Have you heard that Depo medroxyprogesterone acetate (DMPA) use is associated with a brain tumor called meningioma? It has been in the news because there are currently multiple lawsuits against Pfizer, which makes Depo-Provera, the brand name for DMPA. 

Here's what you need to know:

What is meningioma?

Meningioma is the most common tumor in the head and is three times more common in women than in men. While it is benign and does not metastasize, it can compress the brain and cause neurologic problems such as headache, seizures, and paralysis. Treatment is usually surgical excision. Unfortunately, meningioma recurs within 15 years, even after complete surgical removal, about 30% of the time. 

Injectable progestins and meningioma

In September of 2025, JAMA (Tianqi Xiao, Pranav Kumar, & Mina Lobbous, 2025) published a retrospective study of over ten million US women who had been on hormonal birth control, assessing the risk of meningioma. They found that the people who had been on DMPA, an injectable progestin contraceptive, for more than 4 years or started DMPA after age 31 were more than twice as likely to develop a meningioma (Relative Risk 2.43 when compared to controls who did not take contraception). 

Although correlation does not prove causation, this finding is consistent with several previous studies, including a case-control study from France published in the BMJ in 2024 (Roland et al.) However, it is important to remember that the overall risk remains very low, with a number needed to harm (NNH) of 1,152 (meaning 1,152 patients need to be treated with DMPA to cause 1 additional case of meningioma).

No increased risk of meningioma was found with any other U.S. contraceptive, including combined oral contraceptives, progesterone-only pills, and levonorgestrel-containing IUDs.

Interestingly, a small retrospective review in 2023 (Abou-Al-Shaar et al) of meningioma patients found that stopping DMPA led to tumor shrinkage. Ten patients who had either an untreated meningioma or a clear (≥1 cm) residual following surgical intervention were instructed to stop DMPA. Among these 10 patients, five had clear evidence of tumor shrinkage, two were lost to follow-up, and three stopped DMPA within the past year, not allowing for adequate assessment at this time.

Key takeaway points

1. Counsel patients that using injectable DMPA for more than 4 years or starting after age 31 may increase the risk of meningioma. However, two times a rare thing is still a rare thing! Only about 7 per 100,000 women get meningioma each year. Shared decision-making is necessary for patients who use DMPA to help them balance the risks.
2. If someone is found to have a meningioma, stopping DMPA may lead to tumor shrinkage if they are progesterone receptor-positive (consider testing for progesterone receptors).
3. Reassure patients that other progesterone-containing birth control methods used in the U.S. are NOT associated with meningioma.

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