Sign In
International
Media release
From:
Prolonged use of desogestrel pill linked to small increased brain tumour risk
Although risk much lower than some other progestogens and disappeared one year after stopping treatment
Taking the progestogen-only contraceptive pill desogestrel continuously for more than five years is associated with a small increased risk of developing a type of brain tumour called an intracranial meningioma, finds a study from France published by The BMJ today.
However, the researchers stress that the risk is low compared with some other progestogens (for every 67,000 women taking desogestrel, one might need surgery for meningioma) and disappeared one year after stopping treatment.
Intracranial meningiomas are typically non-cancerous brain tumours that occasionally require surgery. They are more common in older women, but many studies lack information on the specific type of progestogen used, and risk has not been measured for continuous, current, and long term use.
To address this knowledge gap, researchers set out to assess the real-life risk of intracranial meningioma associated with short-term (less than 1 year) and prolonged (1-7 or more years) use of oral contraceptives containing desogestrel 75µg, levonorgestrel 30µg, or levonorgestrel 50-150 µg combined with oestrogen.
Their findings are based on data from the French national health data system (SNDS) for 8,391 women (average age 60; 75% older than 45) who had undergone surgery for intracranial meningioma in 2020-2023. Each case was matched to 10 control women without meningioma (total 83,910) of the same age and area of residence.
Potentially influential factors, including use of a known high-risk progestogen in the six years before the study, were taken into account.
The results show a small increased risk associated with use of desogestrel for more than five continuous years.
An increased risk was not found for shorter durations or when desogestrel had been discontinued for more than one year, but it was if other progestogens of known associated increased risk of meningioma had been used in the six years before desogestrel.
This excess risk was greater in women older than 45 years, those with a meningioma located in the front or middle of the skull, and after prolonged use of one of the known high risk progestogens before desogestrel.
The authors estimate that 67,000 women would need to use desogestrel for one woman to need surgery for intracranial meningioma, and 17,000 women if current use was for more than five years.
Reassuringly, no increased risk of meningioma was found for levonorgestrel, alone or combined with oestrogen, regardless of duration of use.
This is an observational study so can’t establish cause and effect, and the authors acknowledge that some information may be missing from the SNDS database. Nor were they able to account for genetic predisposition and exposure to high dose radiation - factors that may have affected the results.
However, by using comprehensive, real-life data, including history of using other known high risk progestogens, they were able to improve reliability and minimise bias.
As such, they suggest that desogestrel should be discontinued if an intracranial meningioma is identifiedand patients monitored rather than undergoing immediate surgery.
Although direct evidence is still lacking, stopping treatment when desogestrel related meningioma is diagnosed may preclude the need for surgery, says neurosurgeon Gilles Reuter in a linked editorial.
“It is already common knowledge that stopping cyproterone, nomegestrol, chlormadinone, promegestone, medroxyprogesterone, or medrogestone precludes the need for surgery,” he explains. “Now we know that stopping desogestrel may also avoid unnecessary potentially harmful treatments.”
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Dr Lana McClements is an Associate Professor in the School of Life Sciences, Faculty of Science at University of Technology Sydney
This French population-based study used national health data (SNDS) to assess whether progestogen-only oral contraceptive pills (POP) with a safer cardiovascular risk profile containing desogestrel 75µg, levonorgestrel 30µg, or levonorgestrel 50-150 µg combined with oestrogen increase the risk of intracranial meningioma (a typically benign brain tumour that can cause neurological symptoms and may require surgery). The study included 8,391 women who had surgery for meningioma between 2020–2023, each matched with 10 controls (totalling 83,910 women).
The results showed a small increased risk of meningioma in women who used desogestrel-only pills (e.g., Cerazette®) for more than five years, especially those over 45 years of age. They calculated that 67,287 women would need to use desogestrel for one woman to need surgery for intracranial meningioma, and 17,331 women if current use was for more than five years. However, the risk was substantially lower than with other progestogens with known increased risk of meningioma like cyproterone or nomegestrol acetate, and risk did not persist if desogestrel was stopped for at least a year.
Levonorgestrel alone or combined with oestrogen did not show an increased risk, though sample sizes were small. The study has limitations, including its observational design and inability to account for all risk factors or medication history.
Take-home message: Desogestrel pills should be avoided in women over 45 and discontinued if intracranial meningioma is diagnosed.
Associate Professor Alex Polyakov is a Clinical Associate Professor at the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne and is a Medical Director of Genea Fertility Melbourne
Meningiomas are benign tumours of the central nervous system that can occasionally require surgery or radiotherapy, particularly when their size or location causes pressure on surrounding brain structures. Previous studies have suggested that the use of certain progestins may increase the risk of meningiomas requiring such treatment.
The study by Roland et al, published in the BMJ, investigated the potential association between two commonly used progesterone-only contraceptives—desogestrel and levonorgestrel—and the risk of requiring surgical treatment for meningioma. While desogestrel is widely used in Europe and the United States as a progesterone-only oral contraceptive, it is not approved or marketed for this indication in Australia. As such, the applicability of the study’s findings to the Australian population is limited in relation to desogestrel.
Levonorgestrel, however, is widely used in Australia across multiple contraceptive formulations, including combined oral contraceptive pills, progestogen-only pills, intrauterine devices (IUDs), and emergency contraceptive pills. Reassuringly, the study found no increased risk of meningiomas requiring surgery among current or former users of levonorgestrel-containing products.
This finding offers important clinical reassurance. While other progesterone-containing therapies should generally be discontinued if a meningioma is diagnosed, levonorgestrel-containing preparations may be safely continued and may even represent a suitable alternative under these circumstances.
Gino Pecoraro OAM is Associate Professor of Obstetrics and Gynaecology at the University of Queensland and President of the National Association of Specialist Obstetricians and Gynaecologists (NASOG). He is also a practising obstetrician and gynaecologist in private practice in Brisbane.
Meningiomas are tumours of the membranes covering the brain and occurring around one in 10,000 people. They are generally slow-growing, more common in women and amenable to surgery and other treatment with five year survival rates of greater than 80% when picked up early.
Previous studies have found that the use of newer so-called third-generation progestogens, as can be found in newer oral contraceptives, are associated with an independent small increase in incidence of this tumour.
This new study, looks at one specific progestogen called desogestrel whether used in combination with oestrogen or by itself. In Australia, only the combined preparation is currently available as Marvelon branded tablets while the desogestrel only preparation or Cerazette is not.
The increased risk appeared to be related to the amount of time a woman has been on the preparation with a statistically significant 30% increase risk after five years.
Importantly, this risk was still lower than with other progestagens in use in Europe (not available in Australia) but higher than levonorgestrel which is found in many Australian pills and contained in progesterone IUDs.
Generally speaking, I do not believe this study should raise cause for alarm but merely drive discussion by women with their doctor around what is the best contraceptive option for them.
Contraception is important to avoid unwanted pregnancy which of itself, carries significant health risk.
Women are frequently on contraceptives for prolonged periods of time and so it is important that research continues on any potential effects from taking these medications. Oral contraceptives are but one method of contraception available to women and there is a significant number of options to choose from. Different contraceptive measures may be used at different times in a woman's life.
As always, contraception advice should only be given after a detailed history and examination by an appropriately qualified professional.
Older contraceptives containing levonorgestrel as the progestogen as well as intrauterine contraceptive devices (with or without added hormone), have not been shown to have any increase in meningioma risk.
