Hormonal contraceptives and the risk of meningioma: A Swedish register-based case-control study

BACKGROUND: Studies of hormonal contraceptives and the risk of meningioma has often relied on self-reported information, primarily focusing on oral contraceptives. Recently, an association between progestins and meningioma was suggested. We aimed to analyze the association between hormonal contraceptives and meningioma using data from Swedish national registries. METHODS: We used the Swedish Cancer Register to identify women born 1955-1995, diagnosed with meningioma at age ≥20 years, between 2007 and 2015 (N = 1055). Twenty controls per case were randomly selected from the Swedish population register, matched by birth year and county of residence. We retrieved information regarding prescriptions of hormonal contraceptives from the National Prescribed Drug Register. Adjusted conditional logistic regression models were used to evaluate the association between hormonal contraceptive use and meningioma occurrence. RESULTS: Women prescribed hormonal contraceptives ≥1 year before the index date had an odds ratio (OR) of meningioma of 1.76 (95% CI, 1.53-2.03). For contraceptives containing medroxyprogesterone the OR was 5.49 (95% CI, 4.51-6.67), while the association was weaker for other progesterone contraceptives (OR = 1.34, 95% CI, 1.09-1.65). No association was found for intrauterine devices, vaginal rings, and subdermal implants. CONCLUSIONS: This large register-based case-control study show a strong association between injectable hormonal contraceptives containing medroxyprogesterone and meningioma risk. The results add to the growing body of evidence of an association between meningiomas and progestins in general and the strong, consistent associations suggest a causal role of injectable medroxyprogesterone in meningioma growth. Our results correspond to 2 additional cases of meningioma per 10 000 women exposed to medroxyprogesterone per year.