Estrogen and Progesterone Therapy and Meningiomas.

A dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with cyproterone acetate (CPA) has been established.

• CPA is a progestin used in hormonal treatments
• The relationship is described as dose-dependent, implicating both duration and amount of CPA use
• More common meningioma occurrence is associated with longer duration of treatment
• This represents a recently established finding based on accumulated study data

CPA-associated meningiomas have distinct clinical and molecular characteristics compared to sporadic meningiomas.

• CPA-associated meningiomas are mainly located in the anterior and middle skull base
• They are more likely to be multiple rather than solitary
• PIK3CA mutations may be present in up to one-third of cases
• These features distinguish CPA-associated meningiomas from typical sporadic meningiomas

Chlormadinone acetate and nomegestrol acetate are associated with a similar but lower risk of meningiomas compared to CPA.

• Both chlormadinone acetate and nomegestrol acetate are progestin treatments
• The risk of meningioma with these agents is described as 'similar but lower' than that seen with CPA
• These findings were recently reported in the literature
• The finding extends the progestin class association with meningioma risk beyond CPA alone

Epidemiological evidence suggests an increased risk of meningiomas in menopausal patients receiving hormonal replacement therapy (HRT), though one study failed to show increased tumor growth.

• Evidence from epidemiological studies favors an increased risk of meningiomas in HRT-treated patients
• A recent study failed to show increased growth of meningiomas in HRT-treated versus nontreated patients
• The authors recommend avoiding HRT in patients with meningiomas until larger studies are available
• The evidence is described as conflicting between incidence risk and growth outcomes

Published data do not support an increased risk of meningiomas with oral contraceptive use.

• Evidence from published data does not seem to support an increased risk of meningiomas with oral contraceptive use
• This finding contrasts with the established risk seen with higher-dose progestin treatments such as CPA
• Data on fertility treatments are described as too scarce to draw conclusions

Therapies targeting hormonal receptors expressed in meningiomas have failed to show an overall favorable clinical outcome.

• Hormonal receptors have been demonstrated to be expressed in meningiomas
• Based on receptor expression studies, therapies targeting these receptors have been tried
• These receptor-targeted therapies have failed to show an overall favorable clinical outcome in meningioma treatment
• Meningiomas have a well-documented female predominance, which has long suggested a role for sex hormones in their etiology