. RCGP Learning

Written by Dr Toni Hazell

Please note further updates may be made to this blog to reflect the concerns about hormonal contraception and meningioma.

Progestogens – in various delivery methods - are commonly used for contraception in the United Kingdom. Oral progestogen-only preparations contain either levonorgestrel, norethisterone, desogestrel, or drospirenone, while combined with an oestrogen desogestrel, gestodene, drospirenone, levonorgestrel, norethisterone and norgestimate are used. The commonest progestogen used in the depot injection is medroxyprogesterone acetate (MPA) – norethisterone enantate is also licensed in the UK but rarely used. The implant contains etonogestrel and levonorgestrel is the progestogen used in intra-uterine devices (IUDs). 

Progestogens have for some time been identified as an independent risk factor for meningioma, the most common intracranial tumour in adults, representing around 38% of all primary central nervous system (CNS) tumours and around 53% of all benign brain tumours¹. Meningiomas are usually benign, but can cause seizures, cognitive impairment, and focal neurological deficits and frequently require neurosurgical and/or radiation therapy. 

Recently, the Patient Safety Commissioner responded to concerns from the public and support groups regarding the association between prolonged use of medroxyprogesterone and an increased risk of intracranial meningioma. There have been several studies in this area from 2024 to 2026; this blog will outline the key features that GPs need to know to be able to counsel their patients on this matter. Those who wish to look in more detail at the studies will find information about them in the CoSRH documents published in March 2024², July 2025³, June 2026⁴ and July 2026⁵. 

The main risk factors for meningioma are age and female sex; incidence per 100,000 of the population rises from 0.16 under the age of 19 to 18.69 over the age of 40⁴. With uncommon conditions such as this, the need to understand the difference between absolute and relative risk is vital. For example, a woman using the depot injection is, on average, 9.7 times more likely to have a meningioma than one who isn’t using the depot, but for someone in their early 30s, the number needed to harm (NNH) is 24,238 i.e. this number of women would need to use the depot for their to be one extra case of depot associated meningioma⁵. Most of us would react quite differently to being told that there is a nearly 10-fold increase in risk, compared to being told that nearly 25,000 people would have to use this medication for one to be caused harm. Those who wish to know more about how to counsel on absolute and relative risk might want to look at the RCGP ‘Five minutes to change your practice’ screencast on explaining risk to patients.

In brief, the links between meningioma and progestogens are as follows, as we understand them in September 2026: 

• The highest odds ratio is for MPA (9.70) – all the other progestogens known to be associated with increased risk have an odds ratio between 1.62 and 2.53. This list consists of combined oral contraception (COC) containing cyproterone, desogestrel, drospirenone, gestodene or levonorgestrel, the desogestrel progestogen only pill (POP) and the 52mg levonorgestrel intrauterine device (LNG-IUD). 
• The absolute risk for all of these progestogens is small – the 2026 paper gives an overall NNH of 4,337 for the MPA depot, with the desogestrel POP, the 52mg LNG-IUD (Mirena®, Benilexa® and Levosert®) and COCs containing cyproterone, desogestrel and drospirenone having NNHs of between 20,000 and 30,000. The desogestrel POP and the gestodene containing COCs have NNHs above 30,000.
• As mentioned above, for younger women with a lower background risk, the NNH falls even further. For example, for those aged under 19, the NNH for the MPA injection is close to 500,000 and for the 52mg LNG-IUD it is over 2.5 million. 
• There is no increased risk of meningioma with the norethisterone POP, COCs containing norethisterone and norgestimate and the lower dose LNG-IUDs (Kyleena® and Jaydess®). There is also clearly no increased risk with the non-hormonal methods such as the copper IUD or condoms. 

CoSRH advice in their various documents on this matter is as follows:

• When we are counselling patients who are starting or continuing hormonal contraception, we should explain that meningioma is an uncommon tumour which is usually benign and that the absolute risk remains low – this is particularly the case for younger women⁵. 
• Women starting methods containing cyproterone acetate, nomegestrol acetate, MPA or desogestrel should particularly be informed about the increased risk of meningioma⁴. 
• The risk of meningioma should be considered alongside the benefits of effective contraception, using a shared decision-making process⁵.
• For women who are under the care of neurosurgery for a current meningioma, their specialist should be contacted for advice about continuing any form of hormonal contraception. Advice should also be sought before starting any hormonal contraception in women with a history of meningioma⁴.

This is a complex area – the mere mention of the words ‘brain tumour’ has the risk of causing panic among patients, and we do not want a relatively small risk to put our patients off from accessing reliable methods of contraception. Many of our patients will also be getting other benefits from their contraception (for example control of dysmenorrhoea, abnormal uterine bleeding or endometriosis) and we know that there are also long-term benefits, such as the halving of ovarian cancer risk in women who use the COC for 10 years, a benefit that persists for decades after stopping the COC⁶. Translating complex scenarios into words that our patients understand and helping our patients to understand the risks and benefits of any proposed intervention, so that they can make a decision that they are happy with, is what GPs do best. 

References:

1. Alruwaili AA, Hall WA. Meningioma. 2026 Jun 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. [Accessed September 2026].
2. CoSRH. FSRH CEU Statement: Response to new study by Roland et al (2024). Use of progestogens and the risk of intracranial meningioma: national case-control study. March 2024. [Accessed September 2026].
3. CoSRH. FSRH CEU Statement: Response to new study by Roland et al (2025). ‘Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study.’ July 2025.  [Accessed September 2026].
4. CoSRH. CoSRH Statement: Meningioma and Progestogens. June 2026.  [Accessed September 2026].
5. CoSRH. CoSRH CEU Statement: Response to new study by Lundstrøm et al. (2026). Contraceptive Progestogens and Incident Meningioma. July 2026.  [Accessed September 2026].
6. CoSRH. Combined hormonal contraception. October 2023.  [Accessed September 2026].