2024-01-15 07:05:27

For several years now, certain hormonal medications, progestins, have been singled out. They increase the risk of developing a meningioma, a tumor of the meninges. Are these medications still prescribed? In what contexts and with what precautions? What is the follow-up for women? The ANSM took stock of the situation and recommendations in December 2023. Details.

What is a meningioma?

Epidemiological and pharmacovigilance studies have revealed a risk of meningioma following the use of certain progestin-only medications, that is to say containing progesterone derivatives. A meningioma corresponds to a tumor of the meninges, the coverings that surround and protect the brain. Meningioma is generally a benign tumor that grows slowly. However, during its development, it can exert deleterious effects on the brain or cerebellum, causing different symptoms:

• Headaches ;
• Convulsions, even epileptic fits;
• Neurological disorders;
• Disorders of consciousness.

Depending on the stage and volume of the tumor, simple monitoring may be sufficient. On the other hand, if the meningioma becomes large and causes symptoms, surgical treatment to remove the tumor may become necessary.

Read also – Place of progesterone derivatives in the treatment of endometriosis

Are all progestins affected?

Progestins refer to natural or synthetic derivatives of progesterone, which exert a biological activity close to progesterone on the body. They are particularly used in the context of female contraception, menopause or in the treatment of endometriosis and menstrual cycle disorders.

But not all progestins are equally involved in the risk of meningioma. The risk is proven for the following progestins:

• Medrogestone;
• Chlormadinone acetate;
• Medroxyprogesterone acetate;
• Nomegestrol acetate;
• Cyproterone;
• Promegestone.

On the other hand, other progestins are not associated with a risk of meningioma:

• Progesterone;
• Dydrogesterone;
• Levonorgestrel intrauterine devices.

Finally, for other progestins, the risk cannot be assessed to date and additional studies are necessary:

• Dienogest;
• Drospirenone;
• Desogestrel.

As the risk is unknown, these progestins are subject to the same precautionary measures as progestins recognized as associated with an increased risk of meningioma.

Read also – A link between the levonorgestrel dosage of IUDs and the occurrence of depressive disorders?

What are the measures to reduce the risk of meningioma?

Among the progestins causing an increased risk of meningioma, promegestone was withdrawn from the market in 2020. Specific monitoring of women who have been treated with this medication has been put in place by the health authorities. For the other progestins involved and which currently remain available, risk reduction measures were established:

• Restriction of conditions of use: they should only be used in certain indications;
• Contraindications to these treatments in the event of a history of meningioma or existing meningioma;
• Systematic search for therapeutic alternatives without risk of meningioma;
• Prescription at the lowest possible effective dose and for the shortest possible duration;
• Annual reassessment of the benefit of the treatment;
• Annual information for the patient on the risks associated with the treatment.

During treatment and following stopping treatment, monitoring of women with imaging is recommended. An MRI (Magnetic Resonance Imaging) must be performed, regardless of the patient’s age, for any sign suggestive of a meningioma, but also following treatment for more than a year.

Read also – Diagnosis of brain tumors: Artificial Intelligence more efficient than doctors!

Estelle B., Doctor of Pharmacy

Meningioma (tumor of the meninges). HCL. Last updated November 20, 2023. Accessed January 2, 2024. https://www.chu-lyon.fr/meningiome-tumeur-des-meninges#:~:text=Le%20m%C3%A9ningiome%20est%20une%20tumeur,%C3%A0%20la%20vo%C3%BBte%20du%20cr%C3%A2ne.

Sources

– Progestins and risk of meningioma: recommendations to limit this risk. ansm.sante.fr. Accessed January 2, 2024.
– Treatment of endometriosis. www.ameli.fr. Accessed January 2, 2024.
– Meningioma (tumor of the meninges).www.chu-lyon.fr. Accessed January 2, 2024.
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