Of Federico Pessina
In a large French study, the most widely used and frequently used molecules were tested and found to be safe, both in terms of dose and duration of intake.
Is it true that drugs containing progesterone increase the risk of brain cancer? I am 53 years old and took the contraceptive pill from 18 to 40. Should I be worried or is it just a hoax?
He replies Federico Pessinahead of Cranial Neurosurgery and director of the School of Neurosurgery specialization at the Humanitas Clinical Institute in Milan (GO TO THE FORUM)
The news has a basis: in the scientific journal British Medical Journal a study has been published which analyzed data from the French health system regarding 18,061 women (average age 58 years) operated for an intracranial meningioma between 2009 and 2018. Meningiomas are benign intracranial tumors in approximately 90-95% of cases. They originate from the envelope of our central nervous system, the meninges, and can be located both at the level of the cerebral hemispheres and at the base of the skull. The treatment is essentially surgical or radiotherapy, but many of these tumors, asymptomatic or small, are only monitored over time with annual MRIs.
When drugs are used
One of their characteristics is that of possessing, in more than 60% of cases, estrogen and progesterone receptors. Progestin drugs are similar to the natural hormone progesterone and are widely used for gynecological conditions such as endometriosis and polycystic ovary syndromeas well as in post-menopausal hormone therapy and contraception. However, this does not mean that any progestin interacts with these receptors and represents a risk factor for their development, growth and above all for a malignant evolution of meningiomas, which is an extremely rare event.
Increased risk of meningiomas
Already in 2018, a dose-dependent relationship was established between the incidence and growth of meningiomas and hormonal treatment with some progestins, the first of which was cyproterone acetateso much so as to induce the Italian Medicines Agency, in 2020, to publish information on the intake of this drug, the duration of its intake and the increased risk of multiple locations of meningiomas at the skull base of which 30% are associated with P1K3CA mutations (often present in some solid tumors).
The most common progestins
The recent French study analyzed a very large number of female patients treated surgically for meningioma in the last 20 years, for which an accurate history was available regarding the hormonal therapies carried out (type, dose and duration). The most popular progestins on the market for contraceptive, post-menopausal replacement and therapeutic use were taken into consideration. (particularly for endometriosis and infertility). It was possible to identify three new molecules associated with an increased risk of developing meningiomas (medrogestone, medroxiprogesterone and promegestone).
The molecules that were found to be safe
But, equally important, the research showed no risk whatsoever progesterone, dydrogesterone and the most widely used intrauterine hormonal systems, regardless of the dose and duration of their intake. Therefore the conclusions of the study should not be alarming, as the most widely and frequently used molecules derived from progesterone have been tested and are found to be safeboth at the dose level and for the period of intake.
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