When Robin Phillip woke up from emergency surgery in 2018, she was told something she never expected to hear. The 45-year-old warehouse worker from the United States had an intracranial meningioma—a tumor of the lining of the brain—and doctors had just performed a craniotomy to save her life.
“I was feeling lost, because where would I have possibly gotten a tumor from? I had a regular life. I did regular things,” Phillip said. “What could have possibly caused this to happen to me?”
For years, she had thought her headaches were migraines. Then one day, the pain became unbearable. “The nurse said, ‘OK, what’s your pain from 1 to 10?’ I said 11, 12,” she recalled. “They put me in the chair, and I don’t remember nothing after that.”
After the surgery, Phillip lost vision in her left eye and had to relearn how to walk. Unable to return to work, she lost her apartment and moved in with her mother. The scar that runs down the side of her head is a daily reminder of what she’s endured.
Phillip believes her tumor was caused by Depo-Provera, a hormonal birth control injection made by Pfizer that she used for nearly 30 years, stopping only when she had her two children. She is one of more than 1,000 women suing the pharmaceutical giant, alleging that it knew about the potential link between the drug and meningiomas but failed to warn patients. Pfizer has asked the courts to dismiss the cases, arguing that because the Food and Drug Administration (FDA) denied its request to include a meningioma warning on the label, the lawsuits are pre-empted by federal law.
Meningiomas are typically noncancerous but can cause serious complications depending on their size and location. In Phillip’s case, the tumor pressed against her optic nerve, leading to partial blindness.
After her initial operation, surgeons could not remove the entire mass. In 2022, she underwent a second surgery followed by radiation treatment that lasted until 2024. Doctors still could not safely remove the remaining portion.
Despite the risk, Phillip continued receiving her Depo-Provera injections until she came across social media posts about studies linking the drug’s active ingredient, medroxyprogesterone acetate (MPA), to meningioma. She stopped the injections and, months later, noticed a difference. “My body is telling me, my head is telling me I don’t have that much pain like I used to have,” she said. Her radiologist told her the tumor was shrinking.
Recent studies have drawn new attention to potential links between hormonal contraceptives like Depo-Provera and brain tumors. One 2025 study published in JAMA Neurology found that women who used MPA had twice the risk of developing meningioma, particularly those who used it for more than four years or began after age 31. Another study published in The BMJ in 2024 found a fivefold increase in risk for long-term Depo-Provera users based on French data.
Experts caution that these are observational studies, meaning they cannot prove causation, but the consistency of findings has raised concern.
“All the available data suggest that progesterone is fuel on the fire,” said Dr. David Raleigh, a radiation oncologist and chair of meningioma research at the University of California San Francisco’s Department of Radiation Oncology. “Progesterone didn’t necessarily start the fire, but the available data suggest that it’s like dumping gas on it.”
Raleigh added that the findings reinforce existing concerns about hormonal influence on brain tumors: “Those of us in the business often recommend that patients with meningioma avoid hormone replacement therapy, use nonhormone-based means of contraception, if possible, and to be cautious with pregnancy and fertility planning because of these very well-documented associations. These new studies only amplify those concerns and considerations.”
Still, other doctors emphasize that the overall risk remains low. “Overall, meningioma is not common. This is not a type of tumor that we see very often,” said Dr. Colleen Denny, an OB-GYN at NYU Langone Health. “The likelihood of having a meningioma as a Depo user is incredibly low. It’s just that it’s incredibly, incredibly low for people who don’t use Depo.”
Dr. Nisha Verma, senior adviser for reproductive health policy for advocacy at the American College of Obstetricians and Gynecologists (ACOG), added: “According to the study, five out of 10,000 women using medroxyprogesterone acetate may possibly develop meningioma compared to one out of 10,000 women not using the medication.”
Verma said such risks must be weighed alongside benefits: “The risk that they’re finding is incredibly small. I think it is a consideration we can talk to patients about, among all of the considerations that patients go through.”
Denny noted that Depo-Provera also reduces uterine cancer risk, which complicates the picture: “Uterine cancer is a lot more common than meningioma, and Depo reduces your risk of uterine cancer. So how do you balance that? It’s complex, and it often depends on the individual patients.”
For Phillip, even a small risk would have mattered. “If I would have [known] from the get-go, I would have never took that shot,” she said.
The lawsuits filed against Pfizer allege that the company ignored decades of evidence connecting progesterone-based drugs to meningiomas. “These women all have meningiomas. Many have surgery, some have radiation, and they’ve all had their lives greatly impacted,” said attorney Ellen Relkin, who represents Phillip and other plaintiffs.
According to court filings, the plaintiffs cite research dating as far back as 1983 linking progesterone and brain tumors. Their complaint argues that Pfizer had an “unassignable duty to investigate” the risks and failed to do so.
The lawsuit states: “Defendants willfully, wantonly, and intentionally conspired, and acted in concert, to ignore relevant safety concerns and to deliberately not study the long-term safety and efficacy of Depo-Provera, particularly in chronic long-term users of Depo-Provera.”
Pfizer maintains that Depo-Provera is safe and effective, noting that hormonal birth control products undergo extensive safety testing before being approved. “Birth control methods that are commercially available have been studied extensively before becoming available to the public, and so we’ve studied every type of birth control,” said Verma of ACOG. “We have guidelines that do intensive reviews of all of the data and help us support patients in what methods may be safer for them.”
In a statement, Pfizer said it “stands behind the safety and efficacy of Depo-Provera.”
In 2023, Pfizer submitted an application to the FDA requesting to add a warning about meningioma risk to Depo-Provera’s label, as well as to two lower-dose MPA pills. The FDA denied the request, stating: “The findings of the available observational studies alone do not support the addition of a warning on Meningioma risk to medroxyprogesterone acetate (MPA)-containing products.”
Because of that denial, Pfizer argues that federal law prevents it from altering the label on its own—a principle known as federal preemption, which can protect drug manufacturers from certain state-level lawsuits when the FDA controls label content.
Pfizer later resubmitted its application in June 2025, which remains pending. “FDA has still not approved any meningioma warning, and Pfizer’s renewed request remains pending,” the company wrote in court filings.
Former FDA principal deputy commissioner Dr. Janet Woodcock, who is not involved in the case, explained the challenge of proving causality in post-market surveillance: “Just because something happened associated in time with something, it doesn’t mean that one thing caused the other. It’s in a company’s best interest to put everything on there, because then if they’re sued, they’d say, ‘Well, it was in the fine print.’”
Relkin argued that Pfizer could have acted years earlier and accused the company of intentionally submitting an overbroad proposal that would invite rejection. “Depo-Provera is 150 milligrams. Three, four times a year, a very high dose,” she said. “There are low-dose, 2.5 and 5 mg pills, where there’s no data showing that they cause a problem. The dose makes the poison. By asking to change the label for all, they were inviting a rejection.”
Pfizer denied the accusation in court: “If FDA truly thought a meningioma warning was necessary for some products (and not others) … FDA could have ‘promptly’ communicated to Pfizer.”
Outside the United States, regulatory agencies have already taken action. In 2024, the European Medicines Agency added meningioma as a “possible side effect” of high-dose MPA products, and Pfizer communicated those risks to doctors in the European Union. Canada’s 2024 label includes the same warning in its “warnings and precautions” section, stating that “meningiomas have been reported following long-term administration of progestins, including medroxyprogesterone acetate.”
In January 2025, South Africa’s drug regulatory agency followed suit, recommending a similar update.
The lawsuit claims Pfizer knew of the potential risks years earlier, citing a 2006 Canadian label that listed meningioma as a “Post-Market Adverse Drug Reaction.”
Despite those changes abroad, American patients have not received the same warning, leaving many women unaware of any possible risk associated with the drug they’ve used for years.
Phillip’s story reveals not only a deeply personal tragedy but also a broader pattern of how U.S. pharmaceutical regulation can fail patients. The combination of FDA caution, legal preemption, and corporate self-protection creates a system in which patients bear the risks without clear warnings.
After years of surgeries and treatment, Phillip says her life will never be the same. For her and hundreds of other women pursuing legal action, the fight is not just about compensation but accountability.
As she put it: “If I would have [known] from the get-go, I would have never took that shot.”
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