The South African Health Products Regulatory Authority (SAHPRA) has issued a clarification regarding the benefits and risks associated with medroxyprogesterone acetate (MPA), a synthetic form of the hormone progesterone. This substance is used for contraception, managing endometriosis-associated pain, and treating certain cancers. SAHPRA has updated the safety warnings for MPA-containing products to include the potential MPA meningioma risk based on epidemiological studies conducted in France and the United States.
Key Insights
SAHPRA identified an increased risk of meningioma associated with prolonged use of MPA. Although the absolute risk remains low, only 32 cases have been reported globally over the past 20 years. MPA appears in various products, such as Depo-Provera, Provera, Petogen, Medroxyprogesterone Mylan, Sayana, Omrastoz, Trivina, and Triclogyn. Healthcare professionals commonly prescribe these products for contraception, managing endometriosis, and providing palliative care for certain cancers. Providers should monitor patients for signs of meningioma and stop MPA use if diagnosed, particularly when used for non-oncological reasons. Patients should discuss potential side effects with their healthcare providers. SAHPRA also urges the public and healthcare professionals to report any suspected adverse drug reactions related to MPA.
Background Context
This update stems from regulatory actions in Europe, prompted by studies identifying an increased risk of meningioma with prolonged MPA use. Similar risks were observed with other progestogens, such as medrogestone and promegestone, though these are not currently marketed in South Africa. Meningiomas are typically benign tumors that develop from the membranes surrounding the brain and spinal cord. They are more common in women and tend to occur in middle-aged and older adults.
Implications
The updated safety warnings on MPA products may change how patients and providers assess risks and benefits. While MPA’s benefit-risk profile is still favorable, the added meningioma risk could, therefore, affect treatment decisions. This may lead to higher monitoring costs and revised treatment plans. Moreover, healthcare systems may need more resources to monitor and manage potential meningioma cases. As a result, this could strain budgets and impact resource allocation. Additionally, patient compliance might decline if concerns about side effects grow. Consequently, clear education and counseling will be vital to keep patients on treatment.
Furthermore, enhanced reporting of adverse reactions is essential to track meningioma cases linked to MPA. Stronger pharmacovigilance practices will, in turn, improve safety and management. Overall, SAHPRA’s update reinforces the need for active monitoring and safety measures. These efforts ensure safer treatments and better health outcomes.
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