Contraceptive pills, progestogens & risk of meningioma

What is a meningioma?

A meningioma is a generally benign tumor that develops from the meninges, the membranes that envelop the brain and spinal cord.

Although often non-cancerous, these tumors can cause serious problems by compressing the brain or nearby nerves.

The pills concerned by the risk of meningioma

MRI control recommendations for Lutéran & Lutenyl at the heart of the scandal: 450 women affected by meningioma accuse the Regional Drug Safety Agency of having kept silent 

Read the article 

The following progestins present an increased risk of meningioma and are subject to specific recommendations by health insurance, with a follow-up MRI.

If you have taken it and have not received any mail from the health insurance or information from your doctor, contact him/her: 

• Lutéran (chlormadinone acetate) and generics
  Usage: Hormonal contraception and treatment of menstrual disorders.
  Measures: Brain MRI monitoring recommended in case of prolonged treatment or symptoms (ANSM).

• Lutényl (nomegestrol acetate) and generics
  Usage: Treatment of menstrual disorders and menopause.
  Measures: Brain MRI monitoring recommended similar to Lutéran (ANSM).

• Colprone (medrogestone)
  Usage: Treatment of endometriosis and bleeding related to fibroids.
  Measures: Brain MRI recommended for patients treated for more than one year (ANSM).

• Depo Provera (medroxyprogesterone acetate)
  Usage: Injectable contraception.
  Measures: Justified use in case of non-compliance or intolerance to other contraceptive methods; brain MRI recommended in case of prolonged treatment (ANSM).

Measures taken for contraceptive pills and hormonal treatments containing cyproterone acetate

These references have also been associated with an increased risk of developing meningiomas, especially after prolonged use.

Here is an overview of the pills concerned and the measures taken:

• Androcur (cyproterone acetate) and its generics (50 mg and 100 mg)
  Usage: Treatment of severe hirsutism, prostate cancer, paraphilias.
  Risks: Increased risk of meningioma after more than six months of high-dose treatment.
  Measures: Annual reassessment of the prescription, minimal effective use, brain MRI in case of symptoms suggestive of meningioma (ANSM) (ANSM).

• Diane-35 and its generics (ethinylestradiol/cyproterone acetate)
  Usage: Treatment of severe acne
  Risks: Increased risk of meningioma in case of history or presence of meningioma.
  Measures: Contraindicated for patients with a history of meningioma (ANSM).

• Climene (estradiol/cyproterone acetate)
  Usage: Hormone replacement therapy for menopause.
  Risks: Similar to those of Diane-35.
  Measures: Contraindicated for patients with a history of meningioma (ANSM).

Progestins under study: the most prescribed for endometriosis 

Some progestins used alone have not yet been clearly linked to an increased risk of meningioma, but further studies are needed:

• Dienogest (Visanne and generics):
  

  Dimetrum
  Endoevely
  Misola
  Qlaira
  Visanne
  Sawis

• Drospirenone (Slinda)

• Desogestrel (Cérazette and generics)

The current results do not allow for the exclusion of a potential risk, and their increasing use justifies further research (ANSM).

Recommendations for users of these treatments:

• Surveillance: Brain MRI recommended for patients presenting symptoms suggestive of meningioma or undergoing long-term treatment.
  
  
• Information and Consent: Mandatory annual signature of an information certificate between the patient and the doctor for cyproterone acetate-based medications.
  
  
• Reevaluation: The prescription must be reevaluated annually to ensure the benefit/risk ratio and adjust the dosage to the minimum effective level.

• Duration: The treatment should always be prescribed at the minimum effective dose and for the shortest possible duration of use.

If you are using or considering using a pill containing cyproterone acetate, it is crucial to discuss it with your doctor to understand the risks and possible alternatives. Vigilance and regular medical monitoring are essential to minimize the risks associated with these treatments.

For more information, consult the full recommendations on the ANSM website:

- https://ansm.sante.fr/actualites/progestatifs-et-risque-de-meningiome-recommandations-pour-limiter-ce-risque