2024-04-09 17:00:00
A large French study reveals an increased risk of meningioma, a tumor of the meninges, when taking certain progestin-only drugs.
These medications can be used as contraceptives, to treat gynecological pathologies such as endometriosis, as hormone replacement therapy for menopause or even during the process of medically assisted procreation.
Previous French studies had already shown the increased risk of meningioma linked to prolonged and high dose use of three progestins, Androcur (cyproterone acetate), Lutéran (chlormadinone acetate, and Lutenyl (nomegestrol acetate). ).
While patients had to turn to alternatives, “it was necessary to know if there was a similar risk with other progestins, according to various routes of administration,” explains the National Medicines Safety Agency. (ANSM) in a press release.
The Epi-Phare group, an alliance of Health Insurance and the ANSM, is publishing the results of their research in the British Medical Journal (BMJ) these days.
74 million women affected
19,061 women aged 45 to 74 years old and operated on for a meningioma between 2009 and 2018 were included in the study, and were compared to 90,305 control women.
The scientists analyzed their data and observed a twice greater risk of meningioma for Surgestone and 3.5 times greater for Colprone.
Finally, Depo Provera (injectable medroxyprogesterone acetate) is associated with a 5.6 times higher risk of being operated on for a meningioma than the general population.
These results were made public in France last July, but this time benefit from international visibility.
A visibility that counts since 74 million women around the world are treated with Depo Provera – “often precarious, mainly in countries with low socio-economic levels”.
In France, according to Le Parisien, only 5,000 people are affected. At less than one year of use, the study shows no additional risk for these three progestins, if no other risky progestins have been used beforehand.
What do you give? “intrauterine” devices with levonorgestrel – Mirena, Donasert, Kyleena and Jaydess, very widely used in France? “The results are very reassuring and support the absence of risk of meningioma.”
A brain MRI after a year of use
In the summer of 2023, the ANSM formulated its first recommendations to avoid the risk of meningioma linked to Colprone, Depo Provera and Surgestone.
Colprone may be indicated in the treatment of menopause, cycle irregularities, premenstrual syndrome and non-severe mastodynia. “The interest in continuing treatment must be reassessed regularly (annually), particularly around menopause, as the risk of meningioma increases sharply with age.”
Concerning Depo Provera, it should only be prescribed as second intention and is only justified in very specific cases (intolerance to the subcutaneous implant or the IUD, in particular).
For patients continuing their treatment, a brain MRI is immediately recommended in the event of factors then, for all, after one year of treatment, at 5 years and every two years.
Minimum dose treatment, as short as possible
“Treatment must be prescribed at the minimum effective dose with the shortest possible duration of use,” notes the ANSM.
The agency adds that a brain MRI should be performed in the event of signs suggestive of a meningioma: headaches, vision, language, memory and hearing problems, nausea, dizziness, convulsions, loss sense of smell, weakness or paralysis.
“Meningioma can be single or multiple and grows slowly. Even if most often these tumors are benign, they can grow and compress neurological structures, which requires surgical decompression or excision, an intervention which is never trivial,” explains the ANSM.
Source: ANSM – LE Parisien
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