AIFA draws attention to the possible link between some hormonal contraceptives and meningioma. The risk does not only concern the pill without distinction: especially some progestins are under observation. Here is which drugs are involved, what the studies say and what indications come from the European authorities.
The word that scares the most, in this case, is “tumor”. If it is then compared to “brain” and to a drug that millions of women have been using for years, the risk is that a pharmacovigilance communication is quickly transformed into an alarm on contraceptive pills. But the story, as often happens when it comes to drugs and health, is more complex. And above all much more precise. Last July the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency (PRAC)recommended new measures for some contraceptives containing desogestrel and etonogestrelafter having re-evaluated the available evidence on the possible increased risk of meningioma. AIFA also reported the update on its website. The risk associated with prolonged use, exceeding one year, is defined as very rare. The estimate communicated by the EMA is one additional case of meningioma for every 67,300 women using these medicines. It therefore does not mean that the pill “causes brain cancer”, nor that all women who take a hormonal contraceptive are exposed to the same risk. And there is another key distinction: meningioma is not, in the vast majority of cases, a malignant tumor. It arises from the meninges, the membranes that cover the brain and spinal cord, and generally tends to grow slowly. However, it can become clinically important due to its location, compressing nervous structures and causing neurological disorders, and in some cases requiring surgical intervention. The question, therefore, is not whether “the pill causes a brain tumor”. The scientifically correct question is another: which hormones, at what doses, for how long and in which women can increase the risk of meningioma? And it is precisely on this ground that new information has accumulated in recent years.
The signal mainly concerns some progestins, not all contraceptives
The first point to clarify is pharmacological. The medicines under observation today contain desogestrel or etonogestreltwo progestins used in contraception. Desogestrel is present in oral contraceptives, while etonogestrel is used, among other things, in the subcutaneous implant and, combined with ethinyl estradiol, in the vaginal ring. The new European indication arises above all from the results of a large French epidemiological study conducted by EPI-PHAREthe research group that brings together the French Medicines Agency and the national health insurance. The study, published in 2025 on The BMJcompared women undergoing surgery for intracranial meningioma with a much larger control group. Overall, 92,301 women were analyzed. The most interesting result concerns the desogestrel at a dose of 75 micrograms. For use of less than a year, no significant increase in risk emerged. With prolonged use, however, the relative risk increased and the increase became more evident after several years of exposure. In women who took the drug for five to seven years, the odds ratio was 1.51, while it reached 2.09 for seven or more years of continuous use. However, it is essential not to stop at these relative numbers: the researchers themselves have estimated that approximately 67,300 users of desogestrel to observe a case of meningioma requiring surgery attributable to the drug.
Then there is a reassuring fact that deserves to be told as much as that on the increase in risk. In the French studio no excess risk emerged for levonorgestrelneither used alone nor in combination with estrogens, regardless of duration of use. Furthermore, the risk observed with desogestrel was no longer evident one year after discontinuation. However, the problem is not completely new. Associations between meningioma and some have been known for years high-dose progestins: for some of these drugs the European authorities had already introduced restrictions and warnings. In the case of cyproterone, for example, the EMA had highlighted a risk of meningioma linked above all to high doses and cumulative exposure over time. The novelty of 2026 is therefore the broadening of attention to desogestrel and etonogestrelfor which the signal appears much smaller than that observed with some progestins already known for this effect.
What changes for those who use these contraceptives: the indications of AIFA and the EMA
The most concrete part of the communication concerns the women who hire desogestrel or etonogestrel. The PRAC has recommended that these medicines should not be used in women who have a meningioma or have had one in the past. If a meningioma is diagnosed during treatment, the medicine should be discontinued. Official product information will be updated with new contraindications, warnings and the indication of meningioma as a possible adverse reaction. The other indication concerns the symptom surveillance. Authorities cite ailments such as vision changes, hearing problems or tinnitus, loss of smell, worsening headache, memory problems, seizures, or weakness in arms and legs. They are not specific symptoms of meningioma and, taken individually, do not mean that a tumor is present at all. But in a person taking these medicines they can represent a reason to contact the doctor and evaluate whether further tests are necessary. The PRAC also highlighted the importance of previous medication history. The risk may be greater in women who have already used progestins for which the association with meningioma is known, such as cyproterone, nomegestrol, medroxyprogesterone or chlormadinone. Therefore, before prescribing desogestrel or etonogestrel, previous exposure to these medicines should be considered.
What should a woman who is taking the pill actually do? Don’t stop it alone for fear of cancer. The new communication does not amount to a withdrawal from the market and does not establish that all users must change their contraceptive method. The correct step is to check with your gynecologist or doctor which active ingredient has been used, for how long, at what dose and whether there are individual factors that make another option preferable.
Today the most correct message is therefore that some contraceptives containing progestins may be associated with an increased risk of meningioma, especially with prolonged use, but the absolute risk remains very low and does not apply to all hormonal contraceptives without distinction. The European authorities have chosen to intervene precisely on this point, introducing contraindications for those who have or have had a meningioma and indications for surveillance, without transforming a rare pharmacological association into a general alarm on contraception.
