Medroxyprogesterone acetate: Risk of meningioma and measures to minimise this risk

Summary

On the 7 October 2024 Pfizer, in agreement with the Medicines and Healthcare products Regulatory Agency (MHRA), produced a Direct Healthcare Professional Communication which provided a safety update concerning medroxyprogesterone acetate. This article provides a summary of this update.

Content

Medroxyprogesterone acetate

Medroxyprogesterone acetate is a type of medicine called progestogen. It is also known by the brand names Depo-Provera and Sayana Press.

Progestogens are similar to a natural hormone made in the body called progesterone. Medroxyprogesterone works in the same way as natural progesterone, but has stronger effects. The injection stops your body from releasing an egg each month and also makes it less likely that an egg would be fertilised or develop.

This can be administered by injection, and medroxyprogesterone can also come as tablets used to treat hormonal conditions including heavy periods, endometriosis, polycystic ovary syndrome and hot flushes caused by treatment for prostate cancer. It also comes mixed with another hormone called oestrogen as a type of hormone replacement therapy, for menopause symptoms.

More information can be found on the NHS website here.

Meningioma

Meningioma is a rare, most frequently benign tumour that forms from the meninges. Clinical signs and symptoms of meningioma may be non-specific and specific to the area of the brain affected. This could include, and is not limited to changes in vision, hearing loss or ringing in the ears, loss of smell, headaches that worsen with time, memory loss, seizures or weakness in the extremities.

Safety update

This letter states that there is a small increased risk of developing meningioma with high doses of medroxyprogesterone acetate (all injectable and ≥100 mg oral formulations), primarily after prolonged use (several years).

It states that for contraception or non-oncological indications:

• Medicines containing high doses of medroxyprogesterone acetate are contraindicated in patients with a meningioma or a history of meningioma. If meningioma is diagnosed in a patient treated with high doses of medroxyprogesterone acetate, treatment must be stopped.

It states for oncological indications:

• If a meningioma is diagnosed in a patient treated with high doses of medroxyprogesterone acetate, the need to continue the treatment should be carefully reconsidered, on a case-by-case basis taking into account individual benefits and risks.

The full letter can be found here.