Relationship Histopathology Grading of Meningioma with the Use of Medroxyprogesterone Acetate (MPA) as A Hormonal Contraceptive

Introduction: Meningioma is a common brain tumor with an incidence of more than 30% of all primary brain tumors in adults. The incidence of meningiomas increases with increasing age, women suffer more from meningiomas with a ratio of 3:1. Meningiomas are known to have steroid receptors in the form of progesterone (88%), estrogen (40%), and androgen (40%). Therefore, the use of hormonal therapy is suspected to affect the incidence and histopathological degree of meningioma. One of the widely used hormonal therapy is medroxyprogesterone acetate (MPA). However, there is not enough literature to explain the relationship between MPA and the incidence of meningioma. Objective: To identify the relationship between the duration of the use of Medroxyprogesterone acetate (MPA) hormonal contraceptives and the histopathological degree of meningioma. Methods: This study is an analytic observational with a retrospective design of meningiomas patients based on the duration of use of MPAtype hormonal contraception who performed surgery at Dr. Soetomo General Academic Hospital during the period January 2015 to December 2019. We determined the inclusion criteria for meningioma patients: a history of using MPA hormonal contraceptives or 3-month injectable contraceptives; and the control group: meningioma patients without a history of hormonal contraception. Results: There were 452 cases of meningioma and 101 patients met the inclusion criteria. Based on the results of statistical analysis, it was found that there was no difference relationship between the grade of meningioma and meningioma patients either using MPA or without using MPA. There was no difference in duration of use between the group using MPA <10 years or more than 10 years with the non-hormonal control group on meningioma grading (p = 0.772). There was also no difference relationship between the group that did not use hormonal contraception and the MPA group on the age of the patient (p = 0.217), both using contraception for <10 years and more than 10 years. Conclusion: There was no relationship found between histopathological degree of meningioma with the patients who use MPA contraceptives, both duration of use <10 years and ≥10 years compared with meningioma patients who do not use MPA contraception.