Progesterone Depot (Medroxyprogesterone Acetate) and Meningioma Policy

Information for Patients

Prepared by your GP practice to support informed choice.

Why am I receiving this leaflet? 

You are considering or using the contraceptive injection containing medroxyprogesterone acetate (often called the ‘progesterone depot’ or ‘depot’ or by brand names such as Depo‑Provera or Sayana Press). This leaflet explains, what a meningioma is, what recent studies and regulators say about a possible link, what symptoms to look out for, when we would stop this medicine on medical grounds, and safe alternatives.

What is medroxyprogesterone acetate (MPA)?

MPA is a progestogen (a hormone similar to progesterone). As an injection, it provides highly effective contraception for 12–13 weeks at a time.

What is a meningioma?

A meningioma is a tumour arising from the protective layers (meninges) around the brain and spinal cord. Most are non‑cancerous (benign) and slow‑growing, but they can cause symptoms by pressing on nearby structures. Symptoms depend on location and can include persistent or worsening headaches, changes in vision, hearing problems or ringing in the ears, loss of smell, memory or thinking changes, seizures, or weakness in an arm or leg. Although they do not spread to other areas, they can require treatment if they cause symptoms.

What does the latest research show?

A large national case‑control study from France (published in the British Medical Journal in March 2024) found that women who used the injectable form of medroxyprogesterone acetate for a year or more had a higher chance of needing surgery for a meningioma than non‑users. The relative increase was around five‑fold, but the overall chance of this happening remained very small.

Importantly, the same study found no excess risk with the levonorgestrel intrauterine system (the hormonal coil).

The numbers explained in a simple and direct way

Statistics for those not on contraceptive depot:

• The risk of needing surgery for a meningioma was 4 per 100,000 per year
• Which is the same as saying for every 25,000 women, 1 would need meningioma surgery in a year 
• As a percentage that is 0.004% of women

Statistics for those who were taking the contraceptive depot:

• 22 out of 100,000 women needed surgery per year. This is 5.5 x higher than the above example 
• Which is the same as saying for every 25,000 women, 5.5 would need meningioma surgery in a year 
• As a percentage that is 0.02% of the women taking the contraceptive depot. 

Although this number is higher than the previous 0.004% the actual risk is still very small, which is why we are not taking the option of having the medication away from patients. We are providing this information in case patients wish to decide against having the treatment voluntarily in light of the above data.

What do UK and international regulators say?

In October 2024, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and Pfizer issued updated advice stating that high‑dose MPA (all injectable forms and oral doses ≥100 mg) carries a small increased risk of meningioma, mainly with prolonged use over several years. For contraception or non‑cancer uses, MPA is now contraindicated in anyone who has a current or past meningioma. If a meningioma is diagnosed while using high‑dose MPA, the injection must be stopped. New Zealand’s medicines regulator (Medsafe) classifies meningioma as a newly identified, very rare side effect and also advises stopping MPA if a meningioma occurs. Because this is such a new finding we are using what the international community is doing to help shape our approach to this new finding.

Who should not use the progesterone depot injection?

We will not offer or continue injectable MPA if:

• you have a current meningioma or a past history of meningioma (medical contraindication).
• you develop a meningioma while using MPA (it must be stopped).

When will we stop the injection on medical grounds?

If you are diagnosed with a meningioma while using MPA, we will stop further injections. If you develop new neurological symptoms possibly suggestive of a meningioma, we will review you promptly, consider investigations, and discuss pausing or switching contraception while this is assessed.

Symptoms to look out for (seek medical advice if you notice any of these):

• Headaches that persist or get worse over time
• Changes in vision
• Hearing loss or ringing in the ears
• Loss of sense of smell
• Memory problems, confusion, or personality change
• Seizures (fits)
• Weakness, numbness, or clumsiness in an arm or leg

What are my alternatives that do not carry this risk?

Based on current evidence, the following contraceptive options have not been shown to increase the risk of meningioma:

• Progestogen‑only pill (POP, e.g., desogestrel) – no established association with meningioma.
• Levonorgestrel intrauterine system (hormonal coil/IUS) – no excess risk seen in the BMJ study.
• Copper intrauterine device (IUD) – non hormonal.

We can help you choose an option that fits your preferences and health needs. If you wish to continue with the injection, we will review this with you and make an individualised plan.

Making your decision

It’s your choice whether to start, continue, or switch contraception. We’re here to help you weigh the pros and cons in the context of your health, values, and plans. Please book an appointment if you have questions or want to discuss switching methods.