BMJ

Oral contraceptives: Intracranial meningioma risk with progestin desogestrel vs. levonorgestrel

July 18, 2025

Key findings from a case-control study of 8,391 French women who required surgery for intracranial meningioma in 2020-23, each matched to 10 control patients without intracranial meningioma:

• Use of the progestin desogestrel at a dose of 75 mcg for more than five continuous years is associated with a small increased risk of intracranial meningioma requiring surgery.
• Levonorgestrel, alone or combined with estrogen, showed no risk of meningioma, regardless of treatment duration.
• While awaiting clinical studies, the preferred approach for intracranial meningiomas associated with desogestrel use would appear to be stopping the progestin, surgical abstention, and neurological monitoring.

_{Numbers needed to harm for one intracranial meningioma requiring surgery, by progestogen use. An interactive version of this graphic is available at https://public.flourish.studio/visualisation/23176824/}

Risk of intracranial meningioma associated with oral contraceptives containing desogestrel 75 mcg, levonorgestrel 30 mcg, or levonorgestrel 50-150 mcg combined with estrogen, and duration of use: short term use was defined by one or more dispensations within the year before the index date only, and prolonged use was defined by continuous use of one year or more (up to seven or more years of continuous use). Conditional logistic regression was used to calculate odds ratios.

Study results show an absence of meningioma risk in levonorgestrel users (alone or in combined form). Monitoring for meningioma should focus on women who have used desogestrel 75 mcg for more than five continuous years, in whom the study found a small risk of meningioma. As with the other progestogens, risk increased with duration of use and after use of a progestogen of known associated increased risk. The risk in desogestrel users was low (number needed to harm was 67,300 women using the oral contraceptive for one intracranial meningioma requiring surgery) compared with that observed for the six progestogens known to be associated with increased risk of meningioma (e.g., 518 women using high dose cyproterone acetate for one woman requiring surgery for intracranial meningioma).

Source:

Roland N, et al. (2025, June 11). BMJ. Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study. https://pubmed.ncbi.nlm.nih.gov/40500141/