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Progesterone-only contraception is associated with a shorter progression-free survival in premenopausal women with WHO Grade I meningioma

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Abstract

The hormonally active nature of intracranial meningioma has prompted research examining the risk of tumorigenesis in patients using hormonal contraception. Studies exploring estrogen-only and estrogen/progesterone combination contraceptives have failed to demonstrate a consistent increased risk of meningioma. By contrast, the few trials examining progesterone-only contraceptives have shown higher odds ratios for risk of meningioma. With progesterone-only contraception on the rise, the risk of tumor recurrence with these specific medications warrants closer study. We sought to determine whether progesterone-only contraception increases recurrence rate and decreases progression-free survival in pre-menopausal women with surgically resected WHO Grade I meningioma. Comparative analysis of 67 pre-menopausal women taking hormone-based contraceptives (progesterone-only medication, n = 21; estrogen-only or estrogen/progesterone combination medication, n = 46) who underwent surgical resection of WHO Grade I intracranial meningioma was performed. Differences in demographics, degree of resection, adjuvant therapy and time to recurrence were compared between the two groups. Compared to patients taking combination or estrogen-only contraception, those taking progesterone-only contraception demonstrated a greater recurrence rate (33.3 vs. 19.6%) with a reduced time to recurrence (18 vs. 32 months, p = 0.038) despite a significantly shorter follow-up (p = 0.014). There were no significant demographic or treatment related differences. The results from this study suggest that exogenous progesterone-only medications may represent a specific contraceptive subgroup that should be avoided in patients with meningioma.

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Author notes

  1. Tessa A. Harland, Jacob L. Freeman have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University of Colorado School of Medicine, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA

    Tessa A. Harland, Jacob L. Freeman, Monica Davern, Kevin Lillehei & D. Ryan Ormond

  2. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA

    D. Jay McCracken & Jeffrey J. Olson

  3. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Emma C. Celano

Authors
  1. Tessa A. Harland
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  2. Jacob L. Freeman
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  3. Monica Davern
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Correspondence to D. Ryan Ormond.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not obtained due to the retrospective nature of this chart review.

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Harland, T.A., Freeman, J.L., Davern, M. et al. Progesterone-only contraception is associated with a shorter progression-free survival in premenopausal women with WHO Grade I meningioma. J Neurooncol 136, 327–333 (2018). https://doi.org/10.1007/s11060-017-2656-9

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  • DOI: https://doi.org/10.1007/s11060-017-2656-9

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