In a recently published paper titled “Use of progestogens and the risk of intracranial meningioma: national case-control study” by Noémie Roland, Anke Neumann et al* the authors assessed the impact of multiple forms of progesterone on the development of brain meningiomas.   The statements in this paper could lead a journalist or patient or anyone not performing a close reading of this study to the false conclusion that all forms of progesterone are linked to brain lesions.  This is not true.

A meningioma is type of lesion is usually noncancerous tumor that arises from the membranes surrounding the brain and spinal cord.  Sixty percent of intracranial meningiomas examined expressed progesterone receptors.  

 The authors investigated multiple forms of progesterone including synthetic progestogens. The forms of progesterone included in the study were progesterone, hydroxyprogesterone, dydrogesterone, medrogestone,medroxyprogesterone acetate, promegestone,dienogest, and intrauterine levonorgestrel.

 

In naturopathic and integrative medicine bioidentical compounded progesterone is typically used and is labelled “progesterone” and may be used in oral, topical or vaginal forms.

 The study was conducted in France over 10 years from January 2009-December 2018.  The study investigated 108, 366 women who had surgery for meningiomas and these were matched to controls.

The authors concluded that no excess risk of meningioma was associated with the use of progesterone, dydrogesterone, or spironolactone, or the hormonal intrauterine systems used worldwide, regardless of the dose of levonorgestrel they contained.”

Meningiomas may also be associated with age over 65, neurofibromatosis type 2 and exposure to ionizing radiation. Meningiomas are also associated with and may enlarge during pregnancy when progesterone levels are normally elevated in support of the pregnancy.  Furthermore, the authors observed decreasing dosing and withdrawal of  progestogens generally led to a reduction in meningioma volume.

“Prolonged use of medrogestone, medroxyprogesterone acetate, and promegestone was found to be associated with an increased risk of meningioma. Future studies should further clarify the association between the duration of use and risk for the progestogens studied and extend the discussion of meningioma risk to dienogest and hydroxyprogesterone.”

Should you receive questions from concerned patients who are using bio-identical progesterone or levonorgestrel found in many intra-uterine devices on the basis of this study, please do review with them the safety, risks and benefits. 

This is yet another example that in the realm of prescribed hormone replacement therapies that it is vital to be clear about the difference between different forms of  hormones and synthetic hormone mimetic drugs.   Too often these are all labeled progesterone or estrogen in the news and are misunderstood by the general public, our patients.  It is our responsibility to make sure patients are well educated and fully informed and have access to reliable information about their health and medical choices.

 Using any type of hormone therapy is a decision made between a patient and their healthcare provider after carefully weighing the risks and benefits. Bioidentical hormones have been controversial, and many are not FDA-approved, but that doesn't mean a healthcare provider will rule them out as a treatment option.

*Roland N, Neumann A, Hoisnard L, Duranteau L, Froelich S, Zureik M, Weill A. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ. 2024 Mar 27;384:e078078. doi: 10.1136/bmj-2023-078078. Erratum in: BMJ. 2024 Mar 28;384:q776. PMID: 38537944; PMCID: PMC10966896.