Incidence of meningioma in women with a history of combined oral contraceptive pill use and polycystic ovary syndrome.
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BACKGROUND: Meningiomas, benign central nervous system tumors, express progesterone and estrogen receptors. Their proliferation has been associated with hormonal and demographic factors, including female sex, obesity, and race. Prior studies on oral contraceptive pill (OCP) use and meningioma risk have been limited in their analysis of the modifying effects of race, obesity, and polycystic ovary syndrome (PCOS). OBJECTIVES: To assess the association between combined OCP use and meningioma development, and to assess how race, obesity, and PCOS influence this relationship. DESIGN: Retrospective cohort study using aggregated electronic health record data in Epic Cosmos. METHODS: Women aged 13-50 from 2005 to 2023 with and without combined OCP use were identified. Patients with history of radiation, neurofibromatosis 2, progestin-only contraceptive use, and hormone replacement therapy were excluded. The cohort was then stratified by PCOS status, obesity, and race. RESULTS: Combined OCP users saw a 40% lower risk of meningioma compared to non-users. PCOS was associated with a bidirectional effect on meningioma risk, modified by obesity. Among patients with obesity, those with PCOS had a 30% lower risk of developing meningioma compared to those without PCOS. Among non-obese patients, those with PCOS had a 108% greater risk of developing meningioma compared to those without PCOS. After adjusting for both PCOS and obesity, women with a history of combined OCP usage had 42% reduced odds of developing meningioma. When stratified by race, combined OCP use was associated with 47% decreased risk in White patients, 34% lower risk in Black patients, and 28% lower risk in Asian patients. Controlling for race overall, combined OCP use remained significantly protective, with 43% reduced odds of meningioma development. CONCLUSION: Findings suggest a potential protective association between combined OCP use and meningioma that remained significant after controlling for obesity, PCOS status, and race. Additionally, this study found that meningioma risk in patients with PCOS differed based on obesity status.