Danish Registry Analysis Associates Medroxyprogesterone Injections and High-Dose Levonorgestrel IUDs With Meningioma Incidence

Researchers matched 1,473 women diagnosed with meningioma to 14,717 controls on age, birthplace and marital status within a 25-year cohort exceeding three million women. Exposure was ascertained from prescription fills; medroxyprogesterone showed the strongest association, followed by 52 mg levonorgestrel IUDs used beyond one year and desogestrel-only pills. Combined estrogen-progestin orals produced smaller elevations that attenuated after discontinuation. Absolute incidence remained low, yet the relative increments reached statistical significance in current users.

Meningiomas express progesterone receptors in up to 87 percent of cases, providing mechanistic plausibility for progestin-driven growth observed clinically during pregnancy or exogenous exposure. Prior French pharmacoepidemiologic work on high-dose cyproterone and nomegestrol already prompted EMA restrictions; the Danish findings extend the signal to contraceptives routinely prescribed in lower-resource settings where injection and IUD uptake is high.

Because the study is observational, residual confounding by indication or surveillance bias cannot be excluded, and no dose-response gradients were reported for all agents. Next steps require prospective cohorts with MRI surveillance and pooled individual-patient data to quantify absolute risk differences by duration and formulation before guideline panels revise first-line recommendations.