Exogenous hormone use and meningioma risk: what do we tell our patients?

The decision to commence or continue use of hormone replacement therapy or oral contraceptives in women presumed or known to be diagnosed with intracranial meningioma is a common clinical question in neurosurgery. A review of the English-language literature was undertaken to examine the association between the use of exogenous hormones and meningioma risk. Seven publications were identified, 6 of which met criteria for inclusion. No randomized clinical trial data were available, hence, results were collected from 2 population-based case-control studies, 2 hospital-based case-control studies, 1 nested case-control study drawn from a large national cohort, and 1 retrospective cohort study. At present, there is no statistical evidence of an increased risk of meningioma among users of oral contraceptives. Although not definitive, available data suggest an association between the use of hormone replacement therapy and increased meningioma risk. Further evaluation of exogenous hormone use in women with meningioma is needed with particular attention to stratification by hormone (ie, estrogen and/or progesterone) composition, duration of and age at use as well as tumor receptor subtype.