Is Zoely a risk factor for meningiomas? Understanding the nomegestrol connection

October 11, 2025 •

3 min read

Although meningiomas are rare, recent epidemiological studies have raised important questions regarding the link between certain hormonal medications and their development. Consequently, specific warnings have been issued concerning whether Zoely is a risk factor for meningiomas, particularly with prolonged use. This raises important questions for users of this common oral contraceptive.

Quick Summary

Nomegestrol acetate, a component in Zoely, has been associated with an increased risk of meningiomas, particularly with high-dose and long-term exposure. Medical bodies recommend caution and contraindicate its use in those with a history of meningioma, though the absolute risk is considered low.

Key Points

Nomegestrol acetate is the key factor: The progestogen ingredient in Zoely, nomegestrol acetate, has been associated with an increased risk of meningiomas, particularly with prolonged, high-dose use.
Lower dose in Zoely, but caution advised: Zoely contains a lower dose of nomegestrol acetate (2.5 mg) than some formulations studied, but medical authorities still advise caution, especially with long-term use.
Increased risk is dose-dependent: Research indicates that the risk of developing a meningioma is higher with increasing cumulative doses and longer duration of use of nomegestrol acetate.
Contraindicated in patients with meningioma history: If you have or have had a meningioma, you should not use Zoely. Regulatory bodies and manufacturers have issued clear contraindications.
Symptoms require immediate medical attention: Patients using Zoely should be aware of symptoms such as worsening headaches, vision or hearing changes, seizures, or weakness and contact a doctor immediately.
Risk may decrease after stopping treatment: In many cases, meningioma volume has been shown to shrink or stabilize after the discontinuation of progestogen treatment.

What is Zoely and what is a meningioma?

Zoely is a combined oral contraceptive containing nomegestrol acetate (a synthetic progestogen) and 17β-estradiol (an estrogen). It prevents pregnancy by affecting ovulation, cervical mucus, and the uterine lining.

A meningioma is typically a benign tumor of the meninges, the membranes around the brain and spinal cord. They are the most common primary brain tumor. Symptoms like headaches, seizures, or vision/hearing changes can occur due to pressure on surrounding tissues. Meningiomas are more common in women and often have hormone receptors, suggesting hormonal influence.

The link between nomegestrol acetate and meningiomas

Research suggests that the progestogen in some hormonal medicines, especially with long-term, high-dose use, can increase the risk and growth of meningiomas. Nomegestrol acetate (NOMAC) is one such progestogen.

Studies in France, using national health data, found a dose-dependent link between prolonged nomegestrol acetate use and intracranial meningiomas requiring treatment. The risk was higher with longer cumulative exposure to higher doses (3.75 mg or 5 mg). The risk was also shown to decrease after stopping the medication.

Is the risk associated with Zoely specifically?

Zoely contains a lower dose of nomegestrol acetate (2.5 mg) than the higher doses evaluated in some studies. Despite this, regulatory bodies and medical experts have issued warnings based on the known risks of nomegestrol acetate.

Regulatory Stance: The European Medicines Agency (EMA) and the Faculty of Sexual & Reproductive Healthcare (FSRH) advise against using Zoely if you have a history of meningioma and recommend monitoring for symptoms.
Manufacturer Warnings: Drug manufacturers now include information in product leaflets about the potential link between nomegestrol acetate and meningioma, particularly with higher doses and durations.
Case Report Evidence: A study in 2025 described a case where a large meningioma significantly shrank after a woman stopped taking Zoely, which she had used for five years. This suggests that even the dose in Zoely may contribute to tumor growth in some individuals.

A comparison of progestogen-associated meningioma risk

Different progestogens are associated with varying levels of meningioma risk:


Progestogen (found in)	Associated Risk	Key Findings
Nomegestrol Acetate (Zoely)	Increased with prolonged use and higher doses, decreases after cessation.	Confirmed dose-dependent association in large French studies. Case of regression after stopping Zoely reported.
Cyproterone Acetate (Dianette)	Strongest association, highest risk, strongly dose-dependent. Used for severe acne and hirsutism.	Risk multiplied by up to 20 for very long-term, high-dose use. Contraindicated in individuals with meningioma history.
Medroxyprogesterone Acetate (Depo-Provera)	Increased risk, especially with long-term injectable use.	Large U.S. and French studies confirmed increased odds, dose-dependent. Specific to cerebral meningiomas.
Chlormadinone Acetate (Belara)	Increased risk, similar to nomegestrol acetate.	EMA review recommended similar precautions to nomegestrol acetate.
Progesterone, Levonorgestrel (IUS)	No excess risk observed with standard usage.	Studies showed no increased meningioma risk with these common options.

Clinical implications and patient advice

Healthcare providers should discuss the potential meningioma risk with patients considering long-term Zoely use. While the absolute risk is small, vigilance for symptoms is important.

Symptoms to monitor

If you use Zoely, be aware of potential meningioma symptoms:

Changes in vision or hearing
Loss of smell
Worsening headaches
Memory loss
Seizures
Weakness or numbness in limbs

What to do if diagnosed

If a meningioma is diagnosed while taking Zoely, the medication should be stopped permanently. Stopping the progestogen has been shown to shrink or stop the growth of meningiomas in some cases.

Conclusion: Balancing contraception needs with meningioma risk

The absolute risk of meningioma from Zoely is low, especially with the lower dose of nomegestrol acetate compared to other formulations. However, a clear link exists, particularly with long-term use. Given the hormonal sensitivity of meningiomas and the established association of nomegestrol acetate with increased risk in studies, medical authorities advise caution. Zoely is contraindicated for women with a history of meningioma. All users should be aware of the symptoms and discuss the individual risk-benefit with their healthcare provider to make informed decisions about contraception. For official guidance, consult resources like the European Medicines Agency (EMA).

Frequently Asked Questions

A meningioma is a type of tumor that grows from the membranes surrounding the brain and spinal cord, known as the meninges. While usually benign, their growth can cause neurological symptoms by compressing surrounding brain tissue.

Meningiomas often have progesterone receptors, and studies have shown that nomegestrol acetate can stimulate their growth. Prolonged use and higher doses of this progestogen have been linked to an elevated risk of meningiomas.

Yes, the risk varies depending on the specific progestogen. While some, like nomegestrol acetate, cyproterone acetate, and medroxyprogesterone acetate carry a higher risk, others like progesterone or levonorgestrel (in hormonal IUDs) have not been associated with this increased risk.

Users should watch for worsening or persistent headaches, changes in vision or hearing, loss of smell, memory loss, seizures, and weakness in limbs. These symptoms warrant immediate medical attention.

If a meningioma is diagnosed, treatment with Zoely must be permanently stopped. Tumor regression has been observed in some cases after discontinuation.

Yes, available evidence suggests that the risk of meningioma decreases after treatment with nomegestrol acetate is discontinued. For some, the risk becomes comparable to that of never-users within a year.

While the absolute risk of developing a meningioma from Zoely is low, particularly given the lower dosage, it is important to be aware of the potential, especially with long-term use. Women with risk factors, or a family history of meningioma, should discuss alternatives with their doctor.

Meningiomas can express estrogen receptors, but the association with meningioma risk is primarily linked to the progestogen component, nomegestrol acetate. Some studies on estrogen-only hormone replacement therapy (HRT) have found conflicting results, with some finding no link to meningioma growth.