Risk of intracranial meningioma requiring surgical intervention among recent hormonal contraceptives users.

PURPOSE: Progesterones have been implicated in meningioma growth. Long-acting progestin-only hormonal contraceptives (HC) are increasingly popular due to sustained serum progestin levels. This study examined the relationship between progestin-only HC exposure and risk of surgically treated intracranial meningioma (STIM). METHODS: Using the Merative Marketscan research database, we identified females aged 15–42 with at least 2.5 years of continuous enrollment. Within a case-control study, STIM cases were identified based on intracranial meningioma diagnosis followed by cranial meningioma surgery procedure codes. Controls were matched up to 1:10 by age, cohort entry date, and follow-up time. HC exposure was categorized into combined oral estrogen-progestin contraceptives (COC), progestin-only pills (POP), progestin intrauterine device (IUD), or intramuscular/subcutaneous progestin (IMSC). Multivariate conditional logistic regression estimated odds ratios adjusting for comorbidities. RESULTS: Among 11,815,164 women, we identified 1,218 STIM cases and 12,172 controls. Exposure to COC increased STIM risk (RR 1.27; 95% CI 1.10–1.50), as did IMSC use (RR 3.79; 95% CI 2.67–5.40) compared to no recent HC use. Compared to COC users, IMSC users had higher risk (RR 2.98; 95% CI 2.06–4.32). CONCLUSION: IMSC use is associated with increased STIM risk relative to no recent HC exposure or COC use. Further research is needed to confirm our findings and to clarify dose, duration, and progestin agent differences.