Objective:

To systematically assess the risk of meningioma associated with various progestogens used in contraception, considering timing of use, pregnancy, and prior hormone replacement therapy.

Approach:

• Study Design: A nested case-control study using nationwide Danish registers to identify cases of meningioma among females aged 15 to 59 years, matched with controls.
• Data Sources: Data was collected from the Danish National Prescription Register, National Patient Register, and National Hospital Medication Register.
• Exposure Assessment: Hormonal contraceptives were categorized by type and route of administration, with exposure defined by prescription dispensing dates and treatment durations.

Key Findings:

• Meningioma is the most common intracranial tumor in adults, representing 38% to 42% of all primary central nervous system tumors.
• Population-based data from the United States show an incidence rate of 10.15 per 100,000 persons overall, with rates of 13.90 and 6.02 for women and men, respectively.
• In Denmark, the incidence is 12.6 per 100,000 persons overall, with 17.9 and 7.4 per 100,000 for women and men, respectively.
• Progesterone receptors are present in up to 87% of meningiomas, suggesting a hormonal influence.
• Conflicting evidence exists regarding the association between hormonal contraceptives and meningioma risk.

Interpretation:

The study aims to clarify the relationship between progestogen use in contraception and meningioma risk, addressing gaps in existing literature.

Limitations:

• Meningioma is rare among women of reproductive age, leading to small exposure groups.
• The study relies on existing health registers, which may have limitations in data completeness and accuracy.

Conclusion:

This study represents a comprehensive assessment of meningioma risk associated with various progestogens in a defined female population.