Search Results (8)

Meningiomas are the most common central nervous system tumour and are associated with significant morbidity. Mounting evidence implicates the role of exogenous hormones in meningioma development and growth. This has led to increasing pressure on healthcare professionals to understand the risk profile of different hormonal compounds with regards to meningioma incidence and growth. This is particularly relevant when managing patients with pre-existing meningioma tumours or with one or more risk factors for meningioma formation. The aim of this review was to summarise existing evidence from clinical studies (cohort and case–control) concerning the risk of meningioma associated with different types of exogenous hormones and the associated meningioma characteristics. The literature review identified over 30 cohort and case–control studies published between 2003 and 2026. Studies demonstrated a mixed risk profile of broadly defined hormonal replacement therapy and hormonal contraceptives; however, many of these studies did not capture specific information about duration, dose or medication type. Risk associated with synthetic progestin-containing compounds such as depot medroxyprogesterone and desogestrel contraceptives was higher and related to duration of use. Highly potent synthetic progestins including cyproterone acetate (CPA) carried the strongest risk profile and showed a strong association with multiple meningiomas and anterior/middle skull base location. In conclusion, there is strong evidence for a link between meningioma incidence and highly potent synthetic progestins such as CPA, but further evidence is needed regarding menopausal hormone therapy and broadly defined oral contraceptives, as well as the doses and durations that are associated with clinically relevant risk. There is a space for translational research in this area to better understand the molecular basis underlying the relationship between hormones and meningioma growth. Full article

Background/Objectives: Depot medroxyprogesterone acetate (dMPA) is a synthetic progestin commonly used for contraception. Recent studies have reported an increased association between dMPA exposure and diagnosis of cerebral meningioma. The current systematic review aims to provide a review of literature on the topic of dMPA and cerebral meningioma as well as conduct a meta-analysis by the duration of dMPA use. Methods: The current study presented a systematic review and meta-analysis of observational studies of dMPA and cerebral meningioma derived from PubMed, Web of Science, and Embase database searches for relevant studies published through February 2026. Odds ratios (ORs) and associated 95% confidence intervals were reported to determine the pooled effect of dMPA on cerebral meningioma diagnosis. Quality of evidence was assessed through the GRADE methodology. Results: Nine case-control studies and one cohort study were selected for review and analysis. The overall pooled OR was 2.78 (95% CI 2.20–3.52). This association was strongest for prolonged (i.e., ≥two-years) dMPA exposure (OR 3.49, 95% CI 2.35–5.18). GRADE analysis suggested a moderate quality of evidence. Conclusions: The results of this meta-analysis indicate that dMPA exposure is associated with an over two-fold increased odds of cerebral meningioma. This effect is consistent across studies and is stronger for prolonged dMPA exposure relative to short-term exposure, suggesting a dose–response effect. Clinicians should consider discussing with patients the cerebral meningioma risks associated with dMPA use when considering long-term birth control options. Full article

The perception that hormonal contraception causes weight gain is a general belief that frequently hinders the initiation and continuation of effective family planning. This narrative review analyses data from Cochrane systematic reviews and recent pharmacogenomic studies to separate patient perception from metabolic reality. Analysis of high-quality data, including Cochrane systematic reviews, indicates that the association between Combined Hormonal Contraceptives (CHCs)—including oral pills, the transdermal patch, and the vaginal ring—and weight gain is not supported by consistent high-quality evidence. Placebo-controlled trials demonstrate that these methods are weight-neutral on average. Perceived weight increases in CHC users are likely mediated in part by fluid retention linked to the estrogenic stimulation of the Renin–Angiotensin–Aldosterone System (RAAS), rather than adipose tissue accumulation. Conversely, Depot Medroxyprogesterone Acetate (DMPA) represents a verified clinical risk for weight gain, showing a demonstrated clinical association with significant fat mass accumulation. Hypothesized biological mechanisms for this increase include hypothalamic appetite stimulation and glucocorticoid-like activity. The etonogestrel implant occupies a complex middle ground. While population-level data suggests weight neutrality, recent exploratory pharmacogenomic research has identified a specific variant in the Estrogen Receptor 1 (ESR1) gene. For the minority of women carrying this variant, the implant may trigger clinically significant weight gain, suggesting a biological basis for their subjective experience despite statistical evidence. Ultimately, the persistence of the weight gain concern is fueled by the nocebo effect and the misattribution of natural age-related weight trajectories to contraceptive use. Full article

Background/Objectives: Medroxyprogesterone acetate (MPA) is a synthetic contraceptive that can be used orally or as a once-every-three-month injection (i.e., depot MPA [dMPA]). Prior research has reported an increased association between dMPA and cerebral meningioma but has been limited in generalizability to meningioma cases treated with surgery or cases derived from an administrative database of commercial insurance enrollees. The current study builds upon prior research by examining the association among public insurance enrollees utilizing both a non-active and active comparator. Methods: Utilizing Alabama Medicaid data, cases of cerebral meningioma were matched to up to ten controls based on age and year of Medicaid enrollment. A conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MPA and dMPA exposure and cerebral meningioma were compared to both an active and non-active comparator. Results: Among 469 cases and 4690 matched controls, there was no association between oral MPA and cerebral meningioma. Associations for dMPA exposure were similar when using a non-active (OR 1.87, 95% CI 1.16–3.00) or active comparator (OR 1.93, 95% CI 01.01–3.69). These associations were strongest for prolonged exposure compared to a non-active (OR 3.80, 95% CI 1.88–7.68) and active comparator (OR 3.67, 95% CI 1.09–12.29). Conclusion: The current results are consistent with the prior literature that dMPA exposure is associated with an increased likelihood of meningioma for prolonged use. More research is needed to examine whether the association is limited to a certain histology or grade of meningioma. Clinicians should consider discussing with patients these reported associations prior to using dMPA. Full article

Depot medroxyprogesterone acetate (Depo-Provera) has been associated with an increased risk of HIV acquisition. We have previously shown that Depo-Provera administration increases immune markers for HIV preference on peripheral and cervical CD4⁺ T cells but decreases the levels of most immune mediators at vaginal and cervical mucosa. In this study, we determined the effect of cervicovaginal secretions from women before (visit 1), one month (visit 2) and three months (visit 3) after Depo-Provera treatment on HIV infectivity ex vivo. The effect of supernatants from vaginal, endocervical, and rectal swabs and from cervical cytobrush on HIV infectivity were assessed by a single-cycle infection assay using CCR5-using HIV-luciferase reporter viruses. We found that endocervical secretions from women after Depo-Provera treatment promoted HIV infectivity. When analyzing the association between endocervical mediator changes in response to Depo-Provera, available in our previous study, and the changes in HIV infectivity pre- and post-treatment, we found that changes in IL-17 and VEGF were positively associated with changes in HIV infectivity at visit 2 compared with visit 1, whereas changes in RANTES and IL-4 were negatively associated with HIV infectivity. The negative association between RANTES and HIV infectivity was also observed at visit 3 compared with visit 1. Additionally, changes in IL-1α at visit 3 were positively associated with changes in HIV infectivity compared with visit 1. These findings suggest that Depo-Provera may increase the HIV risk by shifting the mucosal milieu that promotes HIV infectivity. Full article

The recent literature has reported an increased association between the use of depot medroxyprogesterone acetate (dMPA) and cerebral meningioma (CM). Prior studies have been limited in generalizability and did not use an active comparator as a control. The current matched case–control study utilized a bootstrapped sampling design, matching 241 CM cases with controls (i.e., women diagnosed with non-meningioma brain, breast, or skin tumor, one control per type for three total) on age ± 5 years and diagnosis date ± 3 months. Conditional logistic regression was used to estimate odds ratios (ORs) compared with an active (norethindrone or levonorgestrel) and non-active control group. Exposure to dMPA at any time point was not associated with the diagnosis of cerebral meningioma (OR 1.75, 95% CI 0.81–4.95). Exposure to dMPA within a year of diagnosis was associated with the diagnosis of CM compared to both an active control (OR 3.38, 95% CI 1.13–9.70) and a non-active control (OR 6.90, 95% CI 2.31–17.58). This association was also present for those who were exposed within two years prior when compared to a non-active control (OR 3.54, 95% CI 1.50–11.88) but not an active control. Combined with the prior literature, the current results suggest that future research is warranted to understand this association. Full article

The association between the use of the injectable contraceptive depot medroxyprogesterone acetate and HIV-1 susceptibility has been addressed mainly in respect to the changes occurring in the female genital mucosa and blood. However, one of the main sites of HIV-1 pathogenesis is lymphoid organs. To investigate the immunoregulatory effect of medroxyprogesterone acetate (MPA) at this site, human tonsillar tissue explants were infected ex vivo with either a CCR5 (BaL) or CXCR4 (LAI) HIV-1 variant and the release of p24_gag and cytokines was measured in culture supernatant. The response to MPA was compared with that elicited by treatment with progesterone (P4) and dexamethasone (DEX), which selectively binds the glucocorticoid receptor, in donor-matched explant cultures. MPA treatment reduced the replication of both tested HIV-1 strains as well as the production of the mediators of inflammation IL-1β, IL-17A and CCL5, but not CCL20, in a similar way to DEX, whereas P4 had no effect on HIV-1 replication. The magnitude of both MPA and DEX-mediated responses was proportional to the length of exposure and/or administered dose. Blockage of the progesterone and glucocorticoid receptors with mifepristone abolished all observed changes in HIV-1 and cytokine production, and was associated with increased IL-22 levels in HIV-infected explants. Our data indicate that elevated doses of MPA may affect the immune responses in lymphoid tissue in a glucocorticoid-like fashion with an immediate impact on local HIV-1 replication. Full article

In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual functioning is not so clear, although variations in the plasma levels of sexual hormones could be associated with sexual dysfunction. Permanent hormonal modifications, during menopause or caused by some endocrine pathologies, could be directly related to sexual dysfunction in some cases but not in all of them. HC use seems to be responsible for a decrease of circulating androgen, estradiol, and progesterone levels, as well as for the inhibition of oxytocin functioning. Hormonal contraceptive use could alter women’s pair-bonding behavior, reduce neural response to the expectation of erotic stimuli, and increase sexual jealousy. There are contradictory results from different studies regarding the association between sexual dysfunction and hormonal contraceptives, so it could be firmly said that additional research is needed. When contraceptive-related female sexual dysfunction is suspected, the recommended therapy is the discontinuation of contraceptives with consideration of an alternative method, such as levonorgestrel-releasing intrauterine systems, copper intrauterine contraceptives, etonogestrel implants, the permanent sterilization of either partner (when future fertility is not desired), or a contraceptive ring. Full article