Depo-Provera, a long-used injectable birth control, is now the subject of multi-district litigation (MDL) involving allegations that prolonged use may be associated with an increased risk of meningioma brain tumors. Nationally recognized attorney Ben C. Martin and Dr. Greg Vigna go deeper into the Depo-Provera litigation in this episode.
In this video, we examine:
• The formation of the Depo-Provera MDL
• Scientific and medical studies evaluating meningioma risk
• Changes in Depo-Provera dosage and labeling
• “Dear Doctor” warning letters sent to healthcare providers
• Why patients may not have been fully informed of long-term risks
This discussion is presented from a medical-legal perspective, focusing on how clinical data, prescribing practices, and patient safety intersect with product liability law. If you or a loved one used Depo-Provera for an extended period and were later diagnosed with a meningioma, you may have legal options worth exploring. Learn how medical studies and prescribing practices factor into Depo-Provera litigation.
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TRANSCRIPT:
B: I'm Ben C.
V: I'm Doctor V
The Medical Legal Guys
V: Today we're going to be giving an update on the Depo-Provera litigation and how we're prosecuting these claims. So Ben do you want to give an update on the Multidistrict litigation and and what we're doing with that?
B: The Multidistrict litigation has been compiled and transferred, and created the MDL in Florida, Pensacola, Florida. As of a few days ago, there were just over 1500, possibly by now, 1600 cases filed in the MDL. And we have several dozen filed of those. So that's the MDL. And, Greg, maybe we should talk a little bit about the other filings or filings across the country in California, Washington state, about to be in Wisconsin, filings in, Utah and elsewhere that either have been filed or will be filed shortly. Cases filed in Connecticut, cases filed in New York. But the largest number of cases are filed in the MDL.
V: Yeah, So each case that comes in, we are looking from the get go where, we believe that case should be filed and where we filed the case is where we believe our client will have strongest venue.
B: There's a lot of thought that goes into where to file a case, how to file a case, the language in the case, the language in the complaint, which is what are the original filing? The lawsuit is a complaint. So all of these things, including, the venue venue means the place right where to file a case, whether it's state court, whether it's federal court, all of those things go into, the strategy and the basis of, well, what do we file? Where do we file it, and when do we file? Thing is that people ask me, well, how do you practice all over the country? How do you have cases filed in every state, which we did. The answer is that we always have a local lawyer who is licensed with a good background in whichever state we are filing. That local lawyer will get the lawsuit on file, and we'll do a procedure called a pro hack. That just means pro hack which means essentially that we're allowed to practice in that state for that case, for the period of that, that the pro hack exists.
V: We are evaluating those cases as they come in to understand. Well, is this case, should it be filed in the multidistrict litigation or in state court? And as we get into this, we feel very strongly about this litigation because women are continuing to get these injections for birth control. It's like, the doctors have no clue. And these are serious injuries.What's your thoughts on this, 2025? We're seeing women having craniotomy that are that are just stopping the medication after diagnosis.
B: So first, explanation of a craniotomy that is simply sometimes called a resection. Okay? A resection in this case, a resection where actual, saw opens up the skull. Right. And, of course, right behind the skull there. That's the brain. A meningioma is a type of brain tumor. And it is the type of brain tumor that is caused by Depo-Provera back in March of last year, 2024.
Getting close to the end of 2025. Now March of 2024, the British Medical Journal published an article. The lead author was Doctor Rolling several other articles, really smart people writing that researchers, doctors writing in that study. In that study, there were over 100,000 women who were studied And what the researchers were doing is making a determination as to whether or not there was an association between Depo-Provera and the creation of a meningioma, right?
The development of a meningioma. A meningioma, a very, very serious condition, usually, necessitating a craniotomy or an open surgery through the skull into the brain to take that meningioma out. And these meningioma can be very serious because they're in the brain, in and around the brain. Second reason is they grow and they can grow fast. They can be existent for a long time before anybody starts having the symptoms that would lead them to then have a physician look at it and see if there was something there, and then they find the meningioma in it because it's a time factor.
The longer you go, longer that tumors there, and especially if you're continuing to receive Depo-Provera, then it's going to continue to grow usually. So it's a very important, very tragic condition. Actually part of the tragedy tragedy is that and as shown by the medical Journal, we're talking about a British Medical Journal study. In all these women compared the women who had taken Depo-Provera, had been injected with Depo-Provera, versus women who did not ever receive injections of Depo-Provera.
Okay. Those are called cohorts. One cohort, women that had the injections in their cohort, women without the injections. What that study found, what those researchers found is that there is almost a six times relative risk, 5.6 times relative risk of meningioma in women who were injected with Depo-Provera versus women who were not. That's almost a 600% greater probability of development of a meningioma in the population of people who have had this injections, as opposed to those who have not. That's a huge, huge relative risk. But these women did not know because there was no reason for them to know that this Depo-Provera had this huge, huge factor of risk factor. And so that that's where we are in the after it study came out. Then we started gathering these cases. And when I say gather, we treat it every case separately.
But we were getting these cases and we are getting these cases and we will hopefully be able to do some good things for for our clients who have this tragic development of a meningioma because they took or were injected with Depo-Provera.
V: Studies have been available for the past couple of decades, so this problem, you know, there have been safety signals that have been flashing and now it's like constant light in your face, okay. But there have been safety signals on Depo-Provera, synthetic progesterone, that have identified this association in the past.
B: You're talking about when you talk about safety signals that like a red flag, right. That the distinction I would make, doc V is the distinction between the safety signal that the company knew. Pfizer is the innovator of the drug. Let's say Pfizer developed this drug. And we know that there were safety signals, red flags that would have led any reasonable company to understand and know there was this association.
You don't have to. This is my belief that if you have a drug that is six times more likely to cause a disease or condition, a serious condition like this, you're just not going to not have safety. So needless to say, there's a problem there. And the problem is how was it that for all these years this product was put on the market, 1992 for birth control? So what is that, 33 years, 33 years it took or 32 years it took, for this large universal study to come out.
V: And that study was not sponsored by Pfizer. Right. You know, I mean, a reasonable, pharmaceutical company if there is no association between synthetic progestin, we're talking 2009.
B: But what happened in 2009?
V: Other synthetic progestin, they found dose dependent association.
B: And a dose dependent association means, as far as your, dosage either increases, as time goes on or stays the same, then you have a greater risk of the development of these meningioma in this case, that's the dose dependency, right? Higher the dose, but the longer the, dosage was taken, the higher the number, higher percentage of incidences of meningioma or whatever the disease or condition is for that particular drug, that's dose dependency.
V: You know, every case that comes in, I'm, reviewing the medical records. And so I'm seeing a whole lot of problems, such as a meningioma diagnosed in 2024. You know, it's it's a difficult surgery. And, and the neurosurgeon, because of the dangers of the location and the surgery, they want to follow this conservatively to ensure that if they were to expose that woman to a dangerous brain surgery, because of the size, location of that tumor, you know, they're observing over time, but they're not stopping the Depo-Provera because because the company has not sent out a your doctor letter, there is not a black box warning.
So doctors have not been managing these Depo-Provera dependent tumors. As you know, obviously you stop the drug, right? The tumors are just growing because they're not stopping the medication. And it is. You know, I'm a brain injury doctor. Okay? So I took care of people in rehab hospitals who've had strokes penetrating brain injury, tumors, cancer of the brain.
So, you know, the complications from meningioma, especially the ones that are unresectable, those are not not pleasant deaths. Watching a person who has a tumor that can't be resected, causing progressive neurologic deficits, that's not a good death.
B: We have had clients had been diagnosed with a meningioma, and there have been instances where nonetheless, the doctors continue to inject Depo-Provera diagnosed brain tumor, still injecting Depo-Provera. And because there is a dose dependent relationship between the dose and the event meningioma, it is very bad a situation when you've got that in some instances the physician will say, well, I didn't know, company didn't tell me, they didn't warn me.
Now, we haven't talked about this yet, doc V, but a company, if a company believes that there is a problem with their drug or their medical device, they can send without any connection with the FDA, without any request, they can send what's called a dear doctor letter. They could have send dear doctor letter through these years to the physicians who were injecting these. They they know who who the injectors are because they've got that in their records. They know that it's on this drug tube and it's unique to this particular drug that the patients aren't getting it. They're not going to the pharmacy and picking this up, you know, and it's coming from the doctors and the sales reps are getting the Depo-Provera to the doctors who then inject it.
Guess where it's coming from. It's coming from the manufacturers. Those manufacturers in this case, Pfizer could have sent these dear doctor letters out and told the doctors, you inject this, you have a greater probability of your patient developing meningioma than if you don't think we've got a tragic case where a client developed something like 12 meningiomas over the years, she would continuing to get this Depo-Provera.
Another thing not meaning to monopolize this, but now that I'm thinking about it, it takes a while sometimes for these to develop and the patient doesn't know it and their doctor doesn't know it. And let's say that, you know, meningioma can cause headaches. Well, a lot of things can cause headaches, right? So you had situations where a patient goes in with a headache. One of the things that the doctor is not going to do probably is immediately send that person in for a brain scan of some sort. Right. And so it takes a while to finally get one of these brain scans. And then the patient is in a situation where, my gosh, they probably developed this brain tumor months or years before, but they had no reason, and the doctor had no reason to go send them in for a brain scan because of the symptomology.
And and every case is different. It's from with problems because of the insidious nature of the disease and the fact that the doctors were not told by the company that, number one, there an increased risk in the development of meningioma. If you have been given Depo-Provera and number two, the recurrence and you got to stop the injections, your patient had developed a meningioma.
V: This is a different type of tumor, though. This Depo-Provera, this push tumor that, you know, looking at, as -
B: You say, you call it a pushed tumor?
V: Well, it pushes it. It pushes it to grow progestin. Their progestin receptors like progesterone, progestin is a hormone that can prevent ovulation and -
B: Ovulation being what?
V: The egg being released by the ovaries, which then goes through the fallopian tubes. And then there's fertilization. But progestin pushed these tumors. So we're seeing some unusual tumor behavior that hasn't really been described yet. There's normal CT scans a year before. One year later, three centimeter meningioma. That's growing fast.
B: So and if you don't have a meningioma a year before that and you have A three centimeter one, you're almost the lucky one because you got it within a year. It hasn't been over a year old.
V: So it's all bad okay. But there is no bright side of anything with this war story. Okay, we are looking at state court filings, right now. We recently filed the case in Washington. We're looking at Iowa. We're looking at Wisconsin. We're looking at, a case in New Hampshire.Pretty much everywhere. And so we're looking at each case very carefully. And, you know, these injuries are just bad news.