On progestins, the new ANSM instructions on the risk of brain tumor

MYCHELE DANIAU / AFP A person holds a packet of contraceptive pills, October 13, 2009, in a pharmacy in Caen. AFP PHOTO MYCHELE DANIAU (Photo by MYCHELE DANIAU / AFP)

MYCHELE DANIAU / AFP

Photo illustration of a birth control pill.

HEALTH – The National Medicines Agency (ANSM) published this Thursday, March 2, new recommendations on the use of progestogen-type drugs. The latter, used in various female pathologies, but also in certain contraceptive pills, might present a risk of development of meningioma in women, a form of brain tumor, recalls the health authority.

“A “class” effect”that is to say common to a whole category of drugs, “progestins on the risk of meningiomas cannot be excluded”warned the ANSM in a communiqué. Meningiomas are a form of brain tumor. They are qualified as “benign” because they generally do not evolve into fatal metastases, but can cause serious neurological disorders.

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Progestins are drugs used in various gynecological pathologies (endometriosis, fibroids, long and/or heavy periods, cycle disorders), in hormone replacement therapy (including menopause) but also in obstetrics (infertility, repeated abortions ).

Since the 2010s, several successive epidemiological studies have already proven a risk of meningioma, which increases with the dose received, for three progestins: Androcur, Lutenyl and Luteran.

Some progestins still under study

But the question still arises for other progestins, leading the ANSM to convene a committee of experts in January to formulate recommendations to regulate the risk of meningioma for these treatments, pending the results of new epidemiological studies. . These are the progestins medrogestone (Colprone), progesterone 100 mg and 200 mg (Utrogestan and generics), dydrogesterone (Duphaston) and dienogest (generics from Visanne).

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In the event of a history of meningioma or existing meningioma, the introduction of one of these progestogen treatments is contraindicated, except in exceptional cases to be evaluated by doctors, thus recommends the drug agency. Treatment should be prescribed at the lowest effective dose with the shortest possible duration of use, the agency says.

The interest in continuing the treatment must also “be reassessed regularly (every year), in particular around the menopause, the risk of meningioma increasing sharply with age.

A cerebral MRI should be performed in the event of neurological clinical signs suggestive of a meningioma (headaches, vision, language, memory and hearing disorders, nausea, dizziness, convulsions, loss of smell , weakness or paralysis).

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