Hormonal contraceptive exposure and risk factors for meningioma in Soetomo hospital 2012–2016

Background: Indonesia is the 5th most populated country implementing Family Planning with 3-monthly-injection of DMPA as the most widely used contraceptive method. Hormonal contraceptive has been related to risk for meningioma, a primary brain tumor occurred 2–3 times higher in female than male. This study aimed to investigate the incidence of meningioma in relation to hormonal contraceptive exposure in Indonesia. Method: This was a case-control study in Soetomo Hospital. All female patients with meningioma were confirmed by pathologic anatomy result; patients in the control group were confirmed with non-meningioma by head CT-scan. Results: Out of 212 cases, 184 patients (87%) used hormonal contraceptive, 13 patients used non-hormonal contraceptive IUD (6%), 15 patients (7%) used no method. Progestin-only (P) were used in 151 cases (86%), while combined-hormonal-contraceptive (Estrogen+Progestin) were used by 25 patients (14%). Three-monthlyinjection of DMPA was the most common hormonal contraceptive used in 155 patients (73.1%), in which 63 patients (34.7%) used DMPA with duration of ≥15 years, 54 patients (31.2%) used 10–<15 years, 37 patients (22.9%) used 5–<10 years, 11 patients used 1–<5 years (7.6%), and <1 year in 6 patients (3.5%). Conclusion: Hormonal contraceptive was significantly increased the risk for meningioma (OR 2.19 (CI 95%; 1.32–3.62)), the risk for meningioma was the highest among 3 monthly-injection of DMPA acceptors (OR 3.13 (CI 95%; 2.03– 4.85)), and the longer duration of exposure to DMPA will increase the risk for meningioma, with the highest risk in duration of 10–<15 years (OR 2.33 (CI 95%; 1.31–4.15)) and ≥15 years (OR 4.45 (CI 95%; 2.35–8.35)).