Introduction: Meningiomas are benign tumors of the meninges, the tissues surrounding the brain and spinal cord, and are associated with a greater prevalence in females compared to males. These tumors express progesterone and estrogen receptors, suggesting a possible link to female sex hormones. This study aims to investigate the correlation between a history of hormonal contraceptive use in premenopausal women and a subsequent diagnosis of meningioma in women with and without polycystic ovary syndrome using data from the Epic Cosmos database.

Methods: Data from Epic Cosmos was analyzed to identify women who have been diagnosed with meningiomas who were between the ages of 13 and 50 from 1/1/2005 to 12/31/2023, excluding those with a history of hormone replacement therapy. This study population was stratified into those with a polycystic ovary syndrome (PCOS) diagnosis and those who had been prescribed an oral contraceptive pill (OCP). Meningioma incidence rates were calculated for the stratified groups.

Results: 47,351,376 women in the database who met the population criteria were stratified into those who did and did not have a PCOS diagnosis and did and did not have a history of OCP use. A meningioma incidence rate of 0.196% was found for the 621,656 women with a PCOS diagnosis and no history of OCP use, compared to 0.106% for the 247,076 women with a prior PCOS diagnosis and OCP use. This corresponds to a relative risk of meningioma of 0.48 for PCOS patients who were prescribed OCP compared to those who were not (p-value<0.0001). Comparing women without a PCOS diagnosis, a meningioma incidence rate of 0.120% was found for the 42,644,060 women with no OCP use history, compared to 0.082% for the 3,838,584 women with a history of OCP use. This corresponds to a relative risk of meningioma of 0.68 in non-PCOS patients who were prescribed an OCP compared to those who were not (p-value<0.0001).

Conclusion: Premenopausal OCP use, especially in women with PCOS, is potentially correlated with a decreased incidence of subsequent meningioma diagnosis. The decreased meningioma incidence with OCP use in patients with and without PCOS warrants further investigation. This study underscores the potential benefit of optimizing hormonal medication plans and is the first to utilize a national database to examine the correlation between OCP use, PCOS, and meningioma incidence in the United States from 2005-2023.