BMJ neurology open
Meningioma regression following depot medroxyprogesterone acetate withdrawal: a case series
By De John B, Burman RJ, Sood V and 3 others.
Abstract
Background
Progesterone signalling is a key determinant of meningioma behaviour, particularly in skull base tumours. Cyproterone acetate-associated meningiomas stabilise or regress after withdrawal Whether similar reversibility follows cessation of depot medroxyprogesterone acetate (DMPA), a widely used long-acting injectable contraceptive, is poorly characterised.
Methods
Retrospective case series of three women with intracranial meningiomas who discontinued DMPA following neurosurgical assessment, assessed with post-contrast CT (Cases 1 and 2) or magnetic resonance imaging (Case 3).
Results
All had prolonged DMPA exposure (approximately 14-27 years) and predominantly skull base disease with WHO grade I meningothelial histology. Each demonstrated measurable regression of enhancing soft-tissue tumour after cessation, despite marked heterogeneity in disease burden and chronicity, including one patient with multifocal meningiomatosis and more than a decade of documented progression. Hyperostotic bone showed no regression, and two patients required optic nerve and orbital decompression for progressive visual loss despite soft-tissue regression.