The association between depot medroxyprogesterone acetate and meningiomas: Emerging data and their relevance to the South African context

Authors

  • R J Burman Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa https://orcid.org/0000-0003-3107-7871
  • R de Waal Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa
  • K Cohen Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • M Blockman Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • M Patel Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa
  • D Hockman Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Cell Biology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
  • D M Fountain MRC Weatherall Institute of Molecular Medicine, University of Oxford, UK
  • S Jeyaretna Division of Neurosurgery, Nuffield Department of Surgery, University of Oxford, UK
  • S Singh Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa
  • H Mustak Division of Ophthalmology, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
  • B De John Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa
  • D Lubbe Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Otolaryngology, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2026.v116i1.4529

Keywords:

Meningioma, depot medroxyprogesterone, Brain tumour epidemiology

Abstract

In the past 2 years, evidence suggesting an association between depot medroxyprogesterone acetate (dMPA) use and meningioma has emerged. As dMPA remains one of the most widely used contraceptive methods worldwide, this finding has led to increasing media attention, and regulatory and legal proceedings. The South African Health Products Regulatory Authority (SAHPRA) has issued a statement acknowledging the association between dMPA exposure and the development for meningiomas. However, the paucity of local data on dMPA use and the incidence of and risk factors for meningioma in both the public and private health sector make it difficult to fully assess the implications in SA. This report discusses the relevance of the association between dMPA and meningiomas in the SA context. We provide a summary of the current data on the risk of meningioma with dMPA exposure, and suggest how this should impact on recommendations for the prescribing and use of dMPA from a public health perspective. We further identify gaps in local data, and propose where efforts should be directed to collect relevant data to inform a rational national contraceptive strategy.

References

1. Roland N, Froelich S, Weill A. Medroxyprogesterone acetate and meningioma: A global issue. Front Glob Womens Health 2025;6(1):1470539. https://doi.org/10.3389/fgwh.2025.1470539

2. Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: A review. JAMA 2021;326(24):2507-2518. https://doi.org/10.1001/jama.2021.20763

3. Centers for Disease Control and Prevention. National Survey of Family Growth (NSFG): Key statistics - infertility. US Department of Health and Human Services, 2025. https://www.cdc.gov/nchs/ nsfg/key_statistics/i.html (accessed 4 October 2025).

4. Roland N, Neumann A, Hoisnard L, et al. Use of progestogens and the risk of intracranial meningioma: National case-control study. BMJ 2024;384(1):e078078. https://doi.org/10.1136/bmj-2023-078078

5. Tettamanti G, Shu X, Mogensen H, Kopp Kallner H, Mathiesen T, Feychting M. Hormonal

contraceptives and the risk of meningioma: A Swedish register-based case-control study. Neuro Oncol

2025;noaf228:1-12. https://doi.org/10.1093/neuonc/noaf228

6. GriffinRL.Theassociationbetweenmedroxyprogesteroneacetateexposureandmeningioma.Cancers

2024;16(19):3362. https://doi.org/10.3390/cancers16193362

7. Reynolds LM, Arend R, Griffin RL. The association between medroxyprogesterone acetate exposure

and cerebral meningioma among a Medicaid population. Epidemiologia 2025;6(4):58-68. https://doi.

org/10.3390/epidemiologia6040007

8. Xiao T, Kumar P, Lobbous M, et al. Depot medroxyprogesterone acetate and risk of meningioma in the US. JAMA Neurol 2025;82(11):1094-1102. https://doi.org/10.1001/jamaneurol.2025.3011

9. Lawsuit Information Center. Depo-Provera lawsuit update. Oceanside: Lawsuit Information Center, 2025. https://www.lawsuit-information-center.com/depo-provera-lawsuit.html (accessed 5 October 2025).

10. Carte Blanche. Carte Blanche investigates possible link between injectable contraceptives and brain tumours. Carte Blanche, 2025. https://www.dstv.com/m-net/en-za/news/carte-blanche-investigates- possible-link-between-injectable-contraceptives-and-brain-tumours (accessed 10 May 2025).

11. Chersich M, Wabiri N, Risher K, et al. Contraception coverage and methods used among women in South Africa: A national household survey. S Afr Med J 2017;107(4):307-314. https://doi.org/10.7196/ SAMJ.2017.v107i4.12141

12. Price M, Ballard CAP, Benedetti JR, Kruchko C, Barnholtz-Sloan JS, Ostrom QT. CBTRUS statistical report: Primary brain and other CNS tumors diagnosed in the United States in 2018 - 2022. Neuro Oncol 2025;27(Suppl 4):iv1-iv66. https://doi.org/10.1093/neuonc/noae123

13. Cao J, Yan W, Li G, Zhan Z, Hong X, Yan H. Incidence and survival of benign, borderline, and malignant meningioma patients in the US from 2004 to 2018. Int J Cancer 2022;151(11):1874-1888. https://doi.org/10.1002/ijc.34141

14. Ho VKY, Anten MM, Garst A, et al. Epidemiology of adult meningioma: Report from the Dutch Brain Tumour Registry (2000 - 2019). Eur J Neurol 2023;30(10):3244-3255. https://doi.org/10.1111/ ene.15966

15. Ekqvist O, Raitanen J, Auvinen A. Changes in incidence trends of meningioma in Finland, 1990 - 2017. Acta Oncol 2023;62(9):994-1000. https://doi.org/10.1080/0284186X.2023.2253985

16. Walsh KM, Price M, Raleigh DR, et al. Grade-stratified meningioma risk among individuals who are non-Hispanic Black. J Natl Cancer Inst 2025;117(2):366-374. https://doi.org/10.1093/jnci/djac236

17. Ibebuike K, Ouma J, Gopal R. Meningiomas among intracranial neoplasms in Johannesburg, South

Africa. Afr Health Sci 2013;13(1):118-121. https://doi.org/10.4314/ahs.v13i1.16

18. Ibebuike K, Ouma J. Demographic profile of patients diagnosed with intracranial meningiomas in Johannesburg. Afr Health Sci 2014;14(4):939-945. https://doi.org/10.4314/ahs.v14i4.24

19. Kelly A, Lekgwara P, Mda S. Epidemiology and outcome of patients admitted for elective brain tumour surgery in South Africa. Interdiscip Neurosurg 2020;21(1):100750. https://doi.org/10.1016/j. inat.2020.100750

20. Basson D, Schutte C, van Coller R, Gould T. Brain tumours in the Western Cape Province of South Africa. Wits J Clin Med 2024;6(2):53-60. https://doi.org/10.18772/26180197.2024.v6n2a1

21. Huntoon K, Toland AMS, Dahiya S. Meningioma: A review of clinicopathological and molecular aspects. Front Oncol 2020;10(1):579599. https://doi.org/10.3389/fonc.2020.579599

22. Splavski B, Hadzic E, Bagic I, Vrtaric V, Splavski B. Simple tumor localisation scale for estimating management outcome of intracranial meningioma. World Neurosurg 2017;104(1):876-882. https:// doi.org/10.1016/j.wneu.2017.05.039

23. Fountain DM, Smith MJ, O’Leary C, et al. The spatial phenotype of genotypically distinct meningiomas. Oncogene 2021;40(5):875-884. https://doi.org/10.1038/s41388-020-01563-w

24. Nassiri F, Liu J, Patil V, et al. A clinically applicable integrative molecular classification of meningiomas. Nature 2021;597(7874):119-125. https://doi.org/10.1038/s41586-021-03850-3

25. TaborJK,DincerA,O’BrienJ,etal.Variationsingenomicprofilesandclinicalbehaviourofmeningioma by race and ethnicity. J Neurosurg 2024;141(3):664-672. https://doi.org/10.3171/2023.12.JNS233001

26. Bickerstaff ER, Small JM, Guest IA. The relapsing course of certain meningiomas in relation to

pregnancy and menstruation. J Neurol Neurosurg Psychiatr 1958;21(2):89-91. https://doi.org/10.1136/

jnnp.21.2.89

27. Blankenstein MA, Blaauw G, Lamberts SWJ, Mulder E. Presence of progesterone receptors in human intracranial meningioma cytosols. Eur J Cancer Clin Oncol 1983;19(3):365-370. https://doi. org/10.1016/0277-5379(83)90134-7

28. Agopiantz M, Carnot M, Denis C, Martin E, Gauchotte G. Hormone receptor expression in meningiomas. Cancers 2023;15(3):980. https://doi.org/10.3390/cancers15030980

29. Maiuri F, Mariniello G, de Divitiis O, et al. Progesterone receptor expression in meningiomas. Front Oncol 2021;11(X):611218. https://doi.org/10.3389/fonc.2021.611218

30. Miyagishima DF, Sundaresan V, Gutierrez AG, et al. Gonadal steroid hormone receptors in meningioma: A systematic review and meta-analysis. J Neurosurg 2023;139(6):1638-1648. https://doi. org/10.3171/2023.3.JNS221372

31. Peyre M, Gaillard S, de Marcellus C, et al. Progestin-associated shift of the meningioma mutational landscape. Ann Oncol 2018;29(3):681-686. https://doi.org/10.1093/annonc/mdx782

32. Hage M, Plesa O, Lemaire I, Raffin Sanson ML. Estrogen and progesterone therapy and meningiomas. Endocrinology 2022;163(2):bqab259. https://doi.org/10.1210/endocr/bqab259

33. Abikenari M, Regev A, Himic V, et al. The hormonal nexus in PIK3CA-mutated meningiomas. J Neurooncol 2025;174(2):329-340. https://doi.org/10.1007/s11060-024-04517-3

34. Weill A, Nguyen P, Labidi M, et al. Use of high dose cyproterone acetate and risk of intracranial meningioma in women. BMJ 2021;372(37):n37. https://doi.org/10.1136/bmj.n37

35. Hensiek KH, Hill A. Spontaneous regression of cerebral metastasis followed by meningioma development under medroxyprogesterone acetate therapy. Br J Neurosurg 2000;14(4):354-356. https:// doi.org/10.1080/026886900417388

36. Anggraeni D, Diansari Y, Hafy Z. Demographic, clinical, and tumor profile of meningioma. Biomed J Indones 2022;8(1):1-4. https://doi.org/10.32539/BJI.v8i1.122

37. Rusdi AFP. Association between hormonal contraception and histopathology grading of meningioma. Nat Volatiles Essent Oils 2022;9(1):1583-1592.

38. Supartoto A, Mahayana IT, Christine RN, Suhardjo, Agni AN, Sasongko MB. Exogenous female sex hormone exposure and increased risk of orbito-cranial meningioma. Int J Ophthalmic Pathol 2016;5(3):1000183. https://doi.org/10.4172/2324-8599.1000183

39. Dewata L, Prasetyo B, Yuliati A, Wahyuhadi J. Hormonal contraceptive exposure and risk factors for meningioma. Adv Sci Lett 2017;23(4):3291-3294. https://doi.org/10.1166/asl.2017.9121

40. Wahyuhadi J, Heryani D, Basuki H. Risk of meningioma associated with hormonal contraception. Maj Obstet Ginekol 2018;26(1):36-41. https://doi.org/10.20473/mog.V26I12018.36-41

41. Dustur S, Wahyuhadi J, Utomo B, Parenrengi MA, Bajamal AH, Dwiningsih SR. Histopathology grading of meningioma and use of medroxyprogesterone acetate. Pharmacogn J 2022;14(6):938-941. https://doi.org/10.5530/pj.2022.14.193

42. United Nations Department of Economic and Social Affairs, Population Division. World Fertility and Family Planning 2020: Highlights. New York: UN, 2020. https://www.un-ilibrary.org/content/ books/9789210046527 (accessed 8 October 2025).

43. Westhoff C. Depot-medroxyprogesterone acetate injection (Depo-Provera): A highly effective contraceptive option with proven long-term safety. Contraception 2003;68(2):75-87. https://doi. org/10.1016/S0010-7824(03)00136-7

44. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012;366(21):1998-2007. https://doi.org/10.1056/NEJMoa1110855

45. Polis CB, Phillips SJ, Curtis KM. Hormonal contraceptive effectiveness and considerations for women’s health. Lancet Diabetes Endocrinol 2016;4(7):512-523. https://doi.org/10.1016/S2213-8587(16)30041-7 46. Malueka RG, Hartanto RA, Setyawan NH, et al. Association of hormonal contraception with

meningioma location. Asian Pac J Cancer Prev 2022;23(3):1047-1051. https://doi.org/10.31557/

APJCP.2022.23.3.1047

47. Deschuytere L, Beneke E, John BD, Lubbe D. Simultaneous two-team transorbital neuroendoscopic approach for sphenoid wing meningioma. J Coll Med S Afr 2025;3(1):5-10. https://doi.org/10.4102/ jcmsa.v3i1.224

48. Mbi Feh MKN, Lyon KA, Brahmaroutu AV, Tadipatri R, Fonkem E. The need for a central brain tumor registry in Africa. Neurooncol Pract 2021;8(3):337-344. https://doi.org/10.1093/nop/npab010

49. Kanmounye US, Karekezi C, Nyalundja AD, Awad AK, Laeke T, Balogun JA. Adult brain tumors in Sub-Saharan Africa: A scoping review. Neuro Oncol 2022;24(10):1799-1806. https://doi.org/10.1093/ neuonc/noac110

50. Reuter G, Potorac I, de Herdt C, et al. Recommendations on the management of meningioma and sex hormone therapy. Brain Spine 2025;5(1):104154. https://doi.org/10.1016/j.bas.2024.104154

51. South African Health Products Regulatory Authority. SAHPRA clarifies the benefits and risks of medroxyprogesterone acetate. Cape Town: SAHPRA, 2025. https://www.sahpra.org.za/news-and-updates/ sahpra-clarifies-the-benefits-and-risks-of-medroxyprogesterone-acetate/ (accessed 4 October 2025).

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Published

2026-02-09

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SAMJ Vol. 116 no. 1

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In Practice

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Copyright (c) 2026 R Burman, R de Waal, K Cohen, M Blockman, M Patel, D Hockman, D M Fountain, S Jeyaretna, S Singh, H Mustak, B De John, D Lubbe

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How to Cite

1.
Burman RJ, de Waal R, Cohen K, Blockman M, Patel M, Hockman D, et al. The association between depot medroxyprogesterone acetate and meningiomas: Emerging data and their relevance to the South African context. S Afr Med J [Internet]. 2026 Feb. 9 [cited 2026 Apr. 29];116(1):e4529. Available from: https://samajournals.co.za/index.php/samj/article/view/4529

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