Continuing work on the risk of meningioma associated with certain progestins, the Epi-Phare scientific interest group of the National Health Insurance Fund (Cnam) and the National Medicines Safety Agency (ANSM) presents new results on desogestrel (75 micrograms), levonorgestrel (30 micrograms) and levonorgestrel-ethinylestradiol combination (50-150 micrograms).
It appears from this case-control study based on data from the national health data system (SNDS) that the risk of meningioma operated on between 2020 and 2023 is not increased with levonorgestrel, alone or in combination, whatever the exposure times.
On the other hand, for desogestrel (Antigone, Optimizette, Cérazette, Elfasette, Désogestrel), the team of Dr Alain Weill, deputy director of Epi-Phare, highlighted “a very small increase in the risk of meningioma in women over 45 years of age, during prolonged use”, reports the ANSM press release. This risk appears from 5 years of age and is multiplied by 2 beyond 7 years of exposure. The medicines agency wishes to emphasize that the risk “is, however, much lower than that observed when taking Androcur (cyproterone acetate), Lutéran (chlormadinone acetate) and Lutényl (nomegestrol)”. No risk of meningioma was observed when desogestrel was used for less than one year, “except during previous use of other risky progestins”.
Overall, the study estimates that on average, one case of operated intracranial meningioma is observed for 67,000 women exposed to desogestrel, regardless of the duration of exposure, and one case for 17,000 women exposed for more than 5 years.
In case of meningioma, systematically refer to a neurosurgeon
Taking into account these results, the experts of the temporary scientific committee (CST) brought together by the ANSM have issued preliminary recommendations “awaiting risk reduction measures to come in early 2025”indicates the press release. For health professionals, this involves having a control MRI carried out in the event of suggestive signs. If a meningioma is discovered in a patient taking desogestrel, it is recommended tostop treatment and systematically refer to a neurosurgeon. “If there is a history of meningioma or existing meningioma, progestin contraception or progestin treatment should no longer be used”specifies the press release.
Before any prescription or change of progestogen contraception, it is recommended to check the previous treatments with progestins used and their duration of use. “It will be necessary to evaluate with the patient the contraception most suited to her situation”we read. It is also recalled that contraception must be reviewed annually taking into account age, lifestyle and history and that desogestrel must not be used as hormonal treatment for menopause.
