Use of progestogens and the risk of intracranial meningioma: national case-control study

Dear Editor

This is an important article showing an increased likelihood of meningioma surgery with previous exposure to certain progesterone products including medroxy progesterone which is a common injectable contraception. The most likely explanation is that the exposure accelerates growth in very small meningiomas that would never present clinically to tumours that required surgery. This is plausible as many women are diagnosed with meningioma which are asymptomatic when scanned for other symptoms and most meningiomas have progesterone receptors and can be driven by progesterone. Thus the increased incidence in women of diagnosed tumours in adulthood despite boys having a higher risk than girls. Whilst these results need validation women with NF2 related schwannomatosis should avoid injectable medroxy progesterone acetate and both sexes cyproterone acetate.