Risk of Pseudotumor Cerebri Syndrome (PTCS) with hormonal contraceptive use

Sodhi, Mohit; Sheldon, Claire A.; Carleton, Bruce; Etminan, Mahyar

doi:10.18203/2320-1770.ijrcog20180854

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…Hormonal contraceptives are not contraindicated in IIH8 and there is no preferred contraceptive method. Previously, case reports have linked oral contraceptives to secondary causes of raised intracranial pressure (pseudotumour cerebri); however, more recent literature has shown that they are not associated with increased incidence of raised intracranial pressure 9–11. We have noted that weight gain can be associated with starting oral contraceptives, and this may be something to explore sensitively with patients.…”

Section: Prepregnancymentioning

confidence: 82%

Managing idiopathic intracranial hypertension in pregnancy: practical advice

et al. 2022

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Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. Potentially teratogenic medications including acetazolamide and topiramate are not recommended during pregnancy or in those with immediate plans to conceive; prescribing acetazolamide in pregnancy must only follow discussion with the patient and their obstetrician. Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission.

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Section: Prepregnancymentioning

confidence: 82%

Managing idiopathic intracranial hypertension in pregnancy: practical advice

et al. 2022

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“…The published studies that have attempted to examine the risk of PTCS with contraceptive medications have all assessed this risk in comparison to non-users of contraceptives. The results from some of these studies were underpowered because of a small number of events [1,2,12], leading to wide CIs. Other studies did not control for all potential confounders including age and BMI [5,6].…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebri syndrome with different types of hormonal contraceptives in women of child‐bearing age

Etminan

Khosrow‐Khavar

Sodhi

et al. 2020

Euro J of Neurology

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Background and purpose There is a lack of comparative safety data on the risk of pseudotumor cerebri syndrome (PTCS) associated with different hormonal contraceptives. We sought to quantify the risk of PTCS associated with eight different types of hormonal contraceptives compared with oral levonorgestrel. Methods We conducted a retrospective cohort study, with a case–control analysis of 4 871 504 women aged 15–45 years in the period 2008–2015, using IQVIA Ambulatory Electronic Medical Records data in the USA. Patients who used nine different contraceptive agents including intrauterine levonorgestrel, medroxyprogesterone injection, etonogestrel/ethinyl estradiol vaginal ring and combination oral contraceptives (COCs) that contained ethinyl estradiol and the progestins levonorgestrel, norgestimate, desogestrel, norethindrone and drospirenone, were included. Diagnosis of PTCS was defined using the first International Classification of Diseases, 9th or 10th revision, code for intracranial hypertension in patients who had also received an imaging code in the 30 days prior to the index date. Results A total of 3323 PTCS cases and 13 292 matched controls were identified. No increase in risk was found when analysing intrauterine levonorgestrel or COCs containing desogestrel, norethindrone, drospirenone, norgestimate or norgestrel versus COC levonorgestrel. The adjusted incidence rate ratio for etonogestrel/etonogestrel/ethinyl estradiol vaginal ring and medroxyprogesterone suspension compared with levonorgestrel COC was 4.45 [95% confidence interval (CI) 1.98–9.96] and 2.20 (95% CI 1.33–3.64), respectively. Conclusions This study found an elevated risk for PTCS among users of etonogestrel vaginal ring and medroxyprogesterone suspension when compared with oral levonorgestrel. Future studies are needed to confirm these findings.

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“…Multiple studies using various registries and insurance databases failed to confirm a link with oral contraceptives. [101][102][103][104] Tan et al performed a meta-analysis of articles that reported medicationassociated IH. 105 They found few verifiable cases for contraceptives and were only able to suggest a potentially stronger association with progestin-only preparations compared with combined products.…”

Section: Secondary Intracranial Hypertensionmentioning

confidence: 99%

“…More recent studies have largely refuted the link with oral contraceptives. Multiple studies using various registries and insurance databases failed to confirm a link with oral contraceptives 101–104 . Tan et al performed a meta‐analysis of articles that reported medication‐associated IH 105 .…”

Section: Secondary Intracranial Hypertensionmentioning

confidence: 99%

Pediatric intracranial hypertension: A review of presenting symptoms, quality of life, and secondary causes

Varma,

Aylward

2024

Annals of the Child Neurology Society

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Our understanding of primary (idiopathic) intracranial hypertension has evolved in recent years. There have been efforts to rename the disorder as pseudotumor cerebri syndrome or primary intracranial hypertension. Some studies have suggested a higher threshold opening pressure to define intracranial hypertension. The reported annual incidence varies from 0.6 to 0.9 per 100 000 children around the world. Patients are typically divided into prepubertal and pubertal groups, with pubertal patients having the same risk factors as adults. Prepubertal patients do not share these risk factors. They are more likely to be asymptomatic, have equal gender distributions, and are less likely to be obese. Headache is the most common presenting complaint, followed by vision changes and nausea/vomiting. A newer concept of fulminant intracranial hypertension has emerged, defined as acute onset with rapid progression of visual deficits or papilledema. Quick insertion of a temporary lumbar drain as a bridge while medical management reaches effectiveness improves visual outcomes and helps avoid permanent shunt placement. Headache is typically the first symptom to resolve with treatment, and papilledema resolves in five to six months. Recurrence rates in children and adolescents range from 28.5% to 36.4%, with higher rates after puberty.

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Risk of Pseudotumor Cerebri Syndrome (PTCS) with hormonal contraceptive use

Cited by 3 publications

References 15 publications

Managing idiopathic intracranial hypertension in pregnancy: practical advice

Managing idiopathic intracranial hypertension in pregnancy: practical advice

Pseudotumor cerebri syndrome with different types of hormonal contraceptives in women of child‐bearing age

Pediatric intracranial hypertension: A review of presenting symptoms, quality of life, and secondary causes

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