Contraceptive injection: US debate over meningioma risk – Germany has warned too

The three-monthly contraceptive injection containing the hormone medroxyprogesterone acetate (MPA), known in the US as Depo-Provera, is under discussion there again. As news site Mississippi Today reported on 19 October, enrollees in the state health programme Medicaid in Mississippi filled more than 19,000 prescriptions for the drug in 2025 – relative to the number of enrollees, the highest rate in the US for the fourth year in a row. Because one injection lasts about three months, the number of actual users is considerably lower than the number of prescriptions.

The background is research linking long-term use to a higher risk of meningiomas – tumours of the membranes surrounding the brain that are usually benign. A 2024 French case-control study of more than 108,000 women and a 2025 US analysis of more than ten million women found increased risk after longer use, in the US study after more than four years. The US Food and Drug Administration (FDA) approved a corresponding label warning in December 2025. “The absolute risk of it is so low, and yet, there's an absolute risk,” Dr. Jennifer Karlin of the University of California, San Francisco, told the outlet. More than 6,400 plaintiffs have sued the manufacturers in the US; in June 2026 Pfizer reached a settlement with about 80 percent of them, which the company says includes no admission of liability.

In Germany, manufacturers already informed doctors about the risk in a “Rote-Hand-Brief” safety letter on 9 October 2024. It covers high-dose MPA products of 100 milligrams or more, including the contraceptive injections Depo-Clinovir 150 mg and Sayana 104 mg. According to the letter, meningioma risk rises mainly after several years of use, while absolute risks remain very low. The products must not be used for contraception in patients with a current or previous meningioma; if a meningioma is diagnosed during treatment, it must be stopped. Users should be monitored by a doctor for possible signs. Lower-dose products under 100 milligrams are not covered by the recommendations.