Recent Studies Clarify: Does Oral Medroxyprogesterone Cause Meningioma?

October 11, 2025 •

4 min read

Meningiomas, the most common type of primary brain tumor in adults, are frequently hormone-sensitive and occur more often in women. While recent research has highlighted a concerning association between prolonged use of injectable medroxyprogesterone acetate (MPA) and an increased risk of meningioma, findings for the oral form differ significantly. This article addresses the crucial question: Does oral medroxyprogesterone cause meningioma? (Spoiler: The data says no).

Quick Summary

This article examines recent epidemiological research comparing the safety profiles of oral versus injectable medroxyprogesterone acetate (MPA) concerning meningioma risk. It clarifies that, unlike the established link for long-term injectable use, oral MPA has not been associated with an increased likelihood of meningioma development in large-scale studies.

Key Points

No Link for Oral MPA: Large-scale studies, including those using U.S. insurance data, found no significant association between oral medroxyprogesterone acetate (MPA) and meningioma risk.
Risk Associated with Injectable MPA: The increased meningioma risk is specifically linked to the injectable form of the drug, often called Depo-Provera.
Duration of Use Matters: For injectable MPA, the risk is dose-dependent and increases significantly with prolonged, long-term use (e.g., more than three years).
Hormone Sensitivity: Meningiomas frequently express progesterone receptors, providing a biological basis for how progestogens, particularly in sustained, high doses, might influence their growth.
Symptoms Require Attention: Patients on long-term injectable MPA should be monitored for neurological symptoms such as headaches, vision changes, and seizures, as these could indicate a meningioma.
Discontinuation May Help: Studies have shown that meningiomas associated with progestogen use may stabilize or even regress after discontinuation of the medication.
Specific Tumor Type: The identified risk is specific to intracranial (cerebral) meningiomas, with no association found for spinal meningiomas.

Understanding Medroxyprogesterone and Meningioma

Medroxyprogesterone acetate (MPA) is a synthetic progestogen widely used in both oral tablet form and as a long-acting injectable contraceptive (Depo-Provera). Its uses include contraception, hormone replacement therapy, and the treatment of conditions like endometriosis and uterine bleeding. Meningiomas, typically benign tumors of the membranes surrounding the brain and spinal cord, are known to be influenced by hormones, as demonstrated by their higher prevalence in women and the presence of progesterone receptors on tumor cells. This hormonal link has prompted extensive research into the potential risks associated with various progestogen-based medications.

The Distinction Between Oral and Injectable Medroxyprogesterone

The most critical distinction highlighted by recent studies is the one between different forms of MPA. Multiple large-scale epidemiological studies, particularly from 2024 and 2025, have investigated the potential link with meningioma risk. These investigations consistently show a strong association with the injectable form, particularly with prolonged use, but not with the oral version. For instance, a September 2024 study involving over 117,000 meningioma cases in a U.S. commercial insurance database found a significant association with injectable MPA but reported no association for oral MPA exposure, even when considering the duration of use. This divergence suggests that the high, sustained systemic levels of progestogen achieved by the depot injection may influence tumor growth differently than the lower, more intermittent levels from oral tablets.

Key Findings from Recent Epidemiological Studies

Recent research offers clear conclusions on the oral medroxyprogesterone and meningioma risk question. Here are some of the key findings:

No link for oral MPA: Several large studies have explicitly found no statistically significant association between the use of oral medroxyprogesterone acetate and an increased risk of meningioma.
Link for injectable MPA: The risk is specifically tied to the injectable form (Depo-Provera), with prolonged, long-term use (often defined as over 1-3 years) being the primary driver.
Dose-dependent effect: For injectable MPA, the risk appears to be dose-dependent, increasing with the duration of use. One study showed more than a threefold increase in odds for those with over three years of injectable exposure.
Site-specific risk: The association with injectable MPA is specific to intracranial (cerebral) meningiomas, with no link found for spinal meningiomas.
Different progestogens: Not all progestogens carry the same risk. While some potent synthetic progestogens like cyproterone acetate have a very strong association, others like oral progesterone, dydrogesterone, or levonorgestrel IUDs have not shown an excess risk.

Understanding the Hormonal Connection to Meningioma

For decades, scientists have known about the potential influence of sex hormones on meningioma growth. This is due to the presence of hormone receptors on many meningioma cells, with a high percentage expressing progesterone receptors. Endogenous hormone fluctuations, such as those during pregnancy, have been shown to affect tumor size. The findings regarding synthetic progestogens add another layer to this understanding, suggesting that different molecules and routes of administration can have distinct effects. The concentration and sustained nature of the hormone from the depot injection, for example, may contribute to a proliferative effect on hormone-sensitive tumor cells that is not replicated by the oral formulation.

Weighing the Risks and Benefits of Medroxyprogesterone

For patients and clinicians, understanding the differential risk between oral and injectable MPA is crucial for informed decision-making. The injectable form, while highly effective, now comes with specific warnings regarding long-term use and meningioma risk, as recommended by regulatory bodies in some regions. Oral medroxyprogesterone, often used for different indications, appears to be safer in this regard. As with any medication, the potential benefits of contraception or managing gynecological symptoms must be weighed against any potential risks, especially for individuals with a history of meningioma or other risk factors. Importantly, studies have shown that stopping the implicated progestogen can lead to tumor stabilization or regression in some cases.

Navigating Patient Information and Regulatory Updates

Following the publication of compelling evidence, regulatory actions are underway in various countries. For example, some jurisdictions have added warnings to MPA product information. Health authorities encourage healthcare providers to discuss the potential meningioma risk associated with prolonged injectable MPA use with patients. Patients using injectable MPA for long periods should be informed and monitored for neurological symptoms, especially if other risk factors are present. Discontinuation of the medication is typically recommended if a meningioma is diagnosed. This highlights the ongoing need for communication and vigilance in patient care.

Comparison of Oral vs. Injectable MPA on Meningioma Risk


Feature	Oral Medroxyprogesterone Acetate	Injectable Medroxyprogesterone Acetate (Depo-Provera)
Meningioma Risk	No significant increase in risk found in large studies.	Increased risk, especially with long-term (e.g., >3 years) exposure.
Associated Tumor Type	No association found.	Specific to intracranial (cerebral) meningiomas.
Risk Profile	Not associated with meningioma, based on current evidence.	Dose-dependent risk, increasing with duration of use.
Biological Plausibility	Lower systemic progestogen exposure likely contributes to a different risk profile.	High, sustained progestogen levels may promote growth in hormone-sensitive meningiomas.

Conclusion: Does Oral Medroxyprogesterone Cause Meningioma?

Based on the latest and largest epidemiological studies, oral medroxyprogesterone has not been associated with an increased risk of meningioma. The connection found in research relates specifically to the long-term use of the injectable form (Depo-Provera), where a dose-dependent risk of intracranial meningioma has been identified. This crucial distinction is vital for patient safety and clinical decision-making. While the absolute risk of meningioma remains low, individuals using injectable MPA, particularly for prolonged periods, should be aware of the increased potential risk and discuss it with their healthcare providers. The findings offer reassurance regarding the oral formulation while emphasizing the importance of informed consent and vigilant monitoring for users of the injectable product. More research is ongoing, but the current data is clear in separating the risks associated with the different formulations of medroxyprogesterone acetate.

Visit the official website of the U.S. National Institutes of Health for detailed reports on medical research.

Frequently Asked Questions

No, recent research clearly distinguishes between the formulations. Studies have found no significant association between meningioma risk and oral medroxyprogesterone, while a dose-dependent risk is linked to the long-term use of the injectable form (Depo-Provera).

Multiple large-scale studies have shown a statistical association between prolonged use of injectable MPA and an increased risk of intracranial meningioma. This risk appears to be highest with longer durations of use.

Meningiomas are relatively rare. Even with a statistically significant increase in risk from prolonged injectable MPA, the absolute number of additional cases remains low. It's an important consideration, but the overall incidence remains small.

The difference is likely due to the drug's pharmacokinetics. The high, sustained systemic levels of progestogen achieved by the long-acting depot injection may influence hormone-sensitive meningioma cells differently than the lower, intermittent levels from oral tablets.

Symptoms can vary based on the tumor's location but may include persistent headaches, vision changes (e.g., blurry or double vision), hearing loss, memory loss, dizziness, seizures, and weakness in limbs.

You should discuss the risks and benefits with your healthcare provider. Given the rare nature of meningiomas, no action may be needed, but staying vigilant for any neurological symptoms is wise. In case of a meningioma diagnosis, stopping the medication is typically recommended.

Some international regulatory bodies, such as in Europe and the UK, have added warnings about meningioma risk to injectable MPA product information. The FDA has not yet issued a similar warning in the U.S. as of mid-2025, but lawsuits have been filed over the issue.