Health · 6 Aug
EU regulators warn that long-term use of desogestrel mini-pills and etonogestrel implants and rings carries a small meningioma risk
The Italian Medicines Agency, on behalf of the marketing-authorization holders and in agreement with the EMA, warns that current, prolonged use (a year or more) of contraceptives containing desogestrel or etonogestrel carries a small increased risk of meningioma, a usually benign tumour of the brain's lining. The warning rests on a French national case-control study that matched 8,391 women who had intracranial surgery for meningioma with 83,910 controls: odds ratio 1.3 for a year or more of 75-microgram desogestrel, rising to 2.1 with seven or more years of use. In absolute terms, roughly one additional case is expected per 67,300 treated women. The risk was no longer detectable a year after stopping, and was higher (OR 3.3) in women who had previously used progestogens already linked to meningioma, such as cyproterone, nomegestrol, medroxyprogesterone or chlormadinone.
Because desogestrel is converted in the body to etonogestrel, the finding is taken to apply to etonogestrel implants and rings as well as desogestrel mini-pills. As a result, these products are now contraindicated in women who have or have had a meningioma, prescribers are told to watch for signs such as vision changes, hearing loss or ringing in the ears, loss of smell, headaches that worsen over time, memory loss, seizures or weakness in the limbs, and the drug must be discontinued if a meningioma is diagnosed. Product information is being updated with meningioma listed as an adverse reaction.
The evidence base here is a single observational case-control study, so the absolute risk is what matters: small, and reversible after stopping. Women on long-term treatment should raise it at their next consultation rather than stopping contraception abruptly on their own.