Depot Medroxyprogesterone Acetate Use Associated with an Increased Risk of Meningiomas in the US Population: a Propensity Score Matched Cohort Analysis

Introduction: Meningiomas have a female to male prevalence of 2:1, which may be due to additional exposure to female sex hormones such as progesterone. Roland et al recently demonstrated that French patients receiving meningioma resection had an increased odds of exposure to injection depot medroxyprogesterone acetate (dMPA), an exogenous progesterone commonly used as a long-acting injectable contraceptive in the US. Our study aims to use a large US database, TriNetX, to examine the incidence risk of meningioma diagnosis between dMPA, oral contraceptive (OCP), intrauterine devices (IUD), and controls without any contraceptive use.

Methods: We performed a retrospective population-based cohort study. The groups that we examined were patients exposed to dMPA, OCP, IUD, and controls without any contraceptive prescription. Propensity score matching (PSM) controlled for many various related cofactors. Five main PSM analyses were run (1-3. dMPA, OCP, or IUD vs. Control; 4-5. dMPA vs. IUD or OCP). Our main outcome of interest was meningioma diagnosis any time after initial exposure.

Results: Injection dMPA use is associated with a relative risk (RR) of 2.50 (95%-CI: 1.73–3.61) for a meningioma diagnosis compared to controls. The number needed to harm was 1471. The attributable risk was 0.00068 with an attributable risk percentage of 60.4%. Use of dMPA also had increased risk compared to OCP (RR:2.88, 95%-CI: 1.95-4.26) or IUD use (RR:2.00, 95%-CI: 1.42-2.81). We found no increased risk of meningioma diagnosis with OCP or IUD use compared to control.

Conclusion : Patients exposed to dMPA had a greater risk of developing a meningioma diagnosis compared to propensity matched controls, OCP use, or IUD use. The large number needed to harm indicates a low clinical risk to everyday patients on dMPA. However, meningiomas in the dMPA group may be 60.4% attributable to the exposure. Future research is needed to assess the biological relationship between dMPA and meningiomas.