A major new French study published in The BMJ has linked prolonged use of the progestogen-only contraceptive pill desogestrel to a modestly increased risk of developing a type of brain tumor known as intracranial meningioma. While the absolute risk remains low, the findings add to a growing body of evidence that long-term hormone use may influence meningioma development in some women.
Key Findings: Desogestrel and Risk Over Time
The case-control study by Roland et al., conducted using France’s national health data system (SNDS), analyzed data from 8,391 women who underwent surgery for intracranial meningiomas between 2020 and 2023, comparing them with 83,910 matched controls. The average participant age was nearly 60, and most were over 45.
The researchers found that women who used desogestrel (75 µg)—a progestogen-only pill—for more than five continuous years faced a small but statistically significant increased risk of requiring surgery for a meningioma. The odds ratio (OR) for five to seven years of use was 1.51, and for seven or more years, it rose to 2.09—more than double the baseline risk.
Critically, this risk disappeared within a year of stopping desogestrel, and no increased risk was observed for women who had taken the pill for less than a year or had discontinued it over a year prior.
Levonorgestrel, another progestogen found in several contraceptive formulations, was not associated with an increased risk of intracranial meningioma, regardless of whether it was used alone or with estrogen.
Risk in Context: A Low-Probability but Important Finding
The absolute risk remains small: researchers estimate that 67,300 women would need to use desogestrel for one woman to require surgery for a meningioma. This number drops to 17,000 for those using it continuously for over five years.
“Desogestrel pills should be avoided in women over 45 and discontinued if intracranial meningioma is diagnosed,” said Dr. Lana McClements, Associate Professor at the University of Technology Sydney. However, she noted that the risk is substantially lower than that linked to other high-risk progestogens such as cyproterone or nomegestrol acetate.
Hormonal Pathways and Tumor Regression
Meningiomas are typically non-cancerous tumors arising from the membranes covering the brain and spinal cord. While many remain asymptomatic, others can cause serious neurological symptoms and require surgical removal.
Intriguingly, the study and editorial by neurosurgeon Dr. Gilles Reuter suggest that desogestrel-related meningiomas may regress or stabilize following drug discontinuation—mirroring patterns seen with other hormone-associated tumors. “Spontaneous regression…can be expected in almost every patient on cessation of treatment,” Reuter writes.
Who Is Most at Risk?
The excess risk from desogestrel was greater in women over 45, especially those with tumors in the middle or anterior skull base, and those who had previously used other progestogens known to elevate meningioma risk. Among these women, the risk tripled (OR 3.30) if prior high-risk progestogens had been used within six years of starting desogestrel.
In younger women under 45, desogestrel use did not confer a statistically significant risk unless use exceeded five years, aligning with broader trends that suggest hormonal influence may accumulate over time.
Clinical Guidance and Reassurance
For clinicians, the findings provide new guidance for risk stratification—but not cause for panic. “Generally speaking, I do not believe this study should raise cause for alarm but merely drive discussion by women with their doctor,” said Associate Professor Gino Pecoraro, President of Australia’s National Association of Specialist Obstetricians and Gynaecologists. “Contraception is important to avoid unwanted pregnancy, which itself carries significant health risks”.
Alex Polyakov, Clinical Associate Professor at the University of Melbourne, emphasized the reassuring results for levonorgestrel, which is widely used across contraceptive methods including IUDs and emergency contraception. “This finding offers important clinical reassurance,” he noted, especially for countries like Australia where desogestrel-only pills are not widely used.
A Broader Hormonal Picture
This new research adds desogestrel to the list of synthetic progestogens with potential meningioma links, although its risk profile is milder than that of previous drugs. Earlier studies using the same SNDS dataset identified higher risks associated with cyproterone (hazard ratio 21.7 for cumulative high-dose exposure), nomegestrol (OR 13), and medroxyprogesterone (OR 5.6), among others.
Unlike those compounds, which are derived from 17-hydroxyprogesterone or 19-norprogesterone, desogestrel and levonorgestrel are testosterone-derived gonanes. The relatively lower risk found in this study suggests structural and metabolic differences may influence tumorigenic potential.
Implications for Policy and Patient Care
Given the increasing popularity of desogestrel due to its low cardiovascular risk profile—a major advantage over combined contraceptives—its widespread use in Europe and over-the-counter availability in some countries now warrants closer scrutiny.
Still, systematic MRI screening is not recommended. The authors argue that given the low incidence and costs, such an approach isn’t warranted except for users with prior high-risk progestogen exposure or other risk factors.
Instead, clinicians are advised to collect a thorough hormonal history when assessing women with meningioma and consider stopping desogestrel (or any progestogen) upon diagnosis. In many cases, this may allow for symptom improvement or tumor regression without immediate surgery.
What Happens Next?
While this study doesn’t prove causation—it’s observational—it does offer real-world data strong enough to influence prescribing practices, particularly for women over 45 and those with a prior history of hormone exposure.
Further research is needed to explore molecular pathways, hormone receptor expression, and tumor subtypes to better understand how and why progestogens like desogestrel might promote tumor growth in a small subset of users.
For now, the message is nuanced: Desogestrel remains a safe and effective contraceptive for most women. But for those on long-term therapy, especially over five years, a conversation with their healthcare provider may be warranted.
“The goal,” said Dr. McClements, “is not to create alarm—but to support informed choice.”
References:
- Roland N. et al. BMJ. 2025;389:e083981. doi:10.1136/bmj-2024-083981
- Reuter G. BMJ Editorial. 2025;389:r1095. doi:10.1136/bmj.r1095
- Science Media Centre Expert Reactions (June 2025).