Is Depo Provera (medroxyprogesterone acetate) safe for individuals with a history of neuro tumors?

Depo Provera Safety in Patients with Neuro Tumors

Depo Provera (medroxyprogesterone acetate) should generally be avoided in individuals with a history of neurofibromas or meningiomas due to evidence suggesting it may stimulate tumor growth, particularly when administered as a high-dose depot injection.

Risk Assessment Based on Tumor Type

Neurofibromatosis Type 1 (NF1)

• Expression of progesterone receptors has been found in 75% of neurofibromas, making them potentially responsive to hormonal stimulation 1, 2
• A survey of 59 women with NF1 found that 2 patients (3%) who received depot contraceptives containing high doses of synthetic progesterone reported significant tumor growth 1, 2
• Oral estrogen-progestogen or pure progestogen preparations were better tolerated, with 53 out of 58 (89%) patients reporting no associated tumor growth 1, 2

Meningiomas

• Medroxyprogesterone acetate (MPA) binds to progesterone receptors in meningioma cells, which may influence tumor behavior 3
• Recent research has found an association between injection MPA exposure and a 53% increased odds of meningioma (OR 1.53,95% CI 1.40-1.67) 4
• This association was stronger for cerebral meningiomas (OR 1.68,95% CI 1.50-1.87) and increased with longer duration of injection MPA use 4

Contraceptive Options for Patients with Neuro Tumors

Preferred Options

• Intrauterine devices (IUDs) are well-tolerated by 83.3% of patients with neurofibromatosis 1
• The progesterone-eluting IUD (Mirena) could be beneficial for patients with NF1 at lower doses than injectable forms 1
• Oral contraceptives do not seem to stimulate the growth of neurofibromas in most NF1 patients 1, 2

Options to Use with Caution

• High-dose synthetic progesterone preparations, particularly depot injections, should be used with caution due to reported tumor growth 1, 2
• If hormonal contraception is required to treat a medical condition in patients with neuro tumors, the benefits likely outweigh theoretical concerns, but lower-dose options should be considered first 1

Monitoring Recommendations

For Patients Already Using Depo Provera

• Regular monitoring for changes in existing tumors or development of new tumors is essential 1
• For patients with NF1, assessment should include questions about signs and symptoms of tumor growth at each visit 1
• For patients with a history of meningioma, consider MRI surveillance if continuing Depo Provera is necessary 4

For Patients with Neuroblastoma History

• Patients with a history of neuroblastoma require personalized survivorship care plans that address potential late effects of treatment 1
• These patients should be monitored for endocrine deficiencies, growth retardation, and fertility issues, which could be affected by hormonal contraceptives 1

Clinical Considerations

• The prevention of unintended pregnancy is important, and the benefits of contraception may outweigh theoretical concerns in many cases 1
• Alternative contraceptive methods should be discussed with patients who have a history of neuro tumors, particularly those with documented progesterone receptor-positive tumors 1, 2
• For patients with epilepsy related to brain tumors who require contraception, drug interactions between anticonvulsants and hormonal contraceptives should be considered 1

Common Pitfalls to Avoid

• Assuming all hormonal contraceptives carry equal risk for patients with neuro tumors; depot formulations appear to pose greater risk than oral or IUD options 1, 2
• Failing to consider the specific type of neuro tumor and its hormone receptor status when making contraceptive recommendations 2, 3
• Not discussing the potential delayed return to fertility (9-18 months) after discontinuation of Depo Provera, which is an important consideration for cancer survivors planning families 1, 5