Desogestrel associated with small increase in risk of intracranial meningioma

Women who use the oral contraceptive desogestrel for more than five continuous years have a small increased risk of intracranial meningioma, while no risk exists in users of levonorgestrel (alone or combined with estrogen), a case-control study in France found.

To determine the risk of intracranial meningioma associated with oral contraceptives containing desogestrel, levonorgestrel, or levonorgestrel combined with estrogen, researchers matched 8,391 women who required surgery for intracranial meningioma between 2020 and 2023 in France with 10 controls each based on year of birth and area of residence (92,301 women in total; mean age, 59.7 years). Short-term use was defined as one or more fills of oral contraceptives within the year before the index date, and prolonged use was defined as continuous use for one year or more (up to seven or more years). Findings were published by the BMJ on June 11.

Of the women who underwent intracranial meningioma surgery, 287 (3.4%) used desogestrel, 17 (0.2%) used levonorgestrel, and 157 (1.9%) used levonorgestrel combined with estrogen. Both short- and long-term use of desogestrel was associated with an increased risk of intracranial meningioma (odds ratios [OR] 1.02 [95% CI, 0.77 to 1.34] and 1.32 [95% CI, 1.14 to 1.53], respectively), with risks driven by the increases in those taking the medication for five to seven years (OR, 1.51; 95% CI, 1.17 to 1.94) or seven or more years (OR, 2.09; 95% CI, 1.51 to 2.90). There was no excess risk of intracranial meningioma among women taking levonorgestrel, alone or combined with estrogen, regardless of duration of use.

The results were consistent regardless of the presence of obesity or endometriosis. The estimated number needed to harm with desogestrel was 67,300 women for one intracranial meningioma requiring surgery; risk was no longer elevated one year after discontinuation of the medication, the researchers noted.

Limitations include a lack of data on nonreimbursed drugs and no information on the patients' indications for desogestrel or levonorgestrel.

“The magnitude of meningioma risk associated with desogestrel use is much lower than that found for prolonged use of medrogestone, promegestone, cyproterone acetate, chlormadinone acetate, nomegestrol acetate, and medroxyprogesterone acetate,” the authors wrote, adding that monitoring for the complication should focus on women who have used desogestrel for more than five continuous years.

An accompanying editorial noted there is currently “no reason to modify the indications for desogestrel use, but it is important to be aware of the slightly increased risk of meningioma and that the drug should be avoided in those with a personal or family history of meningioma or breast cancer.” In addition, the study provides important information on the lack of association between levonorgestrel and meningioma, as until now, “it was unclear whether intrauterine devices containing levonorgestrel should be continued in patients with meningioma,” they wrote.