A Systematic Review and Meta-Analysis of the Association Between Depot Medroxyprogesterone Acetate and Cerebral
Lindy M Reynolds1, Rebecca C Arend2, Russell L Griffin1
1Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Abstract:
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.
