Alain Weill, co-director of the Epi-Phare group, an alliance of Health Insurance and the National Medicines Safety Agency (ANSM), immediately warns: “This is a global public health problem! » He and his teams studied the risk of meningioma (or tumor of the meninges, which surround the brain) linked to taking three progestogen drugs. These can be used in particular as contraceptives, in the treatment of endometriosis, against uterine bleeding, or even in hormone replacement therapy for menopause, depending on the case.
This study conducted with Assistance publique - Hôpitaux de Paris had already been presented, in French, in July. It has now been published this Wednesday evening in the British Medical Journal, giving it much wider visibility.
📢Press release @EPIPHARE and @APHP publish in @bmj_latest the results of a study underlying recommendations for the use and monitoring of people who must be treated with #progestins at risk of intracranial #meningiomahttps:// t.co/9Uc04yy8uw
— EPI-PHARE (@EPIPHARE) March 28, 2024
Scientists collected data from more than 18,000 women aged 45 to 74 who underwent meningioma surgery between 2009 and 2018 in France, before comparing them to those of 90,000 other women. Prolonged use (at least one year) of three progestogen medications is associated with an increased risk of meningeal tumor requiring surgical intervention: 3.5 times greater for Colprone (medrogestone molecule), 5.6 times greater for Depo Provera (injectable medroxyprogesterone acetate) and twice as important for Surgestone (promegestone), which has no longer been marketed in France since 2020.
74 million women treated with Depo Provera worldwide
Previous studies had produced similar results for Androcue, Luteran and Lutenyl. Many French women then turned to Colprone, which increased from 10,000 to 30,000 consumers in three years. No increased risk appears for people treated for less than a year, but “if women have used another high-risk progestogen before switching to Colprone, they have an increased risk of meningioma without waiting a year,” warns Alain. Weill. In this scenario, the ANSM now recommends carrying out an MRI.
Depo Provera, an injectable contraceptive, is used very little in France (only 5,000 people affected) but very widely throughout the world (74 million). “Many of these women are disadvantaged and live in countries with low economic income,” warns Alain Weill. Thirteen million of these 74 million citizens reside in Indonesia, in particular. “Imagine the number of meningiomas in this country! » worries the public health specialist. In a press release relayed by The Guardian, the manufacturer of Depo Provera, Pfizer, says it is “aware” of this risk and indicates that it will “update the product instructions”.
Also read Contraception: a future revolution? Five minutes to understand the issues of the pill for men
This study is called “observational”, but “there is very clearly a causal link, because a set of studies converge and the biological mechanisms of progestins on meningeal tissues are known”, develops Alain Weil. Good news, on the other hand, for France: with the hormonal IUD, implanted in around 2 million women, no increased risk appears. “It’s very reassuring,” says the doctor. In general, any progestogen “must always be prescribed at the minimum effective dose and for the shortest possible duration of use,” concludes the ANSM.