Popular Contraceptive Pill Desogestrel May Double Brain Tumor Risk

Women who take the progestogen-only contraceptive pill desogestrel for more than five years may face a higher chance of developing intracranial meningioma that requires surgical treatment. These tumors, though usually non-cancerous, can still lead to serious health complications due to their location in the brain (1^✔ ✔Trusted Source
Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study

Go to source). Intracranial meningiomas are more common in older women and have been associated with hormonal exposure. Previous concerns existed around certain older progestogens, but data on widely used contraceptives like desogestrel and levonorgestrel had remained inconclusive until now.

Impact of Specific Hormones on Tumor Risk

Progestogens are synthetic hormones that mimic progesterone and are widely used in birth control. Some, like cyproterone acetate and medroxyprogesterone acetate, have long been associated with increased tumor risks, particularly when used at high doses or over extended periods.

Desogestrel and levonorgestrel are commonly used in many countries, with desogestrel dominating the progestogen-only pill market in places like France and the United Kingdom. Because of this widespread use, identifying even a small increase in risk becomes important for public health.

Case–Control Data Reveals Risk Patterns

Researchers in France used national insurance records to compare nearly 8,400 women who had surgery for meningioma between 2020 and 2023 with more than 83,000 women of similar age and location who did not develop the tumor. They analyzed three types of oral contraceptives: desogestrel-only, levonorgestrel-only, and levonorgestrel combined with estrogen.

While short-term use under one year showed no elevated risk, prolonged desogestrel use for five to seven years increased the likelihood of requiring surgery for meningioma by 51 percent. Use beyond seven years more than doubled that risk.

Risk Disappears After Discontinuation

Interestingly, women who stopped taking desogestrel for more than a year showed no increased risk, suggesting that discontinuation may help prevent surgery. The increased risk was particularly evident in women over 45 years old and in cases where tumors appeared at the front or middle of the skull base.

There was no increased risk identified with levonorgestrel, whether used alone or in combination with estrogen, regardless of how long it was taken.

Clinical Implications for Long-Term Users

Experts note that while desogestrel may carry a small risk for long-term users, it does not warrant panic. For women concerned about prolonged use, discussing alternative options with healthcare providers and considering discontinuation could help reduce potential risk.

The findings build on existing evidence that stopping certain progestogens—like cyproterone and nomegestrol can reduce the need for surgery, now extending that precaution to desogestrel.

Contraceptive Risk Evaluation Based on Duration

An estimate from the research suggests that approximately 67,000 women would need to take desogestrel for one woman to develop a surgically treatable meningioma, which reduces to 17,000 when usage exceeds five years.

Although correlation does not confirm causation, the data provides a strong case for careful, informed decision-making when it comes to choosing hormonal contraceptives for extended use.

In conclusion, while the risk posed by desogestrel is relatively small and appears only after prolonged use, the findings are significant given the widespread reliance on this contraceptive. For women using it long-term, especially those over 45 or with a history of other high-risk hormonal drugs, switching to an alternative may reduce their risk of serious brain tumors requiring surgery.

Reference:

1. Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study - (https://www.bmj.com/content/389/bmj-2024-083981)

Source-Medindia