Can You Take HRT With Meningioma? Estrogen, Progestins and the Evidence

Can you take HRT with meningioma? Specialist guidance generally advises avoiding HRT if you have, or have had, a meningioma; a few women with severe symptoms may discuss it with their neurosurgeon or neuro-oncologist and a menopause specialist. Cambridge University Hospitals (NHS) advises avoiding HRT if you have a meningioma or have had one removed, and 2025 recommendations from neurosurgical, endocrine and gynecological societies say it is advisable to avoid menopausal hormone therapy in women with meningiomas until more data are available. The clearest risk signals involve certain progestins, such as injectable medroxyprogesterone, while studies of menopausal HRT show small, inconsistent links.

The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.

What we actually verified · Last verified October 2026

• What we read: the full text of a 2024 French national study in The BMJ of 18,061 women who had meningioma surgery; a 2023 Danish study of 789,901 women in PLOS Medicine; a 2020 US study of meningioma growth in women on estrogen therapy; a 2026 US database study of HRT and meningioma; a 2023 meta-analysis of hormone receptors in meningioma (abstract); published abstracts of UK, Danish, US and pooled studies of hormones and brain tumors; European Medicines Agency safety notices on cyproterone (2020), nomegestrol and chlormadinone (2022) and medroxyprogesterone (2024); National Cancer Institute and American Cancer Society pages on meningioma; The Menopause Society's 2022 hormone therapy and 2023 nonhormone therapy position statements; and the FDA labels for Depo-Provera CI, Depo-SubQ Provera 104, Provera tablets, Premarin, Prempro, Prometrium, Climara, Vivelle-Dot and Estrace cream. Every source is listed at the bottom with the date we read it.
• What we did not do: we did not examine anyone, review anyone's scans, records or test results, or speak with a clinician for this page. This is editorial research, not medical review, and not advice for your situation.
• Commercial interest: The HRT Index may earn a commission from some providers featured through The HRT Index's Find My HRT Path tool. No provider paid for this page, and no provider reviewed it. See our affiliate disclosure.
• Verification Standard: we judge online menopause care on five pillars, in this order: clinical legitimacy, care quality, medication fit, price transparency and access. Our methodology explains how.

Jump to: Quick answer by situation · What a meningioma is · Why hormones come up · What studies show about HRT · Which progestogen matters · If you already have one · Vaginal estrogen · Nonhormonal options · Red flags · Who shouldn't take HRT · Questions to ask · Online care · FAQ · Sources

Can you take HRT with meningioma? A quick answer for your situation

A meningioma is a tumor that grows from the membranes that cover the brain and spinal cord. Most are benign and slow-growing, and many are found by accident on a scan done for another reason. Because many meningiomas carry hormone receptors, women who have one, or who have had one removed, often wonder whether menopause hormone therapy is off the table. The honest answer is that it depends on which hormones, at what dose, and on your tumor and its treatment plan. Here is how the evidence we read applies to common situations.

The right online menopause care isn't the same for every woman — it depends on your symptoms, what you've already tried, your age, your state and your health history. Some situations belong with an in-person clinician first. Use The HRT Index's Find My HRT Path tool to explore a featured care option for your situation — and to flag when online care isn't the right starting point — before your first consult.

Find My HRT Path is free, takes about 60 seconds and doesn't ask for your email. It asks about your symptoms (the options are menopause symptoms such as hot flashes, sleep, mood and vaginal dryness), what you've tried, your age, your state and your health history. Then it shows a featured care option or flags when in-person care makes more sense. There's no meningioma checkbox in the health history step, but there is an option to say you'd rather discuss your health history with a clinician. It is not a diagnosis, and it does not decide whether you should be prescribed anything.

What is a meningioma?

The National Cancer Institute (NCI) describes a meningioma as a primary tumor of the central nervous system that forms along the dura mater, the outermost of the layers that cover the brain and spinal cord. Overall, meningiomas are the most common type of primary brain tumor.

Grades

Meningiomas are graded 1, 2 or 3 after a specialist examines tumor tissue:

The American Cancer Society (ACS) says most meningiomas are benign, but because they sit next to the brain or spinal cord, they can still cause problems if they grow large enough.

Who gets them

The ACS says women are more likely than men to have a meningioma, and lists older age, being female and a history of radiation treatment among the biggest risk factors. NCI adds that exposure to radiation, especially in childhood, and the genetic condition neurofibromatosis type 2 raise risk. NCI says the cause of meningiomas is not known.

How they're found and treated

The ACS says most meningiomas grow slowly, and many people have no symptoms, especially early on. Up to 1 in 5 are found incidentally on a scan done for another reason. Meningiomas that aren't causing symptoms can often be watched with MRI scans to see whether they grow.

For grade 1 meningiomas, NCI's patient guide lists these treatment options:

• Active surveillance for tumors with no signs or symptoms
• Surgery to remove the tumor, sometimes followed by radiation if some tumor remains
• Stereotactic radiosurgery for tumors smaller than 3 centimeters
• Radiation therapy for tumors that can't be removed by surgery

For grade 2 and 3 meningiomas, NCI says treatment may include surgery and radiation therapy. Which of these situations you're in matters a great deal for the HRT question, because a small, stable tumor that's being watched is different from a higher-grade tumor that has already come back.

Why hormones come up with meningioma

Researchers have long suspected that sex hormones play a role in meningioma. The ACS says meningioma cells often have receptors for progesterone or other sex hormones, and that this may help explain why these tumors are more common in women. It adds that studies of whether hormones help cause meningiomas "have had mixed results."

The receptor picture is lopsided:

• Progesterone receptors are common. A 2023 pooled analysis of meningioma tissue in the Journal of Neurosurgery found progesterone receptors in about 76% of tumors. They were more common in women's tumors and in tumors at the skull base.
• Estrogen receptors are uncommon. The same analysis found estrogen receptors in about 6% of tumors using immunohistochemistry and about 11% using ligand-binding assays.
• Pregnancy is a clue. The 2024 French study notes that the volume of these tumors has been observed to increase during pregnancy, when progesterone levels are high.

This is why most of the recent safety action has focused on progestins, the synthetic progesterone-like drugs, rather than on estrogen. It's also why the type of progestogen you take, if you need one, may matter more than whether you take estrogen.

What studies show about menopausal HRT and meningioma risk

Most of what we know comes from large observational studies that compare women who used hormone therapy with women who didn't. These studies can show links, but they can't prove that HRT causes meningiomas. Women on HRT may also see doctors and get scans more often, which can turn up tumors that would otherwise never have been found.

Here is what the studies we read found:

How to read those numbers

A relative risk or hazard ratio of 1.2 to 1.3 means about 20% to 30% higher risk than non-users, if the link is real. Because meningiomas are uncommon, that's a small increase in absolute terms. The UK authors estimated the absolute excess risk of brain and spinal cord tumors with estrogen-only HRT at about 2 per 10,000 users over 5 years. The Danish authors wrote that "absolute risks may be relatively small owing to the rarity" of these tumors, though their study couldn't estimate them directly.

Why the studies disagree

• Estrogen-only vs combined. The UK pooled analysis linked estrogen-only HRT to risk, but not estrogen-progestin. The Danish study found the reverse: a link with combined and progestin-only therapy, and no significant link with estrogen-only. One reason may be the progestin. In the Danish study, 74% of combined HRT contained norethisterone (norethindrone). The progestins in other HRT products may behave differently.
• Continuous vs cyclic. Continuous combined HRT, where you take a progestogen every day, showed a stronger link than cyclic HRT in the Danish study. Its authors suggested cyclic therapy may be the safer option for meningioma risk. See continuous vs cyclic HRT for how the two differ.
• Route. In the Danish study, 90.3% of HRT use was oral and only 7.9% transdermal, so the authors couldn't judge whether patches or gels carry a different risk. We found no study that answers that.
• Detection. The 2026 US study found no higher risk over 10 years, and its authors said they couldn't rule out surveillance bias, meaning women who get more scans simply have more tumors found.

None of these studies tested whether HRT is safe for women who already have a meningioma. They looked at whether HRT is linked to new diagnoses.

Which progestogen you take may matter most

If you still have a uterus, estrogen therapy needs a progestogen to protect the uterine lining. See do you need progesterone if you have a uterus? for why. That's where the meningioma evidence is clearest, and where your choices are widest.

The 2024 French study

The largest study we read was a national case-control study published in The BMJ in 2024. Researchers compared 18,061 French women who had surgery for an intracranial meningioma between 2009 and 2018 with 90,305 women who didn't. The women's average age was 57.6. Here's what it found for prolonged use (a year or more):

The study measured only meningiomas that needed surgery, so it may undercount smaller tumors. Its authors wrote that in menopause HRT, where "progestogens can be easily substituted for each other," progesterone "appears to be the safest alternative." See progestin vs progesterone and can Mirena be used as the progesterone for HRT? for more on those options.

Medroxyprogesterone: the injection vs the tablet

Medroxyprogesterone acetate comes as a contraceptive injection (Depo-Provera) and as Provera tablets, which are used in some US menopause HRT.

• The injection. In 2025, the FDA-approved labels for Depo-Provera CI and Depo-SubQ Provera 104 added a meningioma warning in their Warnings and Precautions sections. The labels say meningiomas have been reported after repeated use, "primarily with long term use," and tell prescribers to stop the injection if a meningioma is diagnosed. The labels also say to counsel patients with a history of meningioma "about the possible risk of worsening meningioma." Meningioma is a warning on these labels, not one of their listed contraindications.
• The tablets. The Provera tablet label we read, updated June 2026, doesn't mention meningioma. But a 2025 US study in JAMA Neurology found a smaller relative risk of 1.18 for oral medroxyprogesterone, compared with 2.43 for the injection. The authors estimated that 3,020 women would need to take the tablets for one extra meningioma diagnosis, and 1,152 for the injection. They concluded the overall clinical risk was low. We read the study's abstract, not the full paper.
• In Europe. The European Medicines Agency's safety committee said in 2024 that high-dose medroxyprogesterone (injections and tablets of 100 mg or more) shouldn't be used by people who have or have had a meningioma, except for cancer treatment. It called the absolute risk "very small."

See medroxyprogesterone for menopause and micronized progesterone vs medroxyprogesterone for how the two progestogens compare.

Progestins used outside the US

If you've lived or been treated in Europe, you may have taken a progestin that has its own meningioma warnings:

• Cyproterone. In 2020, the European Medicines Agency restricted cyproterone at doses of 10 mg or more because of meningioma risk, which it said "may affect between 1 and 10 in 10,000 people" depending on dose and duration. It said available data don't show a risk for low-dose 1 or 2 mg combinations, including those used for hormone replacement therapy, but that as a precaution they shouldn't be used by people who have or have had a meningioma.
• Nomegestrol and chlormadinone. In 2022, the agency said medicines containing these progestins, at any dose, must not be used by people who have or have had a meningioma. It called the risk "very low" and said it may decrease after stopping.

None of these three progestins is part of standard US menopause HRT. If you've taken one, tell your clinicians.

If you already have a meningioma

This is the question most readers are really asking, and it has the thinnest evidence.

What the HRT labels say

We read the FDA labels for several common US menopause hormone products:

Postmarketing reports are cases reported after approval. They can't show that a drug caused the problem or how often it happens, but they're a reason to talk it through with your doctors.

The one study of women who already had a meningioma

A 2020 study in Scientific Reports followed women at a US health system whose meningiomas were found by chance. It compared 40 women who used estrogen therapy, for about 5 years on average, with 80 women of similar age who didn't. Tumors in the estrogen group were about 35% smaller on two-dimensional measurements, grew at about half the rate, and went 3.3 years longer before causing clinical progression.

The authors concluded that estrogen therapy "may be safe" in incidental meningiomas. But there are big limits:

• It was small and looked back at records rather than following women forward.
• Women weren't randomly assigned, and the estrogen group had a lower average BMI.
• Its authors said the role of progestins in HRT was not addressed.
• It only included incidental tumors, not ones that were causing symptoms or had been treated.

What stopping a high-risk progestin can do

The French study's authors noted that stopping cyproterone, chlormadinone or nomegestrol generally leads to a reduction in meningioma volume. That's one reason the European regulators tell prescribers to stop these medicines if a meningioma is found. We found no equivalent data for estradiol or micronized progesterone.

Putting it together

If you have a meningioma and bothersome menopause symptoms, the evidence we read suggests a few things worth discussing with your doctors:

• Estrogen isn't a listed contraindication on the estradiol labels we read, and the only growth study found no harm. Two conjugated-estrogen labels list postmarketing reports of meningioma growth.
• The progestogen choice may matter more. Progesterone and the levonorgestrel IUD showed no excess risk in the French study. High-dose or injectable medroxyprogesterone and several European progestins carry warnings.
• No hysterectomy, no shortcut. If you have a uterus, skipping the progestogen isn't a safe workaround. The Climara label warns that estrogen without a progestogen raises the risk of endometrial cancer in women with a uterus.
• Your tumor matters. A small, stable, grade 1 tumor under watch is a different conversation from a growing or higher-grade tumor.

Many women in this situation have two specialists: one for the meningioma and one for menopause. The best decisions usually happen when they talk to each other.

Vaginal estrogen and meningioma

If your main symptoms are vaginal dryness, painful sex or urinary symptoms, low-dose vaginal estrogen may be an option to discuss. The Menopause Society's 2022 position statement says low-dose vaginal estrogen is effective and generally safe for these symptoms, "with minimal systemic absorption," and that it's preferred over systemic therapy when estrogen is used only for genital and urinary symptoms. It also says a progestogen isn't required with low-dose vaginal estrogen, though trial data beyond one year are lacking.

There is one caution. A 2023 Danish study in the European Journal of Neurology looked at vaginal estradiol tablets. Overall use wasn't significantly linked to meningioma (hazard ratio 1.14). Current or recent high-intensity use for two years or more was linked to a hazard ratio of 1.66. The authors called it a "slightly increased incidence of meningioma" and said they couldn't rule out bias. We read the abstract, not the full paper.

See vaginal estrogen vs systemic estrogen and do you need progesterone with vaginal estrogen? for more.

If you'd rather avoid hormones

Some women with a meningioma, or their doctors, would rather not use hormones at all. The Menopause Society's 2023 nonhormone therapy position statement recommends these options for hot flashes and night sweats:

The statement doesn't recommend supplements or herbal remedies, soy foods, cooling techniques or paced breathing for hot flashes. The statement notes that gabapentin is FDA approved as an antiepileptic drug, so if you take seizure medicine after meningioma treatment, ask how any new medicine fits with it. See nonhormonal options and fezolinetant for hot flashes.

Symptoms that need prompt in-person care

NCI says meningioma symptoms depend on where the tumor is. The European Medicines Agency's patient advice lists the symptoms to watch for in people taking higher-risk progestins. Together, they include:

• Changes in vision, such as double or blurred vision
• Hearing loss or ringing in the ears
• Loss of smell
• Headaches that get worse over time, or that are worse in the morning
• Memory loss or confusion
• Seizures
• Weakness in the arms or legs

Many of these symptoms have other causes, and some overlap with menopause, such as headaches or brain fog. But a new seizure, sudden weakness or sudden vision loss needs urgent care. If you have a known meningioma, any new or worsening neurological symptom is worth reporting to your treating team, whether or not you're on HRT. If you've had seizures, see also can you take HRT with epilepsy?, and for headaches, menopause and headaches.

Who shouldn't take HRT, whatever their meningioma

Meningioma isn't on these lists, but the usual reasons not to take estrogen still apply. The Climara label lists these contraindications:

• Undiagnosed abnormal genital bleeding
• Breast cancer or a history of breast cancer
• Estrogen-dependent cancer
• An active DVT or PE, or a history of one
• Active arterial clotting disease, such as a stroke or heart attack, or a history of one
• A known severe allergic reaction to the product
• Liver problems or liver disease
• Protein C, protein S or antithrombin deficiency, or another known clotting disorder

The Prometrium label also says its capsules contain peanut oil, so they shouldn't be used by people allergic to peanuts.

The Menopause Society says that for women younger than 60, or within 10 years of menopause, without contraindications, the benefit-risk ratio is favorable for treating bothersome hot flashes and preventing bone loss. It's less favorable when HRT starts later. See who should not take HRT and HRT contraindications for more.

Questions to ask your neurosurgeon, neuro-oncologist and menopause clinician

Bring these to your appointments, and talk with your clinicians about how they apply to you:

1. What grade is my meningioma, where is it, and is it growing on my scans?
2. Has my tumor been tested for progesterone or estrogen receptors, and does that change anything?
3. Is there any reason, given my tumor, that I shouldn't use estrogen therapy?
4. If I have a uterus, which progestogen would you prefer, and would micronized progesterone or a levonorgestrel IUD be reasonable?
5. Should I stop any progestin I'm taking now, such as Depo-Provera or a European progestin?
6. If I start HRT, how often should I have follow-up scans, and what would make us stop?
7. Would low-dose vaginal estrogen be a lower-exposure option for my symptoms?
8. If I'd rather not take hormones, which nonhormonal options fit me, and do they interact with any seizure medicine I take?

Can online menopause care help if you have a meningioma?

Online care can help with the menopause part of the picture, but it isn't where meningiomas are diagnosed, scanned or treated. Here is how our five pillars apply:

• Clinical legitimacy: a licensed clinician should take a full health history, including your meningioma, its treatment and any progestins you've used, before prescribing anything.
• Care quality: look for a service that will coordinate with your neurosurgeon or neuro-oncologist, review your scan reports and set a clear plan for what happens if your symptoms or scans change.
• Medication fit: the service should offer a choice of progestogens, including micronized progesterone, plus vaginal and nonhormonal options, since those choices matter more with a meningioma.
• Price transparency: you should know what visits, refills and lab work cost before you start.
• Access: you'll still need in-person care and imaging for your meningioma. Online menopause care should fit alongside that, not replace it.

See is online HRT safe? for more on how to judge a service, and HRT side effects for what to watch for after starting.

Frequently asked questions

Can you take HRT with meningioma?

Specialist guidance generally advises avoiding HRT if you have, or have had, a meningioma. A few women with severe symptoms may discuss it with their neurosurgeon or neuro-oncologist and a menopause specialist. The evidence is limited and mixed, some labels list postmarketing reports of meningioma growth, and certain progestins carry warnings.

Does HRT cause meningioma?

It hasn't been shown to. Large observational studies have linked menopausal HRT to a small rise in meningioma diagnoses, roughly 20% to 30% in relative terms, but the results are inconsistent and can't prove cause. Because meningiomas are uncommon, the absolute increase, if real, is small.

Is estrogen or progesterone the bigger concern?

Most meningiomas have progesterone receptors and few have estrogen receptors. The strongest risk signals involve specific progestins, especially injectable medroxyprogesterone and several European progestins. Natural micronized progesterone showed no excess risk in the 2024 French study.

Is Prometrium safe if I have a meningioma?

No study we found tested Prometrium in women who already have a meningioma. Its label doesn't mention meningioma, and the French study found no excess risk with oral or vaginal progesterone. Ask your clinicians whether it's the right progestogen for you.

Should I stop Depo-Provera if I have a meningioma?

The Depo-Provera labels say to stop it if a meningioma is diagnosed, and to counsel people with a history of meningioma about the possible risk of it getting worse. Talk with your prescriber promptly about switching to another contraceptive or progestogen.

Can I use vaginal estrogen with a meningioma?

It may be an option to discuss. The Menopause Society says low-dose vaginal estrogen has minimal systemic absorption. A Danish study found a slight possible link between long, frequent use of vaginal estradiol tablets and meningioma, and said bias couldn't be ruled out.

Can I take HRT after meningioma surgery?

Specialist guidance generally advises avoiding HRT after a meningioma, including after surgery. If severe symptoms make you want to discuss it, it depends on your tumor's grade, whether any remains and what your scans show over time. Talk with your neurosurgeon or neuro-oncologist and a menopause specialist first, and agree on a follow-up plan.

Can Find My HRT Path tell me if HRT is safe with my meningioma?

No. Find My HRT Path asks about menopause symptoms, what you've tried, your age, your state and your health history. It doesn't assess tumors or decide on a prescription. A clinician who knows your full history, working with your treating team, can do that.

The bottom line

Can you take HRT with meningioma? Specialist guidance generally advises avoiding it if you have, or have had, a meningioma; a few women with severe symptoms may discuss it with their neurosurgeon or neuro-oncologist and a menopause specialist. You also deserve a straight answer about the evidence: meningiomas often carry progesterone receptors, studies of menopausal HRT show small and inconsistent links to new diagnoses, and only one small study has looked at HRT in women who already have one. The clearest warnings involve specific progestins, especially injectable medroxyprogesterone, while micronized progesterone and the levonorgestrel IUD showed no excess risk in the largest study. The choices that seem to matter most are which progestogen you use if you have a uterus, the dose, whether a vaginal or nonhormonal option would do, and how your tumor is followed after you start. Talk with your neurosurgeon or neuro-oncologist and your menopause clinician about all of these.

If you're figuring out where menopause care fits alongside your meningioma care, Find My HRT Path can help you see what fits and flag when in-person care should come first.

Related reading

• Progestin vs progesterone
• Micronized progesterone vs medroxyprogesterone
• Medroxyprogesterone for menopause
• Estrogen-only vs estrogen plus progesterone
• Continuous vs cyclic HRT
• HRT after hysterectomy
• Nonhormonal options
• Who should not take HRT

Sources

All sources were read on October 30, 2026.

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