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Meningioma — DFSRH MCQ

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HardSide EffectsMeningiomaDFSRH

A 44-year-old woman has used intramuscular depot medroxyprogesterone acetate (DMPA) 150 mg every 13 weeks for 7 years. It provides contraception and has controlled previously severe dysmenorrhoea. Following investigation of progressive unilateral hearing loss, MRI demonstrates a small intracranial meningioma. The neurosurgical multidisciplinary team recommends radiological surveillance rather than immediate intervention. She has migraine with aura and wishes to receive her next DMPA injection today because she is concerned that other contraception may be less satisfactory. What is the most appropriate contraceptive management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Withhold further DMPA and arrange an alternative contraceptive method

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

Further DMPA should not be administered. Current UK regulatory advice identifies a small increased risk of meningioma with high-dose medroxyprogesterone acetate, including all injectable formulations, particularly after prolonged exposure. For contraception or another non-oncological indication, current or previous meningioma is a contraindication; if meningioma is diagnosed during treatment, medroxyprogesterone acetate must be stopped. Her seven-year exposure is relevant to the observed duration-related association, although the established diagnosis itself determines management. A is incorrect because radiological stability does not remove the contraindication. B is incorrect because subcutaneous DMPA remains an injectable high-dose medroxyprogesterone formulation and is covered by the same warning. D is initially attractive because her tumour requires surveillance rather than surgery, but the contraceptive contraindication is based on the presence of meningioma, not its size, growth or treatment plan. E correctly recognises that migraine with aura precludes combined hormonal contraception, but this does not justify continuation of contraindicated DMPA; suitable non-oestrogen alternatives should be discussed. Case-by-case continuation after meningioma diagnosis applies to high-dose medroxyprogesterone used for oncological indications, not contraception. The next injection should therefore be withheld while effective alternative contraception is arranged.

Reference: Medroxyprogesterone acetate: Risk of meningioma and measures to minimise this risk (7 October 2024) — https://assets.publishing.service.gov.uk/media/672a36c1fbd69e1861921b9c/Medroxyprogesterone_acetate_-_Risk_of_meningioma_and_measures_to_minimise_this_risk_-_to_publish.pdf Depo-Provera 150 mg/ml Injection: Summary of Product Characteristics (29 September 2025) — https://www.medicines.org.uk/emc/product/6721/smpc