An exploratory analysis of the association between progesterone use and tumor-related visual deficit in women with meningioma.

PURPOSE: Meningiomas may express estrogen/progesterone receptors (ER/PR), but hormonal risk is poorly characterized. We characterized association between progesterone supplementation and tumor-related visual deficits in premenopausal women receiving radiation for meningioma. METHODS: We performed a retrospective case-control study with primary endpoint of visual deficit prior to radiation for intracranial meningioma in women ≤55 receiving radiation at one academic center from 2012-2025. Records were reviewed to determine risk factors including age, race, grade, neurofibromatosis / prior radiation (NF/PriorRT), gravida, unopposed progesterone use, skull base location, and time from diagnosis to radiation. All available pathology specimens were tested for ER/PR. Logistic regression was performed to analyze associations with visual deficit. RESULTS: 70 women with median age 45 were included. 32 patients (44%) had meningioma grade ≥2; 51 (73%) had skull base tumors; 8 (11%) had NF/Prior RT. 30 women (43%) had used unopposed progesterone; 16 (23%) used depo-medroxyprogesterone acetate (Depo-Provera) specifically. Visual deficit was present in 38 patients (54%) and was associated with unopposed progesterone use (p=0.001, OR 8.3), black race (p=0.024, OR 5.4), and skull base location (p=0.003, OR 10.3) on multivariable analysis. Proportion using unopposed progesterone was 63% vs. 19% in patients with vs. without visual deficit, respectively (chi-sq p<0.001). 92% of progesterone exposures preceded visual deficit (in those with visual deficit). Only 5/57 (9%) original pathology reports discussed ER/PR status; 42 after pathologic re-analysis. PR was positive in 40 (95%) and ER in 1 (2%). In this subset, there was a nonsignificant trend to an association between progesterone receptor staining % and visual deficit on multivariable analysis (p=0.068, OR 1.03). CONCLUSIONS: Progesterone use was associated with meningioma-related visual deficit in women referred for radiotherapy. Providers should be aware of this potential risk factor and further study is warranted.