Meningioma regression following discontinuation of depot medroxyprogesterone acetate

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OBJECTIVE: The aim of this study was to assess the clinical and radiographic changes in meningioma burden following cessation of depo-medroxyprogesterone acetate (dMPA) in patients with meningioma stabilization or shrinkage. METHODS: This retrospective case series included 3 patients with meningioma who did not undergo resection at the author's institution but who discontinued dMPA during tumor surveillance (2020-2025) and experienced tumor regression. Data collection included meningioma characteristics, previous pathology reports, tumor size across various follow-up time points, and clinical course. RESULTS: The mean cumulative duration of dMPA was 19.7 ± 2.5 years. Tumor regression was identified as early as 14 months after cessation of dMPA and persisted beyond 68 months after cessation. Patient A, with ≥ 20 tumors, demonstrated nearly 39% reduction in overall tumor burden across 45 months. Patient B demonstrated nearly 80% decrease in tumor burden across 68 months. Patient C demonstrated a 6% decrease in tumor burden, with near-complete resolution of 1 anterior skull-base tumor, within 14 months of dMPA cessation. CONCLUSIONS: The authors present 3 patients with previously diagnosed meningioma who were managed with active surveillance and dMPA cessation. After 12 months of follow-up, all patients demonstrated decreases in overall tumor burden. These results highlight an evolving understanding in the management of patients with possible progestin-associated meningioma in the setting of dMPA exposure.

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