Comparative safety data on the risk of pseudotumor cerebri syndrome (PTCS) with different hormonal contraceptives is absent. We sought to quantify the risk of PTCS with eight different types of hormonal contraceptives compared with oral levonorgestrel.
A retrospective cohort study with a case-control analysis was used on 4,871,504 women aged 15-45 from 2008-2015 using data from IQVIA Ambulatory EMR data from the United States was undertaken. 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 following progestins: levonorgestrel, norgestimate, desogestrel, norethindrone, drospirenone were included. Diagnosis of PTCS defined as the first international classification for disease code 9 or 10 edition for intracranial hypertension who had also received an imaging code in the 30 days prior to the index date.
3,323 PTCS cases and 13,292 matched controls were identified. No increase in risk was found when comparing levonorgestrel IUD or COCs containing desogestrel, norethindrone, drospirenone, norgestimate or norgestrel to COC levonorgestrel. The adjusted incident rate ratio (IRR) for etonogestrel/EES vaginal ring and medroxyprogesterone suspension compared with levonorgestrel COC were 4.45, (95% CI:1.98-9.96) and 2.20, (95% CI:1.33-3.64) respectively.
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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