Long-term Use and Brain Tumor Risk? A Balanced Perspective on Contraceptive Research

Contraceptives are medications used daily by many women worldwide. They not only prevent unwanted pregnancies but are also used to manage menstrual pain, heavy periods, endometriosis, and irregular menstruation. These medications support quality of life and have played a significant role in women's health and social participation.

On the other hand, as medications that affect hormones, continuous evaluation of side effects and long-term use risks is necessary. Recently, the UK media outlet Daily Mail reported on a study examining the link between certain contraceptive components and brain tumors known as "intracranial meningiomas." From the article's headline alone, some might worry, "Does taking contraceptives cause brain tumors?"

However, a careful reading of the study reveals that the conclusion is quite limited. The focus is not on contraceptives in general. It specifically highlights that long-term use, particularly over five years, of certain progestogen formulations, especially "desogestrel 75µg," may slightly increase the risk of needing surgery for meningiomas.

The Study Did Not Investigate "All Contraceptives"

This study, published in the medical journal BMJ, is a nationwide case-control study from France. The research team used the French national healthcare database to compare 8,391 women who underwent surgery for intracranial meningiomas between 2020 and 2023 with 83,910 women without meningiomas.

The investigation focused on desogestrel 75µg, levonorgestrel 30µg, and combined contraceptives containing estrogen and levonorgestrel. The study aimed to examine the association between the duration of use of these oral contraceptives and the need for surgery for intracranial meningiomas.

The results showed a slight increase in meningioma risk among women who used desogestrel 75µg continuously for more than five years. The risk was about 1.5 times higher for 5-7 years of use and about twice as high for more than seven years. However, this does not mean that taking the pill will likely cause brain tumors. The original incidence rate is low, so the absolute risk is small.

The research team estimated that among 67,300 desogestrel users, there would be one additional case of meningioma requiring surgery. For current users over five years, the estimate was about one case per 17,000 people. While the numbers are not negligible, in everyday medical decision-making, it's important to consider both "relative risk" and "absolute risk" separately.

No Risk Increase Confirmed with Levonorgestrel

An important point in this study is that not all contraceptives yielded the same results. For levonorgestrel alone or in combination with estrogen, no increase in intracranial meningioma risk was confirmed, regardless of the duration of use.

This highlights the danger of generalizing about contraceptives. There are various types of contraceptive methods, such as pills, mini-pills, hormone injections, and intrauterine systems, each with different hormones, dosages, and administration methods. The study indicates that "some progestogen components may be associated with meningiomas with long-term use," but it does not conclude that "all hormonal contraceptives are dangerous."

In fact, past studies have also pointed out the association between meningioma risk and several progestogen formulations, such as cyproterone acetate, nomegestrol, chlormadinone, and medroxyprogesterone. The European Medicines Agency has also considered the possibility that the risk of meningiomas increases with longer use and higher doses of medicines containing nomegestrol and chlormadinone.

Now, a signal for long-term use of desogestrel has been added to this. However, experts view the risk increase from desogestrel as considerably smaller compared to already known high-risk progestogen formulations.

What is Meningioma?

Meningiomas are tumors that arise from the meninges, the membranes covering the brain and spinal cord. Most are benign and generally differ from "cancer." However, depending on their location and size, they can compress the brain or nerves, causing headaches, nausea, visual disturbances, seizures, numbness in limbs, and changes in cognitive function. If symptoms are severe or the tumor grows, surgery or radiation therapy may be necessary.

Meningiomas are more common in women, and their incidence increases with age. Therefore, the study emphasized the need for caution, particularly among women over 45 or those who have used progestogen formulations known to be associated with meningioma risk for long periods.

However, it is also important to note that the risk is not "all or nothing." Not everyone taking desogestrel needs to rush for tests or stop immediately. It is crucial to make individual decisions with a doctor, considering the purpose of use, age, medical history, compatibility with other contraceptive methods, and the need to avoid pregnancy.

The Importance of "No Risk Increase" After One Year of Discontinuation

The study found no risk increase with short-term use of desogestrel. Additionally, no risk increase was confirmed if more than a year had passed since discontinuation.

This is a reassuring factor. Even if there are effects from long-term use, the risk may not persist indefinitely. Of course, this study is observational and does not prove causality. It also could not completely adjust for all factors, such as genetic factors and radiation exposure history.

Nevertheless, it is a study using large-scale data on medication use history and meningioma occurrence, making it an important reference for clinical decision-making. The researchers suggest that if a meningioma is found, stopping desogestrel and considering observation instead of immediate surgery could help avoid unnecessary treatment.

Experts Emphasize "No Need to Panic"

Experts have urged a calm reception of this study. In comments provided to the Science Media Centre, experts highlighted that while an association with meningioma risk was observed for continuous use of desogestrel for over five years, the risk increase was small, there was no association with short-term use, and no excess risk was seen after more than a year of discontinuation.

In other words, this study is not a warning to "stop taking it immediately," but rather a message that "long-term users, particularly those over 45 or with a history of using high-risk progestogen formulations, should consider checking the medication components and alternatives with a doctor."

Contraceptives offer various benefits beyond contraception. They can reduce menstrual pain and bleeding and help manage symptoms of endometriosis and polycystic ovary syndrome. Oral contraceptives are also known to be associated with a reduced risk of ovarian and endometrial cancer. However, side effects such as thrombosis, breast tenderness, nausea, headaches, irregular bleeding, and mood changes exist, and the suitable method varies depending on individual constitution and medical history.

Therefore, the important thing is not to "stop everything out of fear" or "ignore it because the risk is low." It's about checking the ingredient names of the medications you are using and reviewing them with healthcare providers based on your usage duration, age, and medical history.

Anxiety and Misunderstanding Spread on Social Media

This news also sparked significant reactions on social media. The combination of words like "contraceptive," "brain tumor," and "long-term use" made anxiety spread quickly.

According to AFP's fact-check, in the Philippines, photos of contraceptives containing different components than those studied were spread in connection with the desogestrel study results. Comments expressing anxiety, such as "I've been using this brand for 10 years," and reactions like "Isn't the calendar method better?" were also noted.

However, some brands mentioned in the problematic posts contained levonorgestrel, which was not associated with increased risk in the study, rather than desogestrel. This means that on social media, the "difference in components" was overlooked, and anxiety spread to all contraceptives.

Such reactions are common when medical news spreads on social media. Even though studies draw conclusions with specific conditions, headlines or short posts leave only a strong impression like "pill causes brain tumor." As a result, even those using medications not covered by the study become anxious, while those who truly need to check are buried in a flood of information.

"Natural Methods Are Not Necessarily Safe"

On social media, voices supporting the calendar method or natural contraceptive methods emerged due to anxiety about hormonal contraceptives. However, caution is needed here as well. While there are benefits to non-hormonal methods, contraceptive effectiveness varies greatly by method. Consideration must also be given to the risk of pregnancy if contraception fails, the need for emergency contraception, and the presence or absence of sexually transmitted infection prevention.

Public institutions like WHO and NHS explain that there are multiple contraceptive options, each with different effectiveness, ease of use, side effects, and STI prevention capabilities. For example, there are non-hormonal methods like copper IUDs, methods like condoms that also help prevent STIs, and methods containing hormones but with different components or administration routes.

In this study, contraceptives containing levonorgestrel were noted as having "more reassuring factors." However, which method is suitable depends on the individual's health status, age, smoking status, thrombosis risk, breastfeeding status, presence of menstrual symptoms, and how much they prioritize contraceptive reliability.

Points Readers Should Confirm

For those who became anxious after this news, it's important first to confirm not only the "brand name" but also the "ingredient name" of the contraceptives they are using. Especially those who have used medications containing desogestrel continuously for more than five years, are over 45, or have a history of long-term use of hormone formulations known to be associated with meningioma risk, such as nomegestrol, chlormadinone, cyproterone, or medroxyprogesterone, should consider consulting with a doctor or pharmacist.

However, avoid abruptly stopping on your own judgment. Stopping contraceptives may increase the likelihood of pregnancy, and some may experience worsening symptoms of menstrual disorders or endometriosis. When changing medications, it's advisable to prepare alternative contraceptive or treatment methods before transitioning.

Also, there's no need to immediately suspect meningioma just because of a headache. Headaches are very common symptoms and are often caused by other factors. However, if you experience unusually severe headaches, visual or field of vision abnormalities, unilateral numbness or weakness, seizures, persistent nausea, or changes in consciousness, it's best to seek medical attention promptly.

How to Read This Study

The value of this study lies not in denying the safety of contraceptives but in highlighting the need to examine differences by medication type more closely. Contraceptives have been used for many years, but not all long-term risks are the same for each component. Especially for tumors that respond to hormones, the duration of use and cumulative amount may have an impact.

On the other hand, the study is observational and does not prove that desogestrel directly causes meningiomas. While database studies have strengths in tracking prescription and surgery histories, they cannot fully reflect all background factors, such as lifestyle, family history, genetic predisposition, and past radiation exposure.

Therefore, the conclusion to draw from this article is not "contraceptives are dangerous," but rather "understand the components of the medication you are using long-term and review them as needed." Risks in medicine cannot be judged in isolation. Consider the pregnancy risk of not using contraception, the risk of leaving menstrual disorders untreated, the risk of switching to another medication, and the individual's lifestyle and values.

Summary

The news reported by the Daily Mail about contraceptives and brain tumor risk is certainly noteworthy. The large-scale French study published in BMJ found a slight increase in the risk of intracranial meningiomas requiring surgery among women who used desogestrel 75µg continuously for more than five years. However, no risk increase was confirmed with short-term use or more than a year after discontinuation, and no similar association was found with levonorgestrel.

On social media, anxiety and misunderstandings spread, with even medications not covered by the study being viewed as dangerous. For such medical news, it is crucial not to judge by headlines alone but to confirm the components, usage duration, age, and absolute risk involved.

Contraceptives remain a useful option for many people. However, because they are medications used long-term, regular reviews are necessary. Knowing the components of your medication, consulting with doctors or pharmacists if you have questions, and checking information close to primary sources rather than short social media posts are the first steps to making safer choices without being swayed by anxiety.

Source URL

Daily Mail. The article that triggered the current report.
https://www.dailymail.com/health/article-15947583/Long-term-use-contraceptives-taken-millions-women-linked-brain-tumours-study-finds-researchers-identify-safer-options.html?ns_mchannel=rss&ns_campaign=1490&ito=1490

Research paper published in BMJ. A nationwide case-control study in France examining desogestrel, levonorgestrel, and intracranial meningioma risk.
https://www.bmj.com/content/389/bmj-2024-083981

EPI-PHARE study summary. Summary of the number of subjects, odds ratios, and the point that the risk was not observed after one year of discontinuation.
https://www.epi-phare.fr/en/study-reports-and-publications/desogestrel-levonorgestrel-meningioma/

Science Media Centre expert comments. Expert opinions on how to interpret the study, the small risk, and the lack of need for panic.
https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-the-association-between-prolonged-use-of-progestogen-contraceptive-pill-desogestrel-and-risk-of-brain-tumour/

Scimex expert reactions and BMJ release summary. Explanation of study results, number of subjects, limitations, and alternative options.
https://www.scimex.org/newsfeed/expert-reaction-common-contraceptive-pill-linked-to-small-increase-in-brain-tumour-risk

AFP Fact Check. Confirmation of cases where photos of contraceptives not covered by the study were linked and misunderstandings spread on social media.
https://factcheck.afp.com/doc.afp.com.663R963