Spotlight on Meningiomas: The Diagnosis Behind the Depo-Provera Case

Outline

  1. What Are Meningiomas?
  2. How Progesterone Impacts Meningioma Risk
  3. Where Do We Go From Here?

Depo-Provera (medroxyprogesterone acetate) is a form of hormonal birth control. Almost a quarter of women in the US have used it. 

The “Depo shot” has been around for decades, as has knowledge of its various health risks. The FDA first approved it in 1969 to treat endometrial cancer, followed by approval for contraceptive use in 1992. 

Despite well-established risks of osteoporosis and blood clots, Depo-Provera remains a popular drug for the 9 million women across 90 different countries who use it today. However, a recent flood of lawsuits against Pfizer claims the drug manufacturer failed to inform users about Depo-Provera’s known link to meningiomas. 

This blockbuster case sheds light on the often-underplayed risks of widely prescribed pharmaceuticals and a rare tumor that can significantly impact women’s health.

What Are Meningiomas?

Meningiomas are tumors that form in the tissue layers covering the brain and spinal cord. Specifically, these tumors develop in the middle layer, known as the arachnoid matter, which contains spiderweb-shaped cells. Most meningiomas are benign, meaning they’re noncancerous and won’t spread to other organs. Nonetheless, the problematic location of meningiomas poses a serious threat to life and brain function.

People diagnosed with grade I meningiomas have a 95.7 percent five-year survival rate. Fortunately, this group represents 80 percent of cases. However, survival rates drop to 46.7 percent in those with grade III tumors, which are aggressive, cancerous meningiomas, representing 1.7 percent of cases. While these numbers may seem encouraging, they don’t reflect the significant impact of meningiomas on well-being and quality of life.

Meningiomas are usually slow-growing and tend to go under the radar until they’re big enough to cause complications. This fact hinders the ability to draw connections between Depo-Provera use and the development of tumors. Scientists have identified 15 variations of meningiomas, including those that grow near the olfactory nerve, impacting the sense of smell, and those that develop within the brain, impeding the flow of cerebrospinal fluid. 

Symptoms can include:

  • Bulging eyes
  • Headaches
  • Hearing loss
  • Impaired reflexes
  • Nausea and vomiting
  • Paraplegia (lower body paralysis)
  • Seizures
  • Vision changes

Surgical removal of meningiomas cures the condition up to 80 percent of the time. But operating on the brain or spinal cord is risky and not always feasible. Lasting and disabling side effects from meningioma operations are common. Research suggests almost 29 percent of patients require antiepileptic medication three years post-surgery.

Other treatment options include radiation and chemotherapy, which come with their own array of side effects. Palliative care helps people with meningiomas cope with the various aspects of the disease and its challenging treatment. Since the average diagnosis happens at age 66, it comes at a time when other health issues may further complicate life with meningioma.

How Progesterone Impacts Meningioma Risk

Out of every 100,000 people in the US, 9.5 will develop a meningioma. This risk is higher among certain groups, particularly Black women over age 65, people who have been exposed to intracranial ionizing radiation, and those who have a history of neurofibromatosis type 2.

A 2024 bombshell report in the British Medical Journal (BMJ) showed that one year of Depo-Provera injections boosted the likelihood of a meningioma by five-fold. Although striking, this data was far from the first to demonstrate links between progesterone and meningiomas. For example, scientists have known that meningiomas contain estrogen and progesterone receptors since the 1970s. Whether Pfizer failed to examine this potential risk or ignored readily available data remains to be determined.

A synthetic form of progesterone is the primary agent in Depo-Provera. Interestingly, the recent BMJ study didn’t observe higher rates of meningiomas for many other forms of progesterone, including intravaginal, oral, percutaneous, or those commonly found in intrauterine systems. The unique risks of Depo Provera stand out in an area of research that was hardly unknown to drug makers, particularly those in the hormone therapy space.

Where Do We Go From Here?

The current lawsuits against Pfizer represent another missed opportunity to inform the public about the long-term dangers of prescription drugs. But even when the risks are made known, they too often fall on deaf ears. Weary healthcare consumers have become immune to the lengthy trail of complications at the end of every drug commercial. 

Pfizer maintains that the FDA discouraged them from fully disclosing the risk of meningiomas. However, passing blame doesn’t reverse the reality of meningioma for real patients from whom Pfizer profited. These people struggle to accept their diagnosis and are faced with potentially life-altering treatment decisions as they head into retirement age. 

Ultimately, the outcome of the Depo-Provera cases may set a new precedent for accountability with drug makers. Or they may just provide more sophisticated cost-benefit data to balance big pharma budgets. In either scenario, it’s clear that patient safety takes a back seat in our current healthcare system.

References

 Daniels K, Amba JC.  Contraceptive Methods Women Have Ever Used: United States, 2015–2019. National Health Statistics Report. Centers for Disease Control and Prevention. December 14, 2023.

 FDA gives final approval to Depo amid concerns over safety, cost and coercion. Wash Memo Alan Guttmacher Inst. 1992;(17):2-3.

 Meningioma. Cleveland Clinic. May 9, 2022.

 Roland N, Neumann A, Hoisnard L, et al. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ. Published online March 27, 2024:e078078. doi:10.1136/bmj-2023-078078 

 Reuter G, Potorac I, de Herdt C, et al. Recommendations on the management of meningioma and sex hormone therapy: The results of a collaborative effort between neurosurgical, endocrine and gynecological societies. Brain and Spine. 2025;5:104154. doi:10.1016/j.bas.2024.104154