2016;2016:2649426. doi: 10.1155/2016/2649426 [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Lebeau J, Deprez L, Pintiaux A, Reuter G. Petroclival meningioma regression after combined oestrogen and nomegestrol acetate interruption. BMJ Case Rep. 2025;18(1):e263529. doi: 10.1136/bcr-2024-263529 [DOI] [PMC free article] [PubMed] [Google Scholar]
12.Ahmed-Khalifa T, Gillet R, Blonski M, et al. Radiological evolution of progestogen-induced meningioma: A monocentric retrospective study. Fundam Clin Pharmacol. 2023;37(4):868-878. doi: 10.1111/fcp.12878 [DOI] [PubMed] [Google Scholar]
13.Monthly report. Pharmacovigilance Working Party (PhVWP). November 2009 Plenary Meeting. PhVWP Discussions on safety concerns. European Medicines Agency. Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/report/monthly-report-pharmacovigilance-working-party-phvwp-november-2009-plenary-meeting_en.pdf
14.Pharmacovigilance Risk Assessment Committee (PRAC): assessment report for referral regarding cyproterone acetate. February 13, 2020. European Medicines Agency . Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/referral/cyproterone-article-31-referral-prac-assessment-report_en.pdf
15.Pharmacovigilance Risk Assessment Committee (PRAC): assessment report for referral regarding nomegestrol and chlormadinone. European Medicines Agency . July 13, 2022. Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/referral/nomegestrol-and-chlormadinone-article-31-referral-assessment-report_en.pdf
16.Medroxyprogesterone acetate: Direct Healthcare Professional Communication (DHPC). European Medicines Agency (EMA) . Accessed September 29, 2025. https://www.ema.europa.eu/en/medicines/dhpc/medroxyprogesterone-acetate
17.Pharmacovigilance Risk Assessment Committee (PRAC): minutes of PRAC meeting on 10-12 May 2023. European Medicines Agency . August 18, 2023. Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/minutes/minutes-prac-meeting-10-12-may-2023_en.pdf
18.Muskens IS, Wu AH, Porcel J, et al. Body mass index, comorbidities, and hormonal factors in relation to meningioma in an ethnically diverse population: the multiethnic cohort. Neuro Oncol. 2019;21(4):498-507. doi: 10.1093/neuonc/noz005 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Claus EB, Calvocoressi L, Bondy ML, Wrensch M, Wiemels JL, Schildkraut JM. Exogenous hormone use, reproductive factors, and risk of intracranial meningioma in females. J Neurosurg. 2013;118(3):649-656. doi: 10.3171/2012.9.JNS12811 [DOI] [PMC free article] [PubMed] [Google Scholar]
20.Michaud DS, Gallo V, Schlehofer B, et al. Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study. Cancer Epidemiol Biomarkers Prev. 2010;19(10):2562-2569. doi: 10.1158/1055-9965.EPI-10-0447 [DOI] [PMC free article] [PubMed] [Google Scholar]
21.Cea-Soriano L, Blenk T, Wallander MA, Rodríguez LAG. Hormonal therapies and meningioma: is there a link? Cancer Epidemiol. 2012;36(2):198-205. doi: 10.1016/j.canep.2011.08.003 [DOI] [PubMed] [Google Scholar]
22.Anic GM, Madden MH, Nabors LB, et al. Reproductive factors and risk of primary brain tumors in women. J Neurooncol. 2014;118(2):297-304. doi: 10.1007/s11060-014-1427-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
23.Roland N, Neumann A, Hoisnard L, 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 [DOI] [PMC free article] [PubMed] [Google Scholar]
24.Roland N, Kolla E, Baricault B, et al. Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study. BMJ. 2025;389:e083981. doi: 10.1136/bmj-2024-083981 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Xiao T, Kumar P, Lobbous M, et al. Depot medroxyprogesterone acetate and risk of meningioma in the US. JAMA Neurol. 2025;82(11):1094-1102. doi: 10.1001/jamaneurol.2025.3011 [DOI] [PMC free article] [PubMed] [Google Scholar]
26.Tettamanti G, Shu X, Mogensen H, Kopp Kallner H, Mathiesen T, Feychting M. Hormonal contraceptives and the risk of meningioma: a Swedish register-based case-control study. Neuro Oncol. 2026;28(2):552-561. doi: 10.1093/neuonc/noaf228 [DOI] [PMC free article] [PubMed] [Google Scholar]
27.Griffin RL. The Association between medroxyprogesterone acetate exposure and meningioma. Cancers (Basel). 2024;16(19):3362. doi: 10.3390/cancers16193362 [DOI] [PMC free article] [PubMed] [Google Scholar]
28.Pottegård A. Core concepts in pharmacoepidemiology: fundamentals of the cohort and case-control study designs. Pharmacoepidemiol Drug Saf. 2022;31(8):817-826. doi: 10.1002/pds.5482 [DOI] [PMC free article] [PubMed] [Google Scholar]
29.Gjerstorff ML. The Danish Cancer Registry. Scand J Public Health. 2011;39(7)(suppl):42-45. doi: 10.1177/1403494810393562 [DOI] [PubMed] [Google Scholar]
30.Andersen L, Friis S, Hallas J, Ravn P, Schrøder HD, Gaist D. Hormone replacement therapy increases the risk of cranial meningioma. Eur J Cancer. 2013;49(15):3303-3310. doi: 10.1016/j.ejca.2013.05.026 [DOI] [PubMed] [Google Scholar]
31.Pourhadi N, Meaidi A, Friis S, Torp-Pedersen C, Mørch LS. Menopausal hormone therapy and central nervous system tumors: Danish nested case-control study. PLoS Med. 2023;20(12):e1004321. doi: 10.1371/journal.pmed.1004321 [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114(6):1326-1331. doi: 10.1097/AOG.0b013e3181c2bde8 [DOI] [PubMed] [Google Scholar]
33.Bickerstaff ER, Small JM, Guest IA. The relapsing course of certain meningiomas in relation to pregnancy and menstruation. J Neurol Neurosurg Psychiatry. 1958;21(2):89-91. doi: 10.1136/jnnp.21.2.89 [DOI] [PMC free article] [PubMed] [Google Scholar]
34.Saitoh Y, Oku Y, Izumoto S, Go J. Rapid growth of a meningioma during pregnancy: relationship with estrogen and progesterone receptors—case report. Neurol Med Chir (Tokyo). 1989;29(5):440-443. doi: 10.2176/nmc.29.440 [DOI] [PubMed] [Google Scholar]
35.Pettersson-Segerlind J, Mathiesen T, Elmi-Terander A, et al. The risk of developing a meningioma during and after pregnancy. Sci Rep. 2021;11(1):9153. doi: 10.1038/s41598-021-88742-2 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eTable 1. Overview of data sources and definitions of variables

eReferences.

eTable 2. List of progestogens and corresponding medicinal products used for contraception that were authorized in Denmark in the period 1995-2024

eTable 3. Demographic characteristics of the nested cohort of women selected as cases or controls

eFigure 1. Main analyses stratified by “time since exposure” to progestogen of interest

jamanetwopen-e2622603-s001.pdf^{(1MB, pdf)}

Supplement 2.

Data Sharing Statement

jamanetwopen-e2622603-s002.pdf^{(13.9KB, pdf)}

[zoi260628r1] 1.Price M, Ballard C, Benedetti J, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017-2021. Neuro Oncol. 2024;26(suppl 6):vi1-vi85. doi: 10.1093/neuonc/noae145 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r2] 2.Cea-Soriano L, Wallander MA, García Rodríguez LA. Epidemiology of meningioma in the United Kingdom. Neuroepidemiology. 2012;39(1):27-34. doi: 10.1159/000338081 [DOI] [PubMed] [Google Scholar]

[zoi260628r3] 3.Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821-1834. doi: 10.1093/neuonc/noab150 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r4] 4.Meningiom i Danmark, 2010-2023. Danish Neuro-Oncology Registry (DNOR) . Accessed September 29, 2025. https://dnog.dk/assets/files/dnor-%C3%A5rsrapporter/Meningeomer_OFFICIEL_270625.pdf

[zoi260628r5] 5.Baxter DS, Orrego A, Rosenfeld JV, Mathiesen T. An audit of immunohistochemical marker patterns in meningioma. J Clin Neurosci. 2014;21(3):421-426. doi: 10.1016/j.jocn.2013.06.008 [DOI] [PubMed] [Google Scholar]

[zoi260628r6] 6.Laviv Y, Bayoumi A, Mahadevan A, Young B, Boone M, Kasper EM. Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy. Acta Neurochir (Wien). 2018;160(8):1521-1529. doi: 10.1007/s00701-017-3146-8 [DOI] [PubMed] [Google Scholar]

[zoi260628r7] 7.Bernat AL, Oyama K, Hamdi S, et al. Growth stabilization and regression of meningiomas after discontinuation of cyproterone acetate: a case series of 12 patients. Acta Neurochir (Wien). 2015;157(10):1741-1746. doi: 10.1007/s00701-015-2532-3 [DOI] [PubMed] [Google Scholar]

[zoi260628r8] 8.Kerschbaumer J, Freyschlag CF, Stockhammer G, et al. Hormone-dependent shrinkage of a sphenoid wing meningioma after pregnancy: case report. J Neurosurg. 2016;124(1):137-140. doi: 10.3171/2014.12.JNS142112 [DOI] [PubMed] [Google Scholar]

[zoi260628r9] 9.Chakravarthy V, Kaplan B, Gospodarev V, Myers H, De Los Reyes K, Achiriloaie A. Houdini tumor: case report and literature review of pregnancy-associated meningioma. World Neurosurg. 2018;114:e1261-e1265. doi: 10.1016/j.wneu.2018.03.187 [DOI] [PubMed] [Google Scholar]

[zoi260628r10] 10.Phang SY, Whitfield P. Postpartum regression of a presumed cavernous meningioma. Case Rep Oncol Med. 2016;2016:2649426. doi: 10.1155/2016/2649426 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r11] 11.Lebeau J, Deprez L, Pintiaux A, Reuter G. Petroclival meningioma regression after combined oestrogen and nomegestrol acetate interruption. BMJ Case Rep. 2025;18(1):e263529. doi: 10.1136/bcr-2024-263529 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r12] 12.Ahmed-Khalifa T, Gillet R, Blonski M, et al. Radiological evolution of progestogen-induced meningioma: A monocentric retrospective study. Fundam Clin Pharmacol. 2023;37(4):868-878. doi: 10.1111/fcp.12878 [DOI] [PubMed] [Google Scholar]

[zoi260628r13] 13.Monthly report. Pharmacovigilance Working Party (PhVWP). November 2009 Plenary Meeting. PhVWP Discussions on safety concerns. European Medicines Agency. Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/report/monthly-report-pharmacovigilance-working-party-phvwp-november-2009-plenary-meeting_en.pdf

[zoi260628r14] 14.Pharmacovigilance Risk Assessment Committee (PRAC): assessment report for referral regarding cyproterone acetate. February 13, 2020. European Medicines Agency . Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/referral/cyproterone-article-31-referral-prac-assessment-report_en.pdf

[zoi260628r15] 15.Pharmacovigilance Risk Assessment Committee (PRAC): assessment report for referral regarding nomegestrol and chlormadinone. European Medicines Agency . July 13, 2022. Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/referral/nomegestrol-and-chlormadinone-article-31-referral-assessment-report_en.pdf

[zoi260628r16] 16.Medroxyprogesterone acetate: Direct Healthcare Professional Communication (DHPC). European Medicines Agency (EMA) . Accessed September 29, 2025. https://www.ema.europa.eu/en/medicines/dhpc/medroxyprogesterone-acetate

[zoi260628r17] 17.Pharmacovigilance Risk Assessment Committee (PRAC): minutes of PRAC meeting on 10-12 May 2023. European Medicines Agency . August 18, 2023. Accessed September 24, 2025. https://www.ema.europa.eu/en/documents/minutes/minutes-prac-meeting-10-12-may-2023_en.pdf

[zoi260628r18] 18.Muskens IS, Wu AH, Porcel J, et al. Body mass index, comorbidities, and hormonal factors in relation to meningioma in an ethnically diverse population: the multiethnic cohort. Neuro Oncol. 2019;21(4):498-507. doi: 10.1093/neuonc/noz005 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r19] 19.Claus EB, Calvocoressi L, Bondy ML, Wrensch M, Wiemels JL, Schildkraut JM. Exogenous hormone use, reproductive factors, and risk of intracranial meningioma in females. J Neurosurg. 2013;118(3):649-656. doi: 10.3171/2012.9.JNS12811 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r20] 20.Michaud DS, Gallo V, Schlehofer B, et al. Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study. Cancer Epidemiol Biomarkers Prev. 2010;19(10):2562-2569. doi: 10.1158/1055-9965.EPI-10-0447 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r21] 21.Cea-Soriano L, Blenk T, Wallander MA, Rodríguez LAG. Hormonal therapies and meningioma: is there a link? Cancer Epidemiol. 2012;36(2):198-205. doi: 10.1016/j.canep.2011.08.003 [DOI] [PubMed] [Google Scholar]

[zoi260628r22] 22.Anic GM, Madden MH, Nabors LB, et al. Reproductive factors and risk of primary brain tumors in women. J Neurooncol. 2014;118(2):297-304. doi: 10.1007/s11060-014-1427-0 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r23] 23.Roland N, Neumann A, Hoisnard L, 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 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r24] 24.Roland N, Kolla E, Baricault B, et al. Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study. BMJ. 2025;389:e083981. doi: 10.1136/bmj-2024-083981 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r25] 25.Xiao T, Kumar P, Lobbous M, et al. Depot medroxyprogesterone acetate and risk of meningioma in the US. JAMA Neurol. 2025;82(11):1094-1102. doi: 10.1001/jamaneurol.2025.3011 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r26] 26.Tettamanti G, Shu X, Mogensen H, Kopp Kallner H, Mathiesen T, Feychting M. Hormonal contraceptives and the risk of meningioma: a Swedish register-based case-control study. Neuro Oncol. 2026;28(2):552-561. doi: 10.1093/neuonc/noaf228 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r27] 27.Griffin RL. The Association between medroxyprogesterone acetate exposure and meningioma. Cancers (Basel). 2024;16(19):3362. doi: 10.3390/cancers16193362 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r28] 28.Pottegård A. Core concepts in pharmacoepidemiology: fundamentals of the cohort and case-control study designs. Pharmacoepidemiol Drug Saf. 2022;31(8):817-826. doi: 10.1002/pds.5482 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r29] 29.Gjerstorff ML. The Danish Cancer Registry. Scand J Public Health. 2011;39(7)(suppl):42-45. doi: 10.1177/1403494810393562 [DOI] [PubMed] [Google Scholar]

[zoi260628r30] 30.Andersen L, Friis S, Hallas J, Ravn P, Schrøder HD, Gaist D. Hormone replacement therapy increases the risk of cranial meningioma. Eur J Cancer. 2013;49(15):3303-3310. doi: 10.1016/j.ejca.2013.05.026 [DOI] [PubMed] [Google Scholar]

[zoi260628r31] 31.Pourhadi N, Meaidi A, Friis S, Torp-Pedersen C, Mørch LS. Menopausal hormone therapy and central nervous system tumors: Danish nested case-control study. PLoS Med. 2023;20(12):e1004321. doi: 10.1371/journal.pmed.1004321 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r32] 32.Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114(6):1326-1331. doi: 10.1097/AOG.0b013e3181c2bde8 [DOI] [PubMed] [Google Scholar]

[zoi260628r33] 33.Bickerstaff ER, Small JM, Guest IA. The relapsing course of certain meningiomas in relation to pregnancy and menstruation. J Neurol Neurosurg Psychiatry. 1958;21(2):89-91. doi: 10.1136/jnnp.21.2.89 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi260628r34] 34.Saitoh Y, Oku Y, Izumoto S, Go J. Rapid growth of a meningioma during pregnancy: relationship with estrogen and progesterone receptors—case report. Neurol Med Chir (Tokyo). 1989;29(5):440-443. doi: 10.2176/nmc.29.440 [DOI] [PubMed] [Google Scholar]

[zoi260628r35] 35.Pettersson-Segerlind J, Mathiesen T, Elmi-Terander A, et al. The risk of developing a meningioma during and after pregnancy. Sci Rep. 2021;11(1):9153. doi: 10.1038/s41598-021-88742-2 [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

Contraceptive Progestogens and Incident Meningioma

Nicklas Hasselblad Lundstrøm, MD

Mette Hjorslev Knudgaard, MD

Michael Skaarup Pedersen, MS

Marie Louise Schougaard Christiansen, MD, PhD

Charlotte Wessel Skovlund, PhD

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Exposure

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Study Design

Setting and Participants

Figure 1. Graphical Representation of the Study Design.

Exposure

Main Outcomes and Measures

Statistical Analysis

Results

Figure 2. Flowchart: Selection of Cases and Controls.

Table 1. Use of Hormonal Contraception for Cases and Controls.

Figure 3. Forest Plot Showing Odds Ratios (ORs) for the Association Between Most Recent Use of Different Progestogens Used for Contraception and Meningioma.

Table 2. Numbers Needed to Harm for 1 Additional Meningioma Diagnosis Per Year of Use According to Type of Progestogen and Age Group.

Discussion

Principal Findings

Comparison With Prior Studies

Implications

Strengths and Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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