What is a meningioma?
A meningioma is a generally benign tumor that develops from the meninges, the membranes enveloping the brain and spinal cord.
Although often non-cancerous, these tumors can cause serious problems by compressing the brain or nearby nerves.
Pills concerned by the risk of meningioma
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The following progestogens are associated with an increased risk of meningioma, and are the subject of specific recommendations by the French health insurance scheme, with a follow-up MRI.
If you have taken one and have not received a letter from your health insurance company or information from your doctor, contact him/her:
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Luteran (chlormadinone acetate) and generics
Use: Hormonal contraception and treatment of menstrual disorders.
Measures: Brain MRI monitoring recommended in case of prolonged treatment or symptoms (ANSM).
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Lutényl (nomgestrol acetate) and generics
Use: Treatment of menstrual and menopausal disorders.
Measures: Brain MRI monitoring recommended, similar to Lutéran (ANSM).
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Colprone (medrogestone)
Use: Treatment of endometriosis and fibroid-related bleeding.
Measures: Brain MRI recommended for patients treated for more than one year (ANSM).
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Depo Provera (medroxyprogesterone acetate)
Use: Injectable contraception.
Measures: Use justified in case of non-compliance or intolerance to other contraceptive methods; brain MRI recommended in case of prolonged treatment (ANSM).
Measures taken for contraceptive pills and hormone treatments containing cyproterone acetate
These references have also been associated with an increased risk of developing meningiomas, especially after prolonged use.
Here is an overview of the pills concerned and the measures taken:
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Androcur (cyproterone acetate) and generics (50 mg and 100 mg)
Use: Treatment of severe hirsutism, prostate cancer, paraphilias.
Risks: Increased risk of meningioma after more than six months of high-dose treatment.
Measures: Annual re-evaluation of prescription, minimum effective use, brain MRI in case of symptoms suggestive of meningioma (ANSM) (ANSM).
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Diane-35 and generics (ethinyl estradiol/cyproterone acetate)
Use: Treatment of severe acne
Risks: Increased risk of meningioma in patients with a history or presence of meningioma.
Measures: Contraindicated in patients with a history of meningioma (ANSM).
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Climene (estradiol/cyproterone acetate)
Use: Hormone replacement therapy for menopause.
Risks: Similar to Diane-35.
Precautions: Contraindicated in patients with a history of meningioma (ANSM).
Progestins under study: the most prescribed for endometriosis
Certain progestogens used alone have not yet been clearly linked to an increased risk of meningioma, but further studies are needed:
- Dienogest (Visanne and generics) :
Dimetrum
Endoevely
Misola
Qlaira
Visanne
Sawis - Drospirenone(Slinda)
- Desogestrel(Cerazette and generics)
Current results do not rule out a potential risk, and their increasing use warrants further research (ANSM).
Recommendations for users of these treatments:
- Monitoring: cerebral MRI recommended for patients with symptoms suggestive of meningioma or those undergoing long-term treatment.
- Information and Consent: Mandatory annual signature of an information certificate between patient and doctor for cyproterone acetate-based drugs.
- Re-evaluation: Prescriptions should be re-evaluated annually to ensure the benefit/risk ratio and adjust dosage to the minimum effective dose.
- Duration: Treatment should always be prescribed at the minimum effective dose and for the shortest possible duration.
If you are using or considering using a pill containing cyproterone acetate, it's crucial to discuss the risks and possible alternatives with your doctor. Vigilance and regular medical follow-up are essential to minimize the risks associated with these treatments.
For more information, consult the full recommendations on the ANSM website:
- https://ansm.sante.fr/actualites/progestatifs-et-risque-de-meningiome-recommandations-pour-limiter-ce-risque