January 28, 2025
By Eden Parks, Drexel University College of Medicine

The Depo-Provera shot is a very common form of birth control that contains the progestin medroxyprogesterone acetate. This hormone mimics progesterone, binding to the progesterone receptor and essentially functioning the same way as the hormone. As a form of birth control, there are several functions of this injection. It works to prevent ovulation, preventing the release of an egg from the ovary. It also thickens cervical mucus, inhibiting sperm from entering the uterine cavity. Additionally, it thins the uterine lining, making it less likely for an egg to implant in the uterine wall. The shot is administered to a muscle, typically the arm or buttock, every three months, and it is 96% effective.

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This quickly became a controversial article, prompting response from the American College of Obstetrics and Gynecology, as well as replies to the editor. It was noted that the study has several limitations and warrants further research. The study, which included 18,000 patients affected by intracranial meningioma, had only 9 participants that had received intramuscular medroxyprogesterone. This is in contrast to hundreds who had received other forms of progesterone with no association in meningioma formation. To put the findings into perspective, it was noted that five out of 10,000 women using medroxyprogesterone acetate may possibly develop meningioma compared to one out of 10,000 women not using the medication.

The response article notes that it would be premature to draw conclusions from this data regarding associations between the injection and meningioma development. When calculating the number needed to harm, more than 2,300 individuals would need to use medroxyprogesterone for one associated case of meningioma to arise. The authors also note that the morbidity and mortality associated with an unplanned or mistimed pregnancy occurs at a significantly greater frequency than that of an intracranial meningioma. This underscores the importance of this contraceptive option and the need for further research on this matter before a definitive conclusion can be made.

Sources/Resources:

• Cleveland Clinic. Depo-Provera (birth control shot). Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/drugs/4086-depo-provera-birth-control-shot. Accessed November 26, 2024.
• López-González L, Fernández-Mendoza J, Brantley L, et al. Use of progestogens and the risk of intracranial meningioma: a national case-control study. BMJ. 2023;384:e078078. doi:10.1136/bmj-2023-078078.
• American College of Obstetricians and Gynecologists. Guide for OB-GYNs for Patient Counseling on Birth Control Injection and Meningioma. American College of Obstetricians and Gynecologists. November 2024. Available at: https://www.acog.org/news/news-articles/2024/11/guide-for-ob-gyns-for-patient-counseling-on-birth-control-injection-and-meningioma. Accessed November 26, 2024.
• López-González L, Brantley L, Fernández-Mendoza J, et al. Response to "Use of progestogens and the risk of intracranial meningioma". BMJ. 2023;384: e079123. doi:10.1136/bmj-2023-079123.